Getting to a Mental Health Budget

Carter and Buckley are making both a humane and prudent choice for mental health and chemical dependency.
May 21, 2009 -- The fastest way to get up to speed on how Oregon spends its mental health dollar is to cruise the executive summary of the December 2008 report, Assessment and Evaluation of the Mental Health Care Delivery System in Oregon. This report was prepared at the request of the state legislature by the Public Consulting Group, a Boston-based management consulting firm.
There you will learn that Oregon currently spends about $447 million in federal, state, and local funds for adult inpatient and community-based mental health services each year. The Department of Human Services, Addictions and Mental Health Division (AMH) allocates and administers about $334 million of that sum.
Where does that go? About $129 million (39%) is spent on state hospitals that serve about 1,638 clients per year. The remaining $205 million are used for community mental health services. Approximately $133 million go to local mental health authorities and community mental health providers for services that are not billable to Medicaid. The remaining $72 million are paid to Mental Health Organizations (MHOs) on a capitated basis to cover services for over 28,000 Medicaid-eligible recipients.
The DHS Department of Medical Assistance Programs processes an additional $62 million annually in Medicaid fee-for-service payments for mental health drugs and non-MHO covered Medicaid billable services for adult clients. The state criminal justice system spends an additional $33.6 million per year on mental health services for adult recipients. About 5,600 inmates per year receive mental health services. Counties chip in around $17 million to augment state funding.
Among all these figures, one stands out. For the cost of serving one person in OSH, you can serve 32 people in the community.
In December, Governor Kulongoski released his Governor’s Recommended Budget (GRB), a document that normally kicks off the budgeting discussion for each biennial legislative session.  From the amounts noted above, he proposed cuts in supported employment ($1M), 90% of adult outpatient mental health for non-Medicaid adults ($28.4M), 50% of the acute care budget ($18.1M) and closure of Blue Mountain Recovery Center, Oregon’s state hospital in Pendleton ($4.9M).
Soon thereafter, the Co-Chairs of the Joint Committee on Ways and Means asked state agencies to provide the Legislative Fiscal Office with proposed budget cuts totaling 30% from their 2009-11 essential budget level. The results looked a lot like the GRB. To get to 30%, AMH proposed elimination of funding for acute care, community crisis services, the Mental Health Housing Trust Fund and non-Medicaid adult outpatient services.
Putting aside human suffering and massive financial shifts to the health and public safety areas, these proposals were pushing down the throttle of a slow-motion train wreck.  Oregon is beefing up staffing and supports at Oregon State Hospital in order to avoid a threatened lawsuit from the federal Department of Justice. It has a new, smaller, hospital under construction to replace OSH that will cost more to operate than its predecessor.
Another new state hospital is planned in Junction City that will cost additional millions to staff each year. Even if both hospitals are built, state planners have determined that well over an additional $100 million will be needed for community services each year if we are to keep the hospitals from being filled with patients who do not need hospital-level care. 
It may be that the co-chairs of the Ways and Means Committee have gotten this message. On May 18, they released a proposed budget for 2009-11 that prioritizes “county-level services for mental health and drug/alcohol rehabilitation programs to the greatest extent possible.” The budget slashes supported employment, closes Blue Mountain Recovery Center and adds mental health drugs to the enforceable preferred drug list. Mindful of the Department of Justice, It adds $35,226,621 to the OSH budget.
The co-chairs, Sen. Margaret Carter and Rep. Peter Buckley, say they want to “provide effective, proactive assistance to Oregonians in a way that saves lives in the most cost efficient manner available.” Without substantial new revenue, that is impossible. But compared to what has gone before, and considering the many devastating cuts (such as that to home care workers) in the proposal, Carter and Buckley are making both a humane and prudent choice for mental health and chemical dependency. 
Bob Joondeph is the executive director of Disability Rights Oregon, which empowers individuals with information and tools for successful self-advocacy, provides legal representation and actively promotes policies that benefit all Oregonians with disabilities.