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Over the past year most community mental health advocates made clear that, in addition to developing new services for adults with serious mental illnesses and children with serious emotional disturbances, their primary priorities were to prevent collapse of existing community mental health programs and to provide work incentives for people with psychiatric disabilities. The Governor's Budget Request for 2001-02 addresses both of these priorities. It extends Medicaid coverage to people with disabilities who go to work, and it provides meaningful funding increases for community mental health providers after years of failing to do so.

Both actions are very good news. But some of the details raise questions that should be addressed before celebrating the Governor's proposals.

Clearly the Governor's proposal to bolster funding for community mental health providers arises from his recognition that over the past decade funding for community mental health services has fallen way behind inflation. It has become increasingly difficult to maintain services of acceptable quality, particularly because salaries are too low to recruit and retain enough competent staff. In response the Governor proposes a multi-year plan which includes a 10% hike in outpatient Medicaid rates and a 2.5% cost of living adjustment in each of the next three years.

Funding to cover these increases will come from reductions in spending on inpatient services in state hospitals. The budget proposal projects a reduction of 625 beds over the next three years bringing the number of adult beds to just over 4000. In addition the budget proposal calls for closing two adult psychiatric centers -- Middletown (in Orange County) and Hutchings (in Syracuse). The budget proposal also calls for the relocation of four children's psychiatric centers onto the grounds of adult psychiatric centers.

Over the past seven years, savings from state hospitals have been used to expand community mental health centers, in accordance with The Reinvestment Act. In order to use savings over the next three years to strengthen existing services, The Governor’s Budget Request calls for replacing the Reinvestment Act with a new act called "The Community Mental Health Support and Workforce Reinvestment Act." After providing $6.6 million for new programs in the coming year, the current Reinvestment Act would end forever on September 30, 2001.

That is the first detail to question. The Reinvestment Act has been an important source of funding for additional community mental health services. Does ending reinvestment of the savings from state hospitals for new programs signal a belief on the part of the administration that further growth is not needed or just that it is possible to fund future growth in other ways?

Last year the Governor provided over $200 million for new services beyond reinvestment. This year his budget request calls for the development of 104 new transitional housing beds and 400 supported employment slots for adults as well as 40 new crisis residence for kids, beyond reinvestment. That suggests that an end to the Reinvestment Act does not mean an end to the development of new, needed services.

However, this year's budget request is explicitly cast as a multi-year plan, and it does not address growth in future years.

Whatever position advocates eventually take about ending the Reinvestment Act, we must be clear that it is essential both to preserve existing community mental health programs and to develop new programs to reach adults and children who are not getting the treatment, rehabilitation, and community support services they need. Perhaps the new reinvestment act should be cast to permit reinvestment both in new programs and in keeping pace with inflation.

The second major question of detail is the proposal to relocate several children's psychiatric centers to adult centers. Will kids be securely separated from the adults? OMH promises that they will, but it';s advisable to look carefully at the details of the plans before supporting them.

The third key detail is that increases for community mental health agencies, though meaningful, are inadequate. 2.5% per year will probably enable the agencies to keep pace for the next three years, but it does nothing about the years of falling behind. Shouldn't there be a significant increase to bring salaries to a competitive level as well as annual cost of living adjustments?

It is also important to note that a cost of living adjustment for the next three years does not assure cost of living adjustments in subsequent years or that the proposed adjustment will keep pace with actual inflation. Hospitals, residential treatment facilities, mental retardation programs have an annual "trend factor" which automatically links their funding to actual inflation. Shouldn't community mental health agencies have such a trend factor as well?

The fourth question relates to work incentives. Governor Pataki's proposal is significantly less generous than the proposal passed by the Assembly last year. The differences will need to be resolved during the course of negotiating the budget. In addition, for many people with psychiatric disabilities, job support is essential to their ability to work. New York State provides too few supported employment opportunities. Adding 400 slots this year is not enough.

For a non-election year the Governor's Budget Request for mental health is remarkably good. It is tempting to jump to support it enthusiastically. But as I write this (three days after the Budget Request was released), I am hesitant because there are questions to be answered about whether this budget trades too much of the future for survival over the next three years.