Email | Print

Community-based mental health agencies were disappointed to learn that Governor Pataki's 2002-03 budget proposal did not substantively address the problem besetting the mental health workforce, including an annual staff turnover that is as high as 54%.

Last year, the Governor and the Legislature walked away from promises to the mental health sector for 10% Medicaid fee increase and 2.5% cost-of-living adjustment (COLA). We feel like we were jilted at the altar.

Throughout the heady years of the 1990s, the mental health sector was told to wait for a better time to get a Medicaid fee increase and cost of living increase that would have begun to redress the years of static reimbursement and growing costs. Better times have never arrived and this sector is in greater need than ever before. While we support the governor's initiative for increases for hospital workers who have faced high turnover and staffing shortages, mental health workers should not be left out.

Already, a significant portion of our workforce has been driven to other jobs. Ironically, these are often in the healthcare sector, which pays better salaries. Unaddressed, the persistent and deliberate underfunding of the community mental health system will lead workers to find jobs elsewhere. This will have a deleterious effect, over the long run, on the quality of care and may limit access to people in need. In the meantime, agencies are forced to increase caseloads for caregivers, decrease time spent with each consumer, and raid contingency funds simply to stay afloat. Studies indicate that two of every three people who leave their job in mental health programs have been with the agency longer than a year. We are losing the most experienced staff at alarming rates. In mental health, it means discontinuity and disruptions in the healing relationship, which is so necessary for recovery.

A model of public-private partnership, the non-profit mental health sector is largely funded through contracts with the State. Yet, with the way the budget is structured a flat mental health budget acts as a cut in community mental health services because costs have escalated with annual inflation. State mental health workers, who are contracted to receive a 3% COLA each year, are paid approximately $10,000 more than their counterparts in the community who have the same job description. For each year that community mental health is left out of the budget, the disparity grows even larger.

Moreover, this is also a time when community mental health agencies are being asked to do even more as a result of September 11. The crisis counseling services that are funded by FEMA require a stable base from which to operate. Despite a strong commitment to providing these needed services, agencies are finding it difficult because the infrastructure is so badly frayed. Since 1990, the Consumer Price Index has risen by more than 39%, at the same time the community mental health system has received aggregate increases of less than 4%. This is a road to bankruptcy of a crucial social safety net. Agencies cannot continue to operate under these circumstances, let alone continue to provide vital services.

The Governor's budget also failed to reinstate the landmark Community Reinvestment Act which funneled savings from closed state psychiatric beds into the community mental health sector. Passed in 1993, this legislation has funded more than $200 million in new programs. Part of its appeal is that it costs the State no additional dollars; rather it deploys the same dollars to a community setting that is more efficient and better able to help consumers reach their full potential in their own communities where they live.

Because Reinvestment expired in September, the community mental health sector stands to lose $9.2 million in the current fiscal year alone. By failing to continue Reinvestment in the out years, community mental health stands to lose millions more.

The recent funding for hospital and other health care workers is evidence of what we can do when we all work together to solve an important problem. High staff turnover, zooming caseloads, and quality work environments in community health agencies are clearly a problem of the same or greater magnitude, and should garner the same attention and prompt resolution.