Maryland's long-neglected mental health system for the poor and uninsured could rebound quickly because of a cash infusion proposed by Gov. Robert L. Ehrlich Jr., but it still faces staffing shortages and other problems, experts said yesterday.
At a briefing before the Senate Finance Committee, mental health advocates and experts praised a proposal by Ehrlich to eliminate budget deficits in the system. Those deficits in recent years have led to the closing of clinics, fewer services and stricter guidelines on who qualifies for government-funded help.
But the future of the state's system of public and private mental health care providers remains uncertain because of severe staff shortages and sagging employee morale, the experts said.
"They are running at what we consider minimal for quality care and safety," said Arlene H. Stephenson, acting secretary of the Department of Health and Mental Hygiene. Stephenson is an appointee of former Gov. Parris N. Glendening who is filling in until Ehrlich chooses a new secretary.
Stephenson marveled yesterday at how the new Republican governor stuck to his commitment to make mental health a priority of his administration.
"Ehrlich solved our historic problems in one budget," Stephenson said. "He understood the need and filled the hole."
Ehrlich has proposed giving the Mental Hygiene Administration an additional $30 million this year to close a shortfall in the agency's budget.
To prevent a similar deficit next year, the governor has included an extra $36 million for the agency in his budget proposal. The money marks one of the largest new expenditures in Ehrlich's plan as he tries to close Maryland's almost $1.3 billion budget gap.
If approved by the General Assembly, the increase would create a structural balance in the agency for the first time in several years.
Terry Bohrer, a vice president at the Mental Health Association of Maryland, said Ehrlich's budget proposal takes big steps toward making the network of 11 state-run psychiatric hospitals and 160 public and private clinics solvent.
"We need the money bad, and this is going to address the structural deficit and help us halt further erosion," Bohrer said. "This system has been chronically and grossly underfunded."
The state's mental health system has been in a financial crisis since 2001, when legislative analysts discovered it was serving tens of thousands more people than it had been set up to handle.
The result was a $42 million deficit in fiscal year 2001 and a $54 million deficit the last fiscal year.
Those two shortfalls were closed by the legislature - the one in 2001 by a tax amnesty program and the gap last year by an unexpected infusion of one-time federal funds. But legislative analysts estimated the system would face a $30 million deficit each year unless it was reorganized or new revenue sources were found.
Since it was last reorganized five years ago, the number of people served by the state's mental health system has jumped from 64,000 to almost 90,000; the system was designed for about half of that.
The growth stems from an increase in Medicaid patients and children, who account for 40 percent of the system's users.
The state Mental Hygiene Administration administers all state and federal funds related to mental health services, including Medicaid and the Children's Health Insurance Program. The program also provides services to some of the state's uninsured.
"I think as a state we do a lot more than the average state," said Sen. Thomas M. Middleton, a Charles County Democrat and chairman of the Finance Committee.
But shortfalls forced officials last year to restrict the program to fewer uninsured residents. Until July of last year, uninsured residents who earned less than $26,000 a year were eligible for services. Now the program is limited to residents who earn less than $10,300 and are enrolled in the state's pharmacy assistance program.
Herbert S. Cromwell, executive director of Community Behavioral Health Association of Maryland, a private nonprofit company that operates 52 of the state's clinics, said additional help is needed to hire more workers and pay current workers more.
At both government and private centers, the deficits - combined with a hiring freeze on new state workers - have led to what officials call "skeleton crews" during most shifts. At least a dozen mental health clinics have also closed, although some new ones have opened, too.
"Because of the deficit, there has been no money to adjust rates that pay for the services that are the basic lifeblood of the program," Cromwell said.