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Opponents of the state's plan to close the Upper Shore Community Mental Health Center in Chestertown have a point that the state has not yet provided sufficient details about how the 200 patients a year who rely on the facility will find adequate care in an area where options are relatively few. But that doesn't mean the closure - part of the aggressive cost-cutting measures that have been required to bridge Maryland's recession-induced budget gaps - is the wrong thing to do.
The center is one of just six remaining state-run mental hospitals; others have been closed over the years as Maryland has moved to treat uninsured mental health patients in community-based, noninstitutional settings. Closing the center may cause inconvenience - even suffering in some cases - but so would the alternatives. Cuts to community health services would affect far more people.
Maryland has reached the point at which balancing the budget is going to require extremely painful choices, and Health Secretary John M. Colmers, whose department has been hit harder than most, doesn't have a lot of options left. The state has cut provider payments for Medicaid, reducing the availability of care for the poor. It has reduced funding for nursing homes, community providers of substance abuse treatment and cancer screenings. More cuts are going to be necessary in the current budget year, and the situation in the next is even worse. Comptroller Peter Franchot has asked the department to compile a list of alternate budget cuts that could be considered instead of closing the hospital. The problem is, none of those are likely to be more appealing, and the way things are headed, the department will probably get to them eventually too.
Although the state didn't plan to close the center until faced with the pressure to cut the budget, it is consistent with the long-term trend in how Maryland cares for the uninsured mentally ill. In recent years, the state has closed mental health facilities in Prince George's and Anne Arundel counties and Baltimore City, and in those cases it was able to contract with private service providers in the community. Appropriate options are more limited on the shore, but they aren't nonexistent, particularly considering a large number of the patients the center serves primarily suffer from substance abuse problems, with mental illness as a secondary condition.
Based on the state's experience in closing other centers, even with the added support for community-based treatment, the state could save about $1.6 million this fiscal year and about $9 million a year thereafter. Mr. Colmers is due to present his plan for managing the center's closure next month. It should be carefully scrutinized, not rejected out of hand.
The situation serves to point out a greater problem: the number of people who lack mental health coverage. The center primarily serves the uninsured. The ultimate answer to the question of the Upper Shore Community Mental Health Center's fate, and that of institutions like it, may have more to do with the outcome of health reform debates in Washington than it does with budget cutting in Annapolis. If the nation is able to achieve universal health insurance that includes coverage for mental illness, not only might state institutions like this one be obsolete, but many of the conditions being managed there might be caught and treated earlier, when they are less severe - and less costly to society.
The center is one of just six remaining state-run mental hospitals; others have been closed over the years as Maryland has moved to treat uninsured mental health patients in community-based, noninstitutional settings. Closing the center may cause inconvenience - even suffering in some cases - but so would the alternatives. Cuts to community health services would affect far more people.
Maryland has reached the point at which balancing the budget is going to require extremely painful choices, and Health Secretary John M. Colmers, whose department has been hit harder than most, doesn't have a lot of options left. The state has cut provider payments for Medicaid, reducing the availability of care for the poor. It has reduced funding for nursing homes, community providers of substance abuse treatment and cancer screenings. More cuts are going to be necessary in the current budget year, and the situation in the next is even worse. Comptroller Peter Franchot has asked the department to compile a list of alternate budget cuts that could be considered instead of closing the hospital. The problem is, none of those are likely to be more appealing, and the way things are headed, the department will probably get to them eventually too.
Although the state didn't plan to close the center until faced with the pressure to cut the budget, it is consistent with the long-term trend in how Maryland cares for the uninsured mentally ill. In recent years, the state has closed mental health facilities in Prince George's and Anne Arundel counties and Baltimore City, and in those cases it was able to contract with private service providers in the community. Appropriate options are more limited on the shore, but they aren't nonexistent, particularly considering a large number of the patients the center serves primarily suffer from substance abuse problems, with mental illness as a secondary condition.
Based on the state's experience in closing other centers, even with the added support for community-based treatment, the state could save about $1.6 million this fiscal year and about $9 million a year thereafter. Mr. Colmers is due to present his plan for managing the center's closure next month. It should be carefully scrutinized, not rejected out of hand.
The situation serves to point out a greater problem: the number of people who lack mental health coverage. The center primarily serves the uninsured. The ultimate answer to the question of the Upper Shore Community Mental Health Center's fate, and that of institutions like it, may have more to do with the outcome of health reform debates in Washington than it does with budget cutting in Annapolis. If the nation is able to achieve universal health insurance that includes coverage for mental illness, not only might state institutions like this one be obsolete, but many of the conditions being managed there might be caught and treated earlier, when they are less severe - and less costly to society.
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It's discouraging to read the Sun%u2019s Rx for Upper Shore. It is a slap in the face to a dedicated staff. I was a social worker there for 18 years before retiring in July, and I think Upper Shore serves a vital function. It has served more than 5000 patients since 1982.
Hospital services and community services are not interchangeable. Any plan for mental health services must include hospital stays for patients in crisis, as well as supports in the community. A person in an extreme state of mental illness needs security and time to stabilize under continuous medical supervision. Only when patients manage their symptoms do they succeed in the community.
Mr. Franchot%u2019s suggestion to keep Upper Shore open at least another year has merit. The administration says the fact that Upper Shore serves some 200 of the 270 non-forensic statewide admissions justifies closing it. Doesn%u2019t it also justify keeping it open? Expanding community programs - preparing plans, securing funds, readying housing, obtaining permits, hiring staff, and training employees - is hard and takes time; and it doesn't replace lost hospital capacity.
We have a history in this country of closing state hospitals...period. The result for the mentally ill has traditionally been homelessness, lack of care, increased crime, and imprisonment in large numbers. Is this what the Sun expects us to settle for?
rwood13 (10/09/2009, 8:26 AM )