Maryland Medicaid Cuts

If it didn't impact the lives of Marylanders most vulnerable, the recent request for comment by the Maryland Department of Health and Mental Hygiene (are we ever going to move two centuries forward and change that name) would be laughable.

The Mental Hygiene Administration, itself, has been the cause of hundreds of millions of dollars iof unecessary expenses to the state Medicaid budget. Some examples:

• A ten-year moratorium on the development of affordable housing opportunities by community mental health providers that has ultimately driven thousands of individuals to emergency room visits.
• An intense implementation focus on expensive, evidence-based practices that have not been proven to be efficacious in the state and cost the state tens of millions of Medicaid dollars.
• The reduction of psychiatric rehabilitation day program visits for people with severe psychiatric disabilities that has minimized their ability to learn social skills that help them integrate into the community.

These are just a few examples of how an administrative, void of strategic vision, has caused Medicaid expenditures to escalate over the last decade.

Unfortunately, the state provider association and the consumer "advocacy" organization, which is in the pocket of the Mental Hygiene Administration, have been largely ineffective in pushing for the changes that are needed to positively impact the State's Medicaid budget. If the State is truly interested in cutting costs in the Medicaid budget it needs a significant change in the vision, or lack there of, of the leadership of the Mental Hygiene Administration.

I just returned from an open house for a new affordable housing initiative in Baltimore City which is a shining example of the possibilities for creating housing for people with psychiatric disabilities. No one from the Maryland Mental Hygiene Administration attended the event. Why?

Because the administration has failed to understand that affordable housing is an integral part of the recovery process for people with psychiatric disabilities in Maryland. Instead, they have extended a moratorium on the development of affordable housing by mental health providers that has been in effect since 2001.

Despite the best efforts of small housing development providers like the one I attended today, the effects of the moratorium have been ruinous. This is not to mention the advocacy efforts of the state's consumer "advocacy" organization, in the pocket of the Mental Hygiene Administration, who has advocated for the moratorium, yet benefitted from state funding to develop their own housing.

Although it cannot be scientifically connected, emergency room utilization by people with psychiatric disabilities has increased over the decade.

The prohibition, initially based on financial, potential liability, has come back to bite the entire system. The state is looking to cut $40 million dollars in Medicaid savings would do well to look at the major reason for repetitive emergency room visits- housing.

MD budget hearings

I testified at the Senate budget hearing for the Alcohol and Drug Abuse Administration today and the committee was sympathetic and attentive.

What was really interesting, though, were the folks waiting to testify on the Mental Hygiene Budget. You had the lapdog provider association that has, for years, been "Chamberlainesque" in their dealings with the Mental Hygiene Administration for years, failing to protest obvious state violations of the Supreme Court Olmstead Decision and On-Our-Own members, who have forgotten the face of their fathers, don't come close to representing the vast majority of people with psychiatric disabilities and actually advocate for violations of the Olmstead Decision, specifically the moratorium on the development of affordable housing for people with psychiatric disabilities. This, at the same time, as they reap state monies to develop housing themselves. Hypocrites and violators of civil rights at the same time.

Ultimately, though, the problem lies with a lack of vision and leadership at the state level -- state leaders who pat providers on the head for not making waves or filing legitimate civil rights law suits or lining the pockets of "consumer" leaders who pretend to have the best interest of the masses with severe mental illnesses in mind.

In the richest state in the Union can we afford to have these perennial games go on? I would hope not.

But my hope is lagging.

USPRA

I recently returned from the United States Psychiatric Rehabilitation Association annual conference in Boise, ID. Aside from some representatives from MD VA facilities, I was the only Marylander at the conference.

I think that this is a clear sign that the State of Maryland has abandoned any pretense of wanting the practice of psychiatric rehabiliation in the state.

The Mental Hygiene Administration has continually eschewed the acceptance of the CPRP certification for practitioners, effectively thumbing its nose at quality practice in the field.

The Mental Hygiene Administration has blindly pursued the implementation of expensive "evidenced-based practices" such as assertive community teams and supportive employment, spending scarce resources to benefit the few and ignoring the masses.

The Mental Hygiene Administration is in its 9th year of a moratorium of the development of affordable housing by community mental health providers, thereby denying hundreds, if not thousands, of Marylanders from affordable housing opportunities but denying them the opportunity to learn important living skills in the rare opportunities the get for housing.

The Maryland Mental Hygiene Administration, by forsaking strategies to implement and sustain psychiatric rehabilitation, has demonstrated that it is not only strategically bankrupt, but in the case of its housing policy, morally bankrupt, as well.

They woke up?

Apparently, the forced closure of the Upper Shore Hospital in Maryland's eastern shore has caused enough shock to the Maryland Mental Hygiene Administration that they have quietly abandoned their nine-long year moratorium on the development of affordable housing opportunities for people with psychiatric disabilities.

In preparation for the closure of the hospital, contracts have been let for crisis services, intensive intervention services and residential services for those who will leave the hospital.

Those supports have been tested and available for decades. MHA has consistently chosen not to support crisis residential services at adequate rates and supports for individuals in new residential programs.

The failure of the Mental Hygiene Administration to support these established efforts has cost taxpayers, probably, hundreds of millions of dollars and more importantly, an enhanced quality of life for persons served.

Shame on the Mental Hygiene Administration in Maryland for waiting until a budge crunch forced your hand. Shame on the advocacy community for not forcing your hand earlier.

Congratulations to those individuals who will get an opportunity to be full contributing partners in their community because of the closure of the Upper Shore Hospital. You should well-consider your legal options against the state because of their lack of vision.

I went to a funeral of a friend today. He was 53 years old and died of pneumonia. He also suffered from a chronic, severe mental illness. His death was an avoidable tragedy in more than one way.

He was certainly a poster child for the federal study released two years ago that announced that individuals with severe and persistent mental illnesses tend to die 25 years earlier than those without the illnesses.

That fact is one of the most significant tragedies associated with my friend's death because it is indictment of the nation's and Maryland's health system. Integration of behavioral and somatic health happens rarely in our country and that is a signficant problem and that is why so many people with severe mental illnesses die so young.

I actually have colleagues who express caution in rushing to integrate the care, fearing that mental health care will get short shrift in an integrated system. Mental health care has gotten short shrift in a fragmented system! Come on! People are dying.

My friend actually got better mental health care than most in this country. He lived in a group residence with 24 hour support. He had a good medical daycare program to go to five days a week. He had case management support and access to clinical care.

Would that he had regular access to primary care instead of having to go to the emergency room repeatedly when his COPD became problematic.

My colleagues need to get over their paranoia and push for a system of integrated care for individuals like my friend. Twenty-five years is a crime!

Evidenced Based Practice

This anonymous quote was posted on the OpenMinds site today and is indicative of the lack of vision, practicality and insight of the Maryland Mental Hygiene Administration:
"In our clinic, we are carrying out an EBP—family psychoeducation—and the reviewers who have deemed our practice to have high fidelity to the model focus entirely on process rather than on outcomes. We have been using a unique approach to co-occurring disorders that (in our fairly primitive field research) indicates between 40% and 50% one-year sobriety and stability rates for all who start the program. However, it will not meet the Maryland standard for an EBP, since it appears to be going to a model for which I can find no longitudinal outcome data whatsoever."

This is pretty typical of the MD MHA, which doesn't seem to have the capacity to devine what is in the best interest of Marylanders but must rely on EBP's that haven't been proven here. Millions of dollars have been wasted because of the lack of analytic capacity in the Administration.

Housing development has suffered, critical daily supports have been lost, cost-shifting to jails, emergency rooms and homeless shelters has been rampant because of exceedingly poor policy decisions.

Granted, a laudable, decades late, decision to close Upper Shore Hospital has been made and a decision to close 80 beds at Spring Grove Hospital Center has also come to fruition, but with such tardiness that no one will be able to judge the impact on the quality of lives of people with severe psychiatric disabilities in the state.

Clearly, MHA needs an opthalmic correction for its vision.