by Ted Griggs

Another fiscal year, another state budget shortfall, another good chance that the funding for mental health services will be cut. Louisiana's mental health professionals and advocates are all too familiar with the picture.

With the state Department of Health and Hospitals facing a $295 million deficit, DHH announced a plan to shutter 17 mental healthcare clinics and cut 100 psychiatric beds, 20 of them at University Medical Center in Lafayette. The proposal includes cutting 140 jobs and $9.4 million and 244 jobs from the department's Office of Mental Health.

"It's going to be a disaster if the cuts are as draconian as it looks like they will be right now," said Lois Simpson, executive director of the Advocacy Center.

The nonprofit agency helps indigent Louisiana residents with mental illnesses and physical disabilities.

The proposed cuts to the Office of Mental Health will push more mentally ill people into prisons "because that becomes the modality of treatment for them" and onto the streets, Simpson said.

The rural mental health clinics facing closure include centers in Crowley, Opelousas, New Iberia, and Ville Platte.

However, Dr. Cheryll Bowers-Stephens, assistant secretary for the Office of Mental Health, said she's hopeful that some of the additional $360 million recognized by the Revenue Estimating Conference funds will find its way to mental health.

"I'm told internally that they understand that mental health is a priority, and that it will get some support," Bowers-Stephens said.

In addition, OMH has completed a study aimed at finding ways to reduce its costs, Bowers-Stephens said. DHH has not given its permission to release the study's specifics. However, the study shows that significant savings are possible if the Office of Mental Health closes five large, aging mental health hospitals and replace them with new streamlined facilities.

Some of the hospitals have been around since the 1800s, Bowers-Stephens said. Facilities built to hold up to 4,000 people now house only 250 patients, and keeping the old buildings up and running is expensive.

"By getting out of the old buildings and into new, smaller structures, we can put more emphasis on treatment than operating costs," Bowers-Stephens said.

Simpson said the Office of Mental Health is stretched so thin now it can't take much more in the way of budget cuts.

Mental health doesn't have as many revenue sources available as other areas of disability, such as mental retardation, Simpson said. In addition, mental health bears a stigma that other types of disabilities don't.

People are very sympathetic to other disabilities, but they sometimes think people with mental health issues bring the problem on themselves, Simpson said. People with mental health disabilities also tend to have other problems, such as drug or alcohol abuse.

The combination plays into a misperception that the mentally ill have created their own difficulties, she added.

The budget crunch has taken attention away from DHH and Gov. Kathleen Blanco's efforts to restructure mental healthcare services, Simpson said. Both the department and the administration are trying to do the right thing.

The problem, as always, is will there be enough money to do it, she said.

Recently DHH, with considerable urging by the Advocacy Center, reformed its payment system for the Mental Health Rehabilitation program. The set rate structure that resulted in abuses by some private providers has been replaced by fee-for-service approach.

Bowers-Stephens said that's just one of the steps the office has taken to improve efficiency.

One of OMH's goals is to increase the number of people it helps while reducing costs, she said. The office has established a Quality Council to help achieve that goal.

The office also hopes to expand its Early Childhood Support and Services program into a statewide system of support and care for children up to five and their families, Bowers-Stephens said. The program provides counseling, screenings, intervention and other services to children who have certain risk factors for mental health problems, including abuse, neglect, exposure to violence, and parental mental illness.

The program was launched last year in six parishes, Lafayette, Terrebonne, East Baton Rouge, St. Tammany and Ouachita.

OMH is also working to address the state's acute care crisis in mental health, she said. A number of people with mental illness end up at hospital emergency rooms and sometimes in jail.

The office is working with DHH Secretary Fred Cerise on a bill for uncompensated care that will address the problem, Bowers-Stephens said

Meanwhile, the accreditation of the Office of Mental Health community mental health centers is well underway. The project began last June, with national consultants providing technical assistance. The goal is for the centers to get accreditation from the Joint Commission on Accreditation of Healthcare Organizations.