Massachusetts Commissioner holds public conversation on department of mental health's future

Contributed by: Bob Rousseau, MDiv., MA, ACPS, CMHRE

On Monday, December 6, 2010, at Woodlawn Commons on the University of Massachusetts’ Dartmouth Campus, Commissioner Barbara Leadholm inaugurated the first of a series of public conversations on the future of the Department of Mental Health. The conversation was entitled “Community First and Our Future.” Mr. Joe Dziobek, Fellowship Health Resources’ (FHR)  President/CEO, and Bob Rousseau, an Advanced Certified Peer Recovery Specialist with FHR, added their voices to the conversation.

For readers not familiar with the Community First initiative, it refers to a decade-long effort by DMH to create programming that assists persons with psychiatric disabilities to move out of institutional settings and find their place as active and contributing members of the community. This change in mental health services helps to explain the extraordinary shift in budget allocations that has occurred in the past ten years. In 1990, the State’s DMH spent 51% of its budget on “inpatient” care (i.e., primarily Mental Health Facilities within State Hospitals). The proposed budget allocation for 2011 for inpatient care is 27%. Put succinctly, this means that the DMH has allocated nearly two-third (73%) of its budget to Community First Initiatives.

Commissioner Leadholm emphasized four important areas that the Community First Initiative supports and seeks to strengthen. Community First:
1. Strengthens consumer choice.
2. Is client-centered, family-focused, and driven by client outcomes.
3. Relies on an extensive peer workforce.
4. Focuses on recovery and enhanced ability to move throughout the community and inpatient systems of care.

Currently, FHR collaborates with DMH in three Community First programs. In Fall River and New Bedford, FHR employees are involved with Community Based Flexible Supports (CBFS). CBFS focuses on providing recovery-oriented group homes serviced by nurses, clinicians, vocational specialists, substance use specialists, peer specialists, and residential staff. FHR also operates a Program of Assertive Community Treatment (PACT), also known as Southeast Mobile Treatment, out of New Bedford. PACT provides persons served with psychiatric, nursing, substance use counseling, therapy, vocational support, housing support, case management, recovery discussion group, dual recovery group, and peer specialist services. FHR also administrates Clubhouses on Cape Cod that provide persons served with an extensive variety of human, artistic, social, educational, and vocational opportunities. FHR is currently bidding on a fourth Community First Initiative, namely; the Therapeutic Respite Program (TRP).

Commissioner Leadholm shared DMH’s budget information for 2011. The proposed budget stands at $628.4 million. This is a 1% decrease below the 2010 appropriation. The truly bad news is that further reductions are imminent for 2012. After delineating the allocation for the $628.4 million towards inpatient and Community First programming, the Commissioner spent some time highlighting the benefits and transitional concerns surrounding the opening of the state-of-the-art psychiatric facility scheduled for mid-year 2012 in Worcester, MA.

The Commissioner opened the second part of the evening to the public for comments, observations, and questions.

Senator Mark Pacheco, Senate representative from Taunton, made an impassioned plea to the Commissioner concerning all the good that Taunton State Hospital (TSH) does for residents throughout Southeastern Massachusetts and Cape Cod. He stated that it would be disastrous for his constituents, both economically and from the mental health perspective, if TSH was to close. Leadership in statewide nursing organizations, and family members who have loved ones at TSH, echoed the Senator’s sentiment.

A participant expressed his concern that the State was relying too heavily on private service providers who were receiving large portions of the State’s budget, and whose CEOs were getting rich on these contracts. This was the perfect segue for FHR’s CEO, Joe Dziobek, to assure the public that he was not one of those CEOs making more money then the Commissioner (and that he could prove it since he had a copy of the company’s 990 IRS form in his car). This brought a chuckle from those gathered. Mr. Dziobek’s observation concerned the transparency of the proposed budget. While the budget clearly listed expense allocations, incomes received from Medicare/Medicaid were not so clear.

After a number of observations expressing legitimate outrage concerning the yearly diminishment of DMH’s overall budget, advanced peer recovery specialist, Bob Rousseau, pointed out that the enhanced peer recovery workforce has been a bright spot in meeting DMH’s goal of person-centered treatment and care. Mr. Rousseau asked the Commissioner to set aside funds for the ongoing education of peer specialists, and the creation of mandatory educational trainings for all mental health professionals in recovery theory and practice.

Finally, a DMH case manager from New Bedford lamented the fact that budget restrictions are reducing the number of master’s level clinicians at local DMH sites throughout the State. As a result, there are serious reductions in the quality and frequency of much needed one-on-one therapeutic supports, though the need for such service has increased.

Editor’s Note: The Massachusetts Department of Mental Health’s 1990 budget of 20 years ago was slightly larger ($644 Million) than the proposed 2011 budget of $624 Million.