Department of Mental Health

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5011-0100	Admin.	$35,892,669	$35,989,140	$37,994,485	$34,918,663	$35,376,100	$37,144,330
5011-0300	Pharmaceut. Admin.	538,675	501,291	--	--	--	--
5042-5000	Child & Adolescent	55,867,543	56,419,010	65,698,383	65,740,797	68,573,272	71,417,409
5042-5002	Chld/Adol. Reserve	4000-0160**	9,200,000	5042-5000	--	--	--
5046-0000	Community Mntl. Hlth.	249,588,678	257,798,346	262,976,982	271,620,060	274,852,252	287,340,397
5046-1000	Rental Subsides	3,107,550	^	--	--	--	--
5046-1100	Ret.Rev.-Fed Reimb.	700,000	--	--	--	--	--
5046-2000	Homeless Services	21,944,454	22,069,417	22,172,086	22,182,363^^	22,182,363	22,210,643
5046-4000	Choice Ret. Rev.	125,000	125,000	125,000	125,000	125,000	125,000
5046-9999	Insurance Assess.	7,854,766	7,309,655	***	***	***	***
5047-0001	Emergency Programs	32,341,278	32,398,072	30,932,302	31,016,761	31,485,703	31,482,359
5047-0002	Ret. Rev.	6,000,000	6,000,000	6,000,000	4,500,000	4,500,000	4,500,000
5055-0000	Forensic Services	7,311,564	6,863,712	6,074,464	5,968,876	6,028,399	6,051,792
5095-0015	Facilities	163,365,262	172,121,169	167,585,196	156,753,632	152,420,140	159,579,782
5095-0016	Medfield Consldatn.	--	--	2,983,100	--	--	--
DMH	Totals:	$584,637,439	$606,794,812	$602,541,998	$592,826,152	$595,543,229	$619,851,712

*     FY02 includes the distribution of a $16.6 million Executive Office of Administration & Finance (EOAF) reserve account passed in a supplemental budget.

**   $10 million at the Executive Office of Health and Human Services (EOHHS).

*** Consolidated with 5011-0100.

^      Moved to Dept. of Housing and Community Development.

^^    Includes $1.5 million passed in a supplemental budget.

The Department of Mental Health (DMH) is part of the new Department of Health, clustered with the Office of Health Care Finance and Policy, the Massachusetts Department of Public Health (MDPH), and Medicaid/MassHealth acute care. It is under the umbrella of the Executive Office of Health and Human Services (EOHHS).

The DMH mission is to provide continuing care services to adults with serious mental illness and children and adolescents with serious emotional disturbance. Acute care is provided by the Massachusetts Behavioral Health Partnership, a private managed care organization, through an interagency service agreement with DMH. (MassHealth also contracts with the Partnership to provide mental health services.)

DMH serves approximately 30,000 persons annually (20,000 at any one time)-22,000 adults and 8,000 children/adolescents. Advocates report that Massachusetts has approximately 47,000 residents with serious and persistent mental illness who have substantial impairment in functioning, though the actual numbers are thought to be much higher.

FY05 OVERVIEW

Community System Teeters on Collapse; Modest Expansion Made to Child

Psychiatric Access Program; Funds Shift from Facilities to Community Services

In FY05, DMH is level-funded in most accounts. The FY05 DMH budget has grown by less than 2% as compared with the FY01 allocation, unadjusted for inflation. Compared with the FY02 funding level, it has been cut by $11.2 million. Mental health advocates are emphatic in saying that the system of care is fragile and ready to collapse. Several programs were slated to close if the Department did not receive a supplemental budget. On January 26, 2005, the governor filed a supplemental budget for FY05 with $1.7 million to address a deficiency in the DMH's Child & Adolescent account (line item 5042-5002) for intensive residential treatment programs.

DMH administration has been cut over 20% over the last 4 years, impacting program support and the tracking of service delivery. No one knows what the average caseload is for caseworkers. The residential waiting list has not been updated in two years. The case management waiting list is shrinking, but not because more people are accessing services-advocates warn that people in need are dropping out of sight.

FY05 line item language prevents the closure of another hospital without legislative approval and without the completion of a new hospital feasibility study. Outside Section 364 calls for a special commission to do such a study for Central Mass. In addition, DMH's own plan for adult inpatient continuing care calls for construction of a new state-of-the-art hospital before closure of the Westboro and Worcester state hospitals. Outside Sections 319 and 340 (vetoed but overridden) require that DMH clients benefit from the sale of Medfield State Hospital property. Outside Section 319 calls for the Division of Capital Assets Management (DCAMM) to secure community housing units for DMH clients from the purchaser. Outside Section 340 requires that DCAMM not sell the Medfield property until a proposed site reuse plan-approved by DMH and EOHHS-is also approved by the legislature.

Mental health advocates emphasize the need for investment in community services of any dollars saved through facilities closures.

In FY05, $4 million is shifted from Facilities (line item 5095-0015) to Community accounts-$2.7 million is available in Community Mental Health (line item 5046-0000) and $1.5 million in Acute Services (line item 5047-0001) for developing 76 more community-based beds and continuing funding for 84 beds that were created in FY04. There is no estimate yet for how many facility-based beds will close.

Service Gaps Persist and Worsen

The following are the key service gaps that persist at DMH:

·                 The waiting list: 3,645 people are waiting for residential services (last updated November 2002) and 9,900 are waiting for case management (a recently revised figure).

·                 An overburdened community system: The community system is in need of enhanced clinical capacity after years of funding cuts, compounded by the deinstitutionalization of people with serious mental illnesses. Funds are needed for emergency services, respite care, care coordination, and rehabilitation services.

·                 Substance abuse: There is currently inadequate help for those suffering both mental illness and substance abuse disorders due to benefit cuts at MassHealth, cuts to the Bureau of Substance Abuse Services (DPH), and provider rate reductions.

·                 Homelessness among the mentally ill: Homelessness has been exacerbated by cuts, including a $1.1 million cut in FY03 that eliminated 300 mental health rental subsidies at the Department of Housing and Community Development (DHCD).

·                 Court diversion: Corrections programs are badly needed for youths and adults with mental illness. The restoration of funding for court clinics (often the entry point for services for youth with mental illness and/or substance abuse disorders) is also needed.

·                 Turning 22 students: Young adults are in need of resources and outreach as they age-out of state care provided by the Departments of Education (DOE), Social Services (DSS), and Youth Services (DYS) to prevent homelessness and desperation.

H1 for FY06 OVERVIEW

The Governor Provides Near Maintenance Funding, A Positive First Step. . .

The governor's H1 for FY06 proposes the first maintenance-level funding DMH has received in years. The recommendation includes $24.3 million (3.4%) more than the FY05 funding level, and is sufficient to cover contractual rate increases and annualized costs. However, no one new will be served off the long waiting lists for services.

H1 for FY06 continues the DMH multi-year Olmstead initiative to move 268 adult continuing care inpatient clients into community residential placements. It also supports the initiative to create a total of 254 community-based residential placements by the close of FY06. Olmstead is the 1999 U.S. Supreme Court decision that requires states to provide services to people with disabilities in the most integrated setting appropriate to their needs. H1 provides $8,442,083 in FY06 to annualize the 155 placements created in FY05-which means the funds are provided to pay for a full year of residential supports for these 155 beds-and provides expansion funding of $975,000 to create 15 additional community-based placements.

H1 for FY06 also revives last year's H1 proposal to cut $1.9 million from research programs at Harvard and UMass (see line item 5046-0000 below). These funds leverage federal dollars and help to serve hundreds of people with mental illness.

Advocates are pleased to see that the EOHHS operations account (line item 4000-0300) maintains language that gives the DMH commissioner the authority to approve or disapprove restrictions on medications to treat mental illness, including "prior authorization" requirements. Advocates call this budget a good start and will be advocating for $10 million in additional funding for adult community services to address the waiting list, $1 million to restore the mental health rental subsidies cut in FY02 at the Department of Housing and Community Development, and restoration of the $1.9 million research funding cut proposed by the governor.

Line Item Analysis

Accounts:    Administration and Insurance Assessments

Line Items:  5011-0100 and 5046-9999

The Administration line funds approximately 420 administrative and programmatic full-time equivalent staff (FTEs) at DMH. Insurance Assessments are also funded here. In FY03, line item 5011-0100 was consolidated with line item 5046-9999-raw numbers are therefore not directly comparable across fiscal years.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5011-0100	Admin.	$35,892,669	$35,989,140	$37,994,485	$34,918,663	$35,376,100	$37,144,330
5046-9999	Insurance Assessments	7,854,766	7,309,655	***	***	***	***

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

*** Consolidated with 5011-0100.

FY01-FY05 Impact

Since 2002, 110 staff positions have been cut from this account, a 21% reduction. In FY04 alone, 14% of administrative and programmatic positions were cut. A DMH memo acknowledged that such a cut would reduce DMH's ability to effectively operate and manage services.

The FY05 allocation is $405,061 below DMH's maintenance estimate. DMH estimates it could lose another 7 staff positions as a result.

FY06 Needs

DMH cannot afford another below-maintenance budget for this account without further jeopardizing program support positions.

H1 for FY06 Recommendations

H1 recommends $1,768,230 above the FY05 allocation. DMH reports that the amount is $52,351 short of their FY06 maintenance needs. Most of the increase above the FY05 funding level is for chargebacks-charges DMH must pay EOHHS for centralized administrative services-and for annualized payroll expenses-to pay for a full year of employment expenses for positions which had been backfilled in FY05.

Account:      Child and Adolescent Services

Line Item:   5042-5000

The Child and Adolescent Services account funds community-based and inpatient mental health services for children and adolescents. Services include: respite; case management; court clinics; and individual/family flexible, residential, inpatient, community, and school supports. Approximately 8,000 children (ages birth-18) are served by this account-7,800 of them in the community and 200 on an inpatient basis.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5042-5000	Child & Adolescent	55,867,543	56,419,010	65,698,383	65,740,797	68,573,272	71,417,409
5042-5002	Chld/Adolesc Reserve	4000-0160**	9,200,000	5042-5000	--	--	--

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

**   $10 million at EOHHS.

FY01-FY05 Impact

In FY04, DMH avoided cutting a dozen child/adolescent beds by making adult services cuts. Level funding for many years has meant no movement for the 245 children on the waiting list for community residences. A different waiting list for case management holds 1,600 children.

In FY05, the account is level-funded with FY04, with one exception: $2.5 million will expand the Child Psychiatric Access Pilot Project. This program provides primary care providers with access to child psychiatrists to assist them with care management, transitional counseling, and psychopharmacology services. Eventually, it is hoped that 600,000 children statewide will have access to the program. Also, Outside Section 337 creates a commission to study the use of psychotropic drugs in treating children who are under the protection and care of the Department of Social Services (DSS). [Editor's Note: See the DSS chapter for more information about the mental health needs of children and adolescents.]

FY06 Needs

Advocates are calling for increased funding for this line item. They are also seeking increased support for DSS programs and substance abuse treatment for children with co-occurring disorders (i.e., mental illness and substance abuse).

For FY06, DMH has acknowledged the need for an additional $265,589 to cover 3 specific programs within this account:

·       the Eliminating Barriers Initiative-$75,000 for a stigma reduction campaign in the high schools;

·       the Police Pocket Guide-$90,589 for an education/resource guide for police; and

·       a peer support program for children and adolescents in inpatient treatment-$100,000.

H1 for FY06 Recommendations

H1 recommends $2,844,137 above the FY05 funding level. Comments within the governor's budget indicate the increase is for intensive child/adolescent placements, but DMH reports the increase is for maintenance needs. The recommendation would annualize the governor's $1.7 million supplemental budget that he filed for FY05 by providing a full year of funding for those Intensive Residential Treatment needs (that were originally under-funded). It also includes

maintenance expenses, such as $619,736 to annualize the POS Salary Reserve that was originally allocated in FY05.

Account:      Community Mental Health Services

Line Item:   5046-0000

The Community Mental Health Services account provides 7,000 community residential placements statewide. These are placements in small community-based settings that provide support services for people with serious mental illness.

Annually, 11,800 adults are served with residential placements, representing significant progress-in 1993 there were just 3,909 community beds. However, another 3,400 adults are on the waiting list for placements. Case management is also provided for an additional 11,000 adults. However, another 8,300 adults are on the waiting list for case management.

Finally, outpatient services are provided, including: individual supports for 22,000 adults; 4,000 supported employment placements; drop-in centers and social clubs serving 900 individuals in day services; and skills training, psychiatric day treatment, home-based treatment, crisis intervention, outpatient therapy, and 25 clubhouse programs serving 2,500 members.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5046-0000	Community Mntl. Hlth.	249,588,678	257,798,346	262,976,982	271,620,060	274,852,252	287,340,397

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

FY01-FY05 Impact

In FY02, DMH cut 50% of its contracted outpatient and day services to clients. Also, 130 adults with serious mental illness were cut from day rehabilitation services. In FY03, DMH almost completely eliminated contracted outpatient services, affecting 1,800 adults. Partial hospital programs-daytime hospital treatment and supervision for people with serious illnesses to shorten inpatient hospital stays-were consolidated or eliminated. Also in FY03, the agency finished its Olmstead initiative to create 255 new community placements and 9 Program of Assertive Community Treatment (PACT) teams and closed Medfield Hospital.

In FY04, funds were shifted to line item 5046-0000 (due to the closure of Medfield Hospital) to annualize (i.e., pay for a year of services) the new community placements that had been created in FY03. At the same time, a shortfall here triggered closure of Solomon Carter Fuller's outpatient services; relocation of Mass. Mental Hospital's outpatient department to the Shattuck Hospital (a Department of Public Health facility); and closure of the Intensive Secure Treatment Program at Taunton, eliminating 14 beds for violent patients with severe mental illness.

The FY05 budget supports DMH's modest community residential expansion initiative-$2.7 million shifted to this account from Facilities (line item 5095-0015) will combine with $1.7 million from Acute Services (line item 5047-0001) to annualize the 84 community beds that were new in FY04 and create 76 new community beds in FY05. By the end of FY05, the total number of such beds created will be 160. DMH has no estimate for how many inpatient beds will close in FY05. No hospital will close, as a result of line item language stipulating that a feasibility study for a new hospital in central Massachusetts must be completed first.

FY06 Needs

DMH has acknowledged the need for $7 million in new funds for this account in FY06. The money would support:

·       $2 million for services to young adults, some of whom are aging out of services provided by the Departments of Education (DOE), Social Services (DSS), and Youth Services (DYS).

·       $1.885 million for continued community development. Advocates note that the cost to move 130 discharge-ready patients into safe community-based housing is $8.5 million.

·       $1 million for rental assistance. The money presumably is to restore the FY03 cut that eliminated 300 subsidies at the Department of Housing and Community Development (DHCD). [Editor's Note: See the DHCD chapter to learn about rental subsidies for persons with disabilities through the Alternative Housing Voucher Program.]

·       $1.3 million to establish a mental health training initiative.

Advocates are also seeking more funds for this account to address the more intensive needs of individuals transitioning from restrictive settings to community placements. Community service programs need more resources to handle the needs for emergency services, respite care, care coordination, and rehabilitation services.

H1 for FY06 Recommendations

H1 provides $12,488,145 above the FY05 funding level. DMH reports that the apparent increase is really mostly maintenance funding, including the annualization of 155 community placements begun in FY05 ($7.46 million) and PACT annualization ($1.1 million). "Annualization" is a full year of funding for services newly created or newly provided part way through the previous year. This maintenance level of funding also includes payroll adjustments made necessary by the salary reserve passed in the FY05 budget , and by a new collective bargaining agreement with unionized workers.

DMH also reports that H1 eliminates $1.9 million in research funding. This reduction is the same one sought by H1 for FY05. The cut would eliminate research into the causes and treatment of mental illness carried out at the Harvard and UMass Medical Schools. The state funds have helped to leverage private and federal government dollars. The combined money supports the treatment of 750 individuals with disabilities and family members annually at the Harvard program and the involvement of more than 1,000 individuals with disabilities and family members annually with the UMass program.

DMH also reports that $975,000 in expansion is provided for 15 new community-based placements ($65,000 each) in FY06.

Account:      Homeless Services

Line Item:   5046-2000

The Homeless Services account provides residential/housing, employment, and outreach services to homeless individuals with mental illnesses throughout the state. Residential/housing services are provided to 2,400 formerly homeless individuals, while outreach services reach 1,500 persons.

Research suggests that among the single adults who are homeless, 30-40% are mentally ill. DMH estimates 2,000 homeless people with mental illness across the state, of whom 1,200 are in Boston. Many advocates believe the actual numbers are considerably higher.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5046-2000	Homeless Services	21,944,454	22,069,417	22,172,086	22,182,363^^	22,182,363	22,210,643

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

^^    Includes $1.5 million passed in a supplemental budget.

FY01-FY05 Impact

Homeless Services has been nearly level-funded for 5 years, providing below-maintenance resources.

In FY03, the legislature cut one-third of the funding ($1,107,550) to the rental assistance program for DMH clients at the Department of Housing and Community Development (line item 7004-9033). Over 300 subsidies were eliminated and program rent shares for all tenants were raised from 25-30% to 35% of income. Clearly, the loss of a housing subsidy for this population may have impact on the rates of homelessness.

FY06 Needs

DMH has acknowledged the need for an additional $600,000 for this account in FY06. The expansion would fund homelessness prevention through a tenancy preservation program in which DMH works with district courts to prevent evictions. NAMI-Mass is advocating for the restoration of homeless mentally ill funding to this line.

H1 for FY06 Recommendations

H1 for FY06 provides $28,280 above the FY05 level. These funds maintain the salary increase made possible by the FY05 POS Salary Reserve.

Account:      Emergency Programs

Line Item:   5047-0001

The Emergency Programs account includes $22.2 million to fund contracted emergency services providers (ESPs) through an interagency agreement with the Office of Medicaid (MassHealth). This acute care-which serves as a front door to DMH and Medicaid services-is provided in general hospitals across the state, with 26 sites in total. The account also includes $9.3 million for community-based services (the same services as those funded by line item 5046-0000, see above).

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5047-0001	Emergency Programs	32,341,278	32,398,072	30,932,302	31,016,761	31,485,703	31,482,359

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

FY01-FY05 Impact

FY03 and FY04 budget cuts eliminated the inpatient bed days that were formerly funded here. In FY05, the account is still $855,575 below FY01, unadjusted for inflation. DMH reports, however, that $1.5 million is available for the creation of new community-based placements in FY05.

FY06 Needs

DMH has acknowledged the need for an additional $6.5 million for this line in FY06. The funding would enhance services at certain sites and make offerings consistent statewide. NAMI-Mass calls for a redesign of the Emergency Service System to enhance services to elders and improve mobile access, crisis stabilization, and diversionary services.

H1 for FY06 Recommendations

H1 recommends funding that is nearly level with the FY05 allocation.

Account:      Retained Revenue

Line Item:   5047-0002

The Retained Revenue account funds Community Mental Health services. The account collects federal financial participation (ffp) dollars generated through MassHealth from the Emergency Services and Acute Inpatient Care Program (line item 5047-0001)-the funds are used to augment the community system. Approximately $7 million is generated each year.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5047-0002	Ret. Rev.	6,000,000	6,000,000	6,000,000	4,500,000	4,500,000	4,500,000

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

FY01-FY05 Impact

In past years, $1 million of this Retained Revenue was returned to the General Fund, while $6 million was returned to DMH for community services.

In FY04, the ceiling on this account was lowered. Of the $7 million that is collected, only $4.5 million is now returned to DMH. DMH chose to preserve the community system and cut an inpatient unit in Taunton instead (see line item 5046-0000 above) in FY04.

In FY05, the cap remains just $4.5 million, straining the community system.

FY06 Needs

For FY06, advocates across the board are requesting more funds for the community mental health system. Restoration of the $6 million ceiling to this line item is considered a good place to start.

H1 for FY06 Recommendations

H1 for FY06 maintains the FY05 revenue ceiling on this account.

Account:      Forensic Services

Line Item:   5055-0000

The Forensic Services account funds the Division of Forensic Mental Health, which provides court clinics (forensic evaluations) and consultations to county jails. NAMI-Mass reports that March 2003 statistics show 1,999 inmates-20.85% of the total Department of Corrections (DOC) population-with open mental health cases. Of these, 1,391 (14.5%) are on psychotropic medication.

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5055-0000	Forensic Services	7,311,564	6,863,712	6,074,464	5,968,876	6,028,399	6,051,792

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

FY01-FY05 Impact

In past years, DMH provided assessment, crisis intervention, evaluation, medication and release planning services for mentally ill inmates in county correctional facilities. DMH has eliminated all of these services, leaving the DOC with primary responsibility. Additionally, due to MassHealth cuts, 6 of 22 detoxification facilities have closed. The Mass. Public Health Association reports a dramatic increase in involuntary 30-day civil commitments to DOC facilities for substance abuse treatment.[1]

In FY05, the account is 17.5% below its FY01 level, unadjusted for inflation. DMH has been struggling to maintain the court clinics, which are mandated by law.

FY06 Needs

Advocates call for more consultation and training for prison staff in the areas of screening, crisis intervention, and maintaining inmates on their medication. Prison staff often have little understanding of mental illness.

Advocates also call for additional funding to this account to increase mental health capacity within the adult and juvenile court systems. More community diversion and re-entry services are needed.

DMH has acknowledged the need for an additional $3.463 million to this account in FY06 to fund juvenile court diversion for children ages 12 and under. The Parent/Professional Advocacy League (PPAL) reports that last year 230 kids under age 12 went to juvenile court for low-risk crimes and found no community diversionary services available to them.

H1 for FY06 Recommendations

H1 recommends no funding expansion to this account. The slight increase is for annualization of FY05's POS Salary Reserve and other maintenance payroll adjustments.

Account:      Facilities

Line Item:   5095-0015

The Facilities account funds the operation of adult inpatient facilities and community health centers. Since the FY03 closure of Medfield State Hospital, only Taunton, Worcester, and Westboro remain. Additional inpatient units exist at Lindemann (42 beds), Tewksbury (144 beds), and Shattuck (125 beds) state facilities. Parkview Hospital (30 beds) in Springfield is also contracted. The population served is the long-term chronically ill. The length of stay ranges from a high of 855 days to a low of 240 days, with an average length of stay of 469 days.

In 1993, the Department's adult continuing care inpatient bed capacity was at 1,444. Approximately 46% of the Department's service delivery budget was spent for inpatient care, while 54% was spent on community services. In 2004, the Department's adult continuing care inpatient bed capacity was 900. Approximately 26% of the Department's service delivery budget is spent for inpatient care; 74% is spent for community services.

The average cost (i.e., direct care, administrative and fringe) of providing continuing care inpatient services in a DMH hospital is approximately $168,489 per bed per year. Revenue averages $40,160 per bed per year. The major revenue source is Federal Financial Participation (FFP), which is the federal government's share of a state's expenditures under the Medicaid program. After revenue offset, the net state cost of providing adult continuing care inpatient services in a DMH hospital is approximately $128,329 per bed per year.

By contrast, the average cost to discharge a current DMH adult continuing care inpatient client and provide necessary community services would be approximately $80,000 per person per year. This amount includes projected average DMH costs of $65,000 per person per year and projected average Medicaid costs of $15,000 per person per year.[2]

Line Item	Description	FY01	FY02*	FY03	FY04	FY05	H1 for FY06
5095-0015	Facilities	163,365,262	172,121,169	167,585,196	156,753,632	152,420,140	159,579,782

*     FY02 includes the distribution of a $16.6 million EOAF reserve account passed in a supplemental budget.

FY01-FY05 Impact

Since FY02, the facilities account has declined by nearly $20 million, unadjusted for inflation. In FY02, DMH began consolidating Medfield State Hospital and closed one inpatient unit (at the Lindemann Mental Health Center in Boston). Between FY02 and FY03, DMH closed 183 inpatient beds and eliminated 375 full-time staff positions.

The FY04 budget for this line item was $10.8 million below the FY03 allocation, due to the closure of Medfield Hospital. There is a corresponding $8 million increase in the Community Mental Health line item. DMH reports that the remaining $2.8 million was reportedly absorbed through "efficiency initiatives" (i.e., cuts) at the hospitals.

For FY05, an additional $4,333,492 was cut from Facilities. The funds are reportedly shifting to community programming, but advocates are concerned that there isn't additional funding in the Community Mental Health account (line item 5046-0000) to correspondingly expand the capacity of community placements. DMH reports $2.7 million from Community Mental Health and $1.5 million from Acute Services (line item 5047-0001) funding will be used to develop 76 more community-based beds and continue funding for the 84 beds created in FY04. However, DMH has no estimate yet for how many facility-based beds will close due to the funding cut. Line item language prevents the closure of Worcester or Westboro State Hospitals without legislative approval and not until completion of a study of the building plan for a new hospital in central Massachusetts that would replace the out-dated facilities.

FY06 Needs

Advocates want people with mental illness to benefit from the sale and development of state hospitals. They recommend that at least 25% of the developed property value be set aside in cash to be used in a housing trust, or alternately that at least 25% of the housing developed is set aside to serve the mentally ill.

DMH estimates that 268 current adult continuing care inpatient clients are ready for discharge to the community if sufficient resources are made available.[3] DMH reports that a total of $17 million will be necessary to fund the 268 community placements going forward on an annual basis.

H1 for FY06 Recommendations

H1 for FY06 recommends $7,159,642 above the FY05 allocation. Of that amount, $2,446,835 is for collective bargaining agreements with unionized workers and $4,348 is to maintain the salary increase made possible by the FY05 POS Salary Reserve. DMH reports that this proposal is $103,222 below its FY06 maintenance estimate.