Feeling the effects of the state's growing mental health crisis, Omni House - a provider of services to Anne Arundel County's poor mentally ill for 20 years - is struggling to remain open after closing two of its clinics.
The Glen Burnie facility joins the list of community-based mental health providers across the state that are trying to cope with lack of funding and administrative problems in the state's public mental health system.
Financial pressures forced Omni House to close its mental health clinic for children and adolescents two months ago, as well as its substance abuse clinic. Together, the clinics served more than 240 patients, and each program was losing about $10,000 a month, agency officials said.
Omni House also laid off about 10 employees, including child psychiatrists and social workers.
"The system at the moment is in crisis, and the crisis is statewide," said Herbert S. Cromwell, executive director of the Community Behavioral Health Association, which represents community mental health programs in Maryland. "Every clinic we've surveyed is losing money, and they're real essential community support systems for people."
Lois Miller, founder and chief executive officer of Omni House, said that despite the setbacks, the facility will continue its other programs, which include an outpatient mental health clinic and psychiatric rehabilitation services. She estimated the agency's losses at $200,000 over the past several months.
"We didn't do it without a lot of thought, but if you're taking a loss of $10,000 a month, you can't absorb it," Miller said of the clinics.
State lawmakers and mental hygiene officials are working to avoid widespread clinic closings as the mental health system faces a $21 million deficit.
Four clinics closed in Montgomery County last year, and the Corner Clinic closed two of its mental health facilities in Anne Arundel County in 2000.
"So many people are demanding services, and they're eligible for services," said Frank Sullivan, executive director of the Anne Arundel's mental health agency. "The question is, where is funding going to come from if the growth rate continues?"
Omni House transferred some of the affected patients into its other programs, and the rest were referred to county mental health providers for treatment, which generally includes therapy and medication management.
"It's kind of a what-are-you-going-to-do situation," said Chuck Walsh, program manager for Psychotherapeutic Treatment Services, an Annapolis provider that has taken on about a dozen of the Omni House patients.
"These people have been provided services for years," Walsh said, "and as a provider in Anne Arundel County, we have an obligation to take them."
For many patients, Sullivan said, the transition has not been easy.
"These are very ill people, and these programs are their lifelines," he said. "They get attached."
Providers say the problems in the state's mental health system have been building since 1997, when the state Mental Hygiene Administration hired Maryland Health Partners - a unit of Columbia-based Magellan Behavioral Health - to determine eligibility of patients, authorize treatment and pay claims. Previously, many nonprofit mental health providers received grants directly from the state to provide services. Since the switch, the number of patients receiving services through community-based clinics has grown from 50,000 to 80,000, but state funding has not kept pace.
"The sad thing is, we still have to continue to take care of our clients no matter what, and it's really become a terrible fight," Walsh said. "We battle Maryland Health Partners constantly."
Providers say the governor's proposed $25 million mental health budget for next year is not enough to solve the problems. To further reduce the shortfall, Maryland Health Partners began scrutinizing claims more closely several months ago, and health officials plan to help clinics with filing claims for reimbursement.
The crackdown has worsened some clinics' precarious finances and has resulted in denials of service for patients, providers said.
"Suddenly, half of the children in our programs were denied services," said John F. Cuddy, chief financial officer at Omni House.
Patients younger than 21 account for 42 percent of the patients in the public mental health system, up from 30 percent three years ago.
"Every day we're faced with some decision suddenly announced that involves somebody losing services, and frequently it's kids," Cromwell said.