Disorderly conduct, continued

by Kristen Lombardi

It would be unfair to paint state officials -- at least, those at the DMH -- as indifferent to the sorry state of mental-health care for youth. "As commissioner," says DMH head Marylou Sudders, "I do not want a crisis." Since last year, in fact, she and her staff have joined with advocacy groups such as PAL and MABHS to press for some immediate solutions in an effort to calm the storm.

First, they've successfully lobbied politicians for a $10 million fiscal-year 2001 budget item that allows for the opening of 80 new beds at residential homes across the state, thus moving more stuck kids into aftercare. Second, the DMH and advocates have pushed for the "mental-health-care parity bill," as it's known, which mandates that insurers offer equal coverage for mental and physical illnesses. Signed into law this year, the legislation is expected to help close the gap between service costs and insurance reimbursements to hospitals.

But even Sudders admits that these efforts amount to only a quick fix. (Though money has been approved for 80 beds, there is only enough staff to open 56 of them.) State officials, patient advocates, and mental-health workers agree that to solve the long-standing problems, the so-called continuum must be improved. That means offering better prevention services so that troubled children don't have to resort to emergency rooms. It means increasing staff size and clinical capacity at aftercare facilities. And it means improving coordination among state agencies, insurers, and providers. What is needed, in short, is a massive influx of funds and resources -- a shift in budget priorities -- to allow for the build-out of what Sudders calls "the front-door and back-door services."

It's a level of change that demands work, for sure. Until now, the political will to carry out long-term solutions has been almost nonexistent. As Mattioto, who has lobbied to fix the mental-health system's gridlock for two years, attests, "Public officials have pushed these larger problems to the back burner. The urgency isn't there."

Though it's true that legislators and Governor Paul Cellucci responded to the crisis by supporting the $10 million budget item, not everyone is convinced that those who hold the state's purse strings view mental health as a spending priority. Cellucci, in particular, can be accused of sending mixed signals. For nearly two years, PAL flooded his office with 600 letters detailing the plight of stuck kids before he approved funds for more beds. And it's widely believed his proposed tax-cut ballot initiative would gut existing human services. "Passing that tax cut would devastate the mental-health system," says Stoddard, who is also president of the Massachusetts Psychiatric Society.

Spurred on by an uncertain political climate, the psychiatric society's task force has reached out to state legislators such as Representative Kevin Fitzgerald (D-Mission Hill), who heads a caucus on children's issues. Fitzgerald says that his assembly, as well as a mental-health caucus led by Representative Kay Khan (D-Newton), plans to gather information and examine the situation in hopes of proposing how to manage the system better. "These problems aren't going away," he says, "and I'm committed to waking up other legislators."

This type of commitment is what's required for ultimate success. Problems in children's mental-health care have persisted in part because no one has managed to keep them in the spotlight and thus force the public to recognize the issue. Sudders, who has neither a timeline nor a price tag for long-term solutions, explains, "To have change, you first need an organized and broad-based coalition."

Which is exactly why those in mental health welcome the latest developments among doctors. There's no question that the pediatric push represents a step toward a unified voice, one that may be more effective at galvanizing the community at large. As a lobby, pediatricians have influenced policy; most recently, they pressed for medical services to be funded by the state tobacco tax and for new vaccinations. Lauren Smith, who directs inpatient pediatric services at BMC, says, "We tend to be able to get people's ears and to give credibility to issues."

Now that they've enlisted in the battle to restore mental-health services to the state's most vulnerable children, they could be the very thing needed to help capture public attention and thus effect change.

After all, as one state official, says, "Until people outside of the mental-health community stand up and say, `This is not acceptable,' things will probably stay the same."

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Kristen Lombardi can be reached at klombardi[a]phx.com.