Tennessee's mental health cuts deepen

Patient advocates say loss of services could cost lives By Christina E. Sanchez • THE TENNESSEAN • February 8, 2010 Tennessee's mental health agency, already struggling from last year's budget cuts, is facing a double whammy in 2010 — deeper cuts to its own budget coupled with reductions in TennCare insurance for many of its patients. Advocates for the mentally ill say more reductions in services may endanger lives. "The mental health system was severely underfunded to begin with, and it's increasingly fragile," said Sita Diehl, executive director of the National Alliance on Mental Illness of Tennessee. "We can't take any more cuts. If they take away from the system, these people will end up in another — jail or, even worse, the morgue." Since July 2008, the mental health agency has shed nearly a quarter of its staff — 672 positions — and more than 247 beds at its state hospital. Now, the Department of Mental Health and Developmental Disabilities is facing $9.4 million in additional cuts. For many patients, the newly proposed TennCare health plan cuts will compound the challenge by restricting doctor visits and laboratory tests. "Someone who is mentally ill, is poor and has a hard time managing mental illness will end up at the hospital, and the state will end up paying more," said Pam Womack, executive director and co-founder of the Mental Health Co-op in Nashville. Children's unit to be closed The lone state-run children's mental illness unit, comprising 14 beds at Middle Tennessee Mental Health Institute, will be closed under next year's fiscal budget, said Sarah Lingo, spokeswoman for the Tennessee Department of Mental Health. But the department feels private hospitals' beds for children will be sufficient. Also in jeopardy are programs designed to help the mentally ill within their own communities. Lingo said the department will see significant gaps in funding for alcohol- and drug-abuse treatment and for peer support centers, in which people with mental illness run recovery programs to help others who are mentally ill. "As the number of uninsured individuals increases, funding for crisis services will not keep pace with the need for those services in the proposed budget," Lingo said. However, the department plans to protect its $21.5 million budget for the Behavioral Health Safety Net. The "safety net" provides services for the sickest mentally ill clients who don't qualify for TennCare but lack private insurance. "When looking at these budget cuts, we tried to keep core services so when the time is right and the economy recovers, we can restore programs," Lingo said. "Since (the TennCare cuts) have not been approved by the Centers for Medicare and Medicaid Services, we don't have a good idea on how that impact would impact our services." The TennCare bureau submitted its proposed $200 million cuts to CMS last week, and it is unknown when the federal agency will approve or deny the request. Among other things, the proposed cuts would limit participants to eight doctor visits a year, place a $10,000 annual cap on payments for inpatient hospital care, and restrict how many times lab work can be performed. The Department of Mental Health had been slated to receive a $37 million cut for the current fiscal year, which ends June 30, but federal stimulus money and restored funding brought the cut to about $15 million, said Lingo. Centers got high marks Just last year, a report from NAMI hailed Tennessee as an innovator for its peer support centers, which give people with mental illness a chance to work and to support one another. The peer support program had grown to nearly 50 locations across the state by 2008 — before it was downsized. Today, there are seven. Bonnie Kelly, 55, said bipolar disorder had prevented her from working until she found peer support centers. Bouts of extreme creativity and energy would help her function, but then she would crash, come down off her high and enter a severe depression. At the peer support center, she got a job as an activities director. No other place would hire her. Community programs and housing liaisons, who help the mentally ill find places to live, are vital to recovery outside a hospital, said Anthony Fox, executive director of the Tennessee Mental Health Consumers Association, who also suffers from bipolar disorder. "There is nothing wrong with us, but we're trying to overcome an illness that most people don't understand," Fox said. Kelly now uses the Mental Health Co-op program, which she says saved her life. The co-op, a nonprofit mental health crisis organization, gets help for the patients with severest mental illnesses and serves as a gatekeeper for the state mental institutes. She worries about the impact of the budget cuts. "People will die. They will be sick and not get the care they need," said Kelly. "I didn't choose to be mentally ill. It's rough to be very severely mentally ill." NAMI, which grades states' mental health systems, said Tennessee's mental health crisis has been getting more serious, and demoted the state from a grade of C in 2006 to a D in 2009. No state in the nation got an A. Tennessee fell about in the middle of the pack. Police have had hands full The cuts have meant that Nashville police officers have had their hands full at times when the 200-bed Middle Tennessee Mental Health Institute is full. Officers watch the patients until a bed is available, sometime on the other side of the state, said Commander Bob Nash of the Metro police. "If I've got officers tied up for several shifts; that keeps them from performing other duties, such as working on criminal activities," said Nash. NAMI of Tennessee estimates that at least 20 percent of the jail population is mentally ill, and that number could be closer to 25 percent or 30 percent. Police want to help speed the process of getting clinical services. That might require a policy change so that officers could transport mental health patients to other state hospitals where beds are available, Nash said. Two weekends ago, Metro police officers were tied up for several patrol shifts to watch over a mentally ill patient until he could get a bed at the Middle Tennessee Mental Health Institute. "Helping people through crisis is one of our duties, and we may very well save someone's life," said Nash. "But the probability that we might not have a bed available is going up."