Budget shortfall leads state mental health programs to cut 200 positions

The Minnesota Department of Human Services on Tuesday announced it will cut 200 full-time positions from a program that provides direct care to people with mental illnesses.

The cuts are part of $17 million in reductions for State Operated Services that were part of Gov. Tim Pawlenty's latest budget recommendations. The cuts would need to happen by June 30, 2011.

Besides eliminating positions through closing facilities, officials said the cuts would also be achieved by operating mental health services more efficiently.

In a news release, officials outlined what they consider a redesign to make access to psychiatric care more equitable and more coordinated. But some advocates are questioning whether the same level of care can be provided while operating with $17 million less than before.

Job cuts

Dr. Read Sulik, assistant commissioner for Chemical and Mental Health Services at DHS, predicts most of the 200 positions eliminated will be by attrition and eliminating jobs currently not filled.

"We are convinced through this analysis that we are not inhibiting access to care and ultimately will be improving access to care."

"We are convinced through this analysis that we are not inhibiting access to care and ultimately will be improving access to care but we've got to do so in a much more efficient way than we've done so historically," Sulik said.

The DHS announcement said state services should not duplicate existing services or compete with private providers.

The redesign, Sulik said, includes creating regional psychiatric care centers.

He said they'll be in each region of the state with 24-hour service for people experiencing the most serious problems.

Still to be determined, Sulik said, is how the regions will be defined, and how far people might have to travel if they need help.

"That needs to be worked with community stake holders," he said. "What we see is if you can imagine a radius of 120 miles, anything outside that radius is probably too far."

Effects on current facilities

Patrice Vick, a spokeswoman for the Minnesota Department of Human Services, said the cuts won't affect direct care except at facilities the department has decided to close. That includes permanent closure of the Community Behavioral Health Hospital-Cold Spring, the 10-bed Mankato Crisis Center and the state-operated adult mental health residential facility in Eveleth.

Services in Mankato would be transferred to the Community Behavioral Health Hospital in St. Peter, and services in Eveleth would be replaced by a new adult therapeutic transitional foster care facility in northeastern Minnesota.

Other changes to achieve the job cuts include ending state-operated dental services in favor of another model that works with community providers, and transferring one unit of the Anoka-Metro Regional Treatment Center to a state psychiatric nursing facility in St. Peter.

DHS also wants to replace a centralized admissions process for State Operated Service with a psychiatric access service, which provide 24-hour consultation to various mental health providers.

Vick said the reductions will occur over the next 15 months.

"They're kind of plugging this as a redesign of the system, but it still is a $17 million cut," said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. "I really do find it hard to believe that we're going to be able to cut $17 million and improve and enhance our services at the same time."

Abderholden said the plan, which came after several community meetings to gather input from providers and advocates, does take some positive steps.

For example, she said, it provides a new psychiatric transportation system so that individuals could be transported to a commitment hearing by something other than an ambulance or law enforcement vehicle.

Abderholden said having Level 1 psychiatric care centers in each region of the state -- another part of the plan -- is also important, though she's waiting for details on where they would be.

Abderholden also noted that State Operated Services is a small part of mental health care funded by the state, and that budget cuts will affect other services.

"It has to also be viewed I think in light of everything else that's going on in the budget," she said. "We are worried. It's not like anyone would call the mental health system robust or well-funded."

Problems still remain

The 2007 infusion of money addressed some long-standing problems afflicting the Minnesota's mental health care system.

One problem is federal designation of more than 60 Minnesota counties that fall short of supplying critical mental health services.

DHS assistant commissioner Read Sulik is aware of the deficiencies.

Sulik is a pediatrician and a child and adolescent psychiatrist in a state chronically short of such expertise.

"We are in the bottom third of the country in the number of child psychiatrists we have per capita in Minnesota, and the national average is about one fifth of the national need," Sulik said.

Another problem is that Minnesota's mental health services are consistently reviewed as existing in silos where medical doctors, psychiatrists, psychologists, social workers and others who work with patients don't share information.

Sulik said the state is still a long ways from solving that issue.

"We are nowhere near integrated and we've got a long way to go to truly become an integrated network of care across the state that can be most effective," he said.

Sulik said he doesn't know if the state's recurring budget problems will mean additional cuts for mental health care services.