Mental Health services losing ground?

1. The MA House budget did propose to increase the mental health budget this coming year by about 4%. This helps maintain services as they are and if finally enacted, improve on some child and adolescent services. As our State Senator, please keep up this momentum! Thanks so much.

   Pam

2. Dear Pam:

   The Massachusetts Department of Mental Health was only able to speak to the Massachusetts numbers, but we in Senator Brownsberger’s office are checking the numbers the Kaiser Foundation reported regarding the other states, which we should be able to confirm this week. We are also keeping track of the mental health budget as it moves through each stage of the budget process. The Massachusetts House of Representatives will be debating and voting on amendments to the budget proposed by the House Ways and Means Committee this week.

   Best,
   Anne

   Anne Johnson, Committee Counsel and Policy Advisor
   Office of State Senator William N. Brownsberger

3. I have spoken with someone in the state mental health departments of each of the New England states and am awaiting a reply from most of them. A representative from the Vermont Department of Mental Health did get back to me, and he provided the following information regarding Vermont’s current per capita mental health spending:

   1) Community mental health spending: $214.63/capita
   2) State hospital spending: $35.41/capita

   As best I can determine, the Kaiser Family Foundation numbers are from 2009. They are generally considered a credible source. It seems the parameters they used to define “mental health services” were as follows:

   “Medicaid revenues for community programs are not included in SHMA-controlled expenditures. . . SMHA-controlled expenditures include funds for mental health services in jails or prisons. . . Children’s mental health expenditures are not included in SMHA-controlled expenditures.” See http://www.statehealthfacts.org/comparemaptable.jsp?cat=5&ind=278.

   With regard to our state budget, both the Governor’s proposal (at $153,488,321) and the House Ways and Means budget (at $152,988,321) for Fiscal Year 2013 community-based mental health services reflect an increase over Fiscal Year 2012 spending (at $146,732,857). Next week, the version of the budget voted on by the House of Representatives should be made available. The Senate Committee on Ways and Means will release its version of the budget next month for consideration and deliberation by the Senate; we will be sure to keep an eye on the mental health budget in the Senate’s version of the budget. You can find a breakdown of all of the mental health-related budget line items under the line-items beginning with 5. Please see the Governor’s proposal here (http://www.mass.gov/bb/h1/fy13h1/brec_13/hsummary.htm) and the House Was and Means proposal here (http://www.malegislature.gov/Budget/FY2013/House).

4. Thanks. I’m looking forward to the results of your research. I’m wondering if we in MA are spending less than other New England states, as a number of Mental Health advocates say. Money paying for effective programs goes a long way toward alleviating them. What is the MA per capital spending in equivalent categories? Your research is closer to getting an up-to-date answer than anyone else’s.

   Best,
   Pam

5. Dear Pam:

   I just wanted to give you an update on the final numbers that emerged from the House and Senate budget deliberations with regard to community-based mental health services. Line-item 5095-0015, which funds community-based mental health services, received $161,488,321 in the House budget and $158,488,321 in the Senate budget. Both figures represent a significant increase over this past year’s funding level of $146,732,857. The exact number for FY13 will be identified by the budget conference committee but will be no less than the Senate number.

   According to our own Department of Mental Health, the Department does not have the resources to perform the analysis required to determine per capita community-based mental health spending. (The Department legislative liaison could speak only to the overall budget numbers.) If I define the parameters of “community-based mental health spending” as the FY12 figure for line-item 5095-0015, and identify the “capita” as the population of Massachusetts as identified in the July 2011 census (6,587,536), then I calculate community-based mental health spending for the previous year at $22.18 per capita. This number is still significantly below the number the Kaiser Family Foundation found in their analysis (http://www.statehealthfacts.org/comparemaptable.jsp?cat=5&ind=278), which causes me to believe they included additional line-items and/or defined their “capita” as population served, rather than population of the state. We have reached out to the Kaiser Family Foundation for an explanation.

   Our office has not heard back from other states with respect to their own community-based mental health services funding, but we are still trying to track down those numbers. We will be sure to let you know when we have some more concrete information.

   Best,
   Anne

6. The Kaiser Family Foundation pulled their numbers from the National Association of State Mental Health Program Directors Research Institute: http://www.nri-inc.org/projects/Profiles/Prior_RE.cfm. I will be sure to review this site carefully, as well.

7. Dear Pam:

   We have done some in-depth follow-up research to your question here in the office, and we think that we have an answer. Upon investigation into the survey at question, we found some interesting data, including an over $200 increase in per capita spending in Maine from FY05-FY06, which you can view here: http://www.statehealthfacts.org/comparetrend.jsptyp=4&ind=278&cat=5&sub=149&yr1=28&yr2=29&srgn=21.

   This led us to contact the Kaiser Family Foundation, their data source (the National Association of State Mental Health Program Directors Research Institute (NRI)), and both the Massachusetts Department of Mental Health and other states’ similar departments. The findings show that Massachusetts’ apparent lower level of funding is due to both the research criteria and the way in which individual states track and route their mental health expenditures.

   Regarding the means of data collection used in the survey, NRI depended on state departments of mental health (or corresponding agency) to self-report their funding. NRI did not conduct any further research beyond this self-reporting, according to a representative I spoke to over the phone. This left some room for varied results as states use different criteria for what counts as mental health spending.

   According to the NRI survey, there are seven outlier states that did not include in their criteria federal Medicaid funds used for community-based mental health care initiatives, including Massachusetts. You can see that data here: http://www.nri-inc.org/projects/Profiles/RevExp2009/T13.pdf. Since Medicaid in the Commonwealth is handled through MassHealth, the federally funded mental health spending is counted with MassHealth’s expenditure and not in the Department of Mental Health.

   According to information learned in a phone call with the MassHealth office, it distributes these funds as lump sums to local providers of care, who then administer the care (including mental health care). In short, the money is never routed through the Department of Mental Health, and is therefore not recorded by the Commonwealth as mental health spending.

   This creates the illusion that Massachusetts spends less on mental health than it actually does. To solidify this point, an NRI representative informed me that the over $216 per capita jump in Maine’s mental health spending from FY05-FY06 was due to Maine’s shift in mental health expenditure reporting that started to include Medicaid spending in FY06.

   To conclude and summarize, the apparent lower level of spending on mental health in the Commonwealth is due to a variation in criteria among the states in what counts as mental health spending and the fact that Massachusetts did not report federally funded Medicaid spending on mental health services as part of the Commonwealth’s mental health expenditures. In reality, Massachusetts probably has a much higher per capita spending rate on mental health than reported in the Kaiser Family Foundation’s database.

   I hope that helps to answer your question, Pam!

   Very respectfully,
   Myles Tucker
   Intern, Office of State Senator William N. Brownsberger

8. Thank you, Myles, for your investigation. This provides good insight, and I’ll share it with others so we know how the study was conducted. I will forward to you all some information from the clubhouses (if they don’t do that themselves) that relate to the use of available funds. As the requirements for participation become stricter and availability of transportation disappears, a number of participants are unable to use the few resources that are community based. It might be a good idea for you, Will, to visit some of the clubhouses to see what they’re all about and to see the population they serve. The one I’m most familiar with Elm Brook Clubhouse in Bedford, which is out of his district, but I believe it tells the same story as the others in our district. It’s good to know you get it; it becomes a passion when you’ve seen who it serves and the good it does firsthand.

   1. Yes, I have made these visits and I do think that the clubhouses are very valuable.

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