Mental health programs in Tennessee face cuts

From The Tennessean in Nashville:

Possible state budget cuts could make the state's mental health service providers and their utilizers the next victims of the economic crisis, according to mental health experts.

Jane Baxter, a spokeswoman for the Tennessee Coalition for Mental Health and Substance Abuse Service, says if funds to treat uninsured people with mental health needs are not available to people who need them, communities such as Murfreesboro, Smyrna and La Vergne might see an increased burden on emergency services.

The coalition is holding a community forum at 8:30 a.m. Feb. 2 at Patterson Park Community Center in Murfreesboro to speak to residents — and possibly to local officials, Sheriff Truman Jones and local police chiefs — about the "growing crisis," according to Baxter. The meeting is open to the public.

"We especially want the legislators, elected officials, sheriff and police chiefs from this area to attend," she said. "If funds to treat uninsured individuals with mental health needs are not available, communities can expect to see increased suicide, incarceration, emergency room admission and homelessness."

Tennessee is facing a projected revenue shortfall between $800 million and $1 billion, forcing cuts to most state departments. Gov. Phil Bredesen has instructed state departments to reduce their budgets, with the Department of Mental Health facing a $20 million cut in funds from the $168 million it receives. The budget and proposed cuts have not been finalized.

"It is too early to tell what effect the budget cuts will have, so no one should jump to conclusions until Gov. Bredesen formally presents his budget early next month," said Lydia Lenker, Bredesen's press secretary. "Keep in mind the commissioner of mental health was tasked by the governor to put together a plan on how to best move forward."

Complicating the matter, however, is that the TennCare program may need to cut up to $386 million in state dollars during the 2009-10 fiscal year, according to Sita Dieh, executive director of the National Alliance on Mental Illness (NAMI) Tennessee. The cuts, if they become reality, will come from reductions in enrollment, benefits or eligibility change.

That, coupled with the reality that TennCare is expecting at least 30,000 new enrollees this year, creates huge concerns for many mentally ill persons seeking help and health care providers in Murfreesboro and elsewhere in Tennessee.

"I think right now everybody has a sense of uncertainty," said Chris Wyre, CEO of Volunteer Behavioral Health, the parent organization of The Guidance Center in Murfreesboro. "No one knows how it is going to end up affecting mental health. We're kind of holding our breath."

Causing even more confusion is a switch in TennCare's "state only" program, which provides state money for people with severe mental illness who don't qualify for
Medicaid.

The almost 12,000 mentally ill persons in that program have been transferred into the mental health "safety net" program run by the Department of Mental Health and Developmental Disabilities, part of an effort to clear TennCare rolls of non-Medicaid-eligible enrollees. Another 4,200 people with mental illness who were involuntarily committed by a judge (but who were not necessarily accused of any crime) are also being shifted to the Department of Mental Health.

TennCare will cut off funding for those people July 1, and after that the Department of Mental Health will be on its own. If extra funds are not allocated for mental health, department officials have said they likely would have to cut beds at state mental health hospitals and reduce community services. But the reduction in services could actually end up costing local governments and the state government even more money in the long run, according to Dieh.

"What we don't pay for in the behavior safety net program ... we will pay for in uncontrolled local and state costs," Dieh explained. "One emergency room visit would offset the (approximately $700 per person per year) cost of the behavior safety net program. The cost of housing an inmate with mental illness (per year) will offset the program. Cutting services will result in a bunch of personal tragedy and uncontrolled costs."

Some mentally ill persons who might not get the help they need would have to be institutionalized, according to Wyre. That could also cost the state more money.

"The state recognizes that individuals who are severely mentally ill who don't get the treatment they need may have to be institutionalized," Wyre said. "So it's smart for the Department of Mental Health to treat those people to keep the state from incurring the cost (more than $400 a day) of institutionalizing a person."

Officials at the mental health department have been working with providers to determine how those affected by the switch will get the care they need, according to Jill Hudson, spokeswoman for the department. If safety net funds turn out not to be sufficient enough to serve all who may need and are eligible for services, the department is "hopeful that community providers will offer an increased number of mental health/substance visits on a sliding fee scale."

"We have been encouraging them to do so," she said.