Mental hell

Poor wages and working conditions have
Massachusetts mental-health workers up in arms. Will politicians deliver the cash to fix the system?

by Kristen Lombardi

Mental illness has never registered much on the political radar screen -- until now. Things started changing when Tipper Gore, wife of Democratic presidential hopeful Al Gore, revealed just over a year ago that she'd been treated for depression. Then, at a Rhode Island mental-health forum, US Representative Patrick Kennedy made it known he, too, had battled depression severe enough to require medication.

At last week's Democratic National Convention in Los Angeles, mental health crept into the spotlight once again. In his convention address Monday, President Clinton praised Mrs. Gore for her tireless efforts at "bringing the cause of mental health into the broad sunlight of our national life." Gore followed suit in his own speech, pledging to "end the stigma of mental illness . . . everywhere in the nation."

However noble the vow, Gore has a long, tough haul ahead.

The Massachusetts mental-health system is a case study in how difficult it is to change things for the better without massive infusions of cash. Nearly a decade ago, then-governor William Weld pushed through a plan for partial privatization of the state's mental-health services in an effort both to cut costs and to strengthen the system. Today, poor wages and working conditions have sparked unparalleled unrest among affected mental-health professionals -- particularly among those employed by private agencies that contract with the state. Last September, 70 social workers and clinicians at the North Suffolk Mental Health Association in Chelsea walked off the job. The reason: the clinic would not grant raises of two to four percent or guarantee to keep outpatient programs open. The two-week strike ended when the agency agreed not to slash services for six months.

In November, 250 workers at Worcester-based Community Healthlink went on strike because of a plan to cut employer contributions to health benefits by 25 percent. The action ended abruptly when the agency disclosed a fiscal crisis that threatened services for 18,000 AIDS, mental-health, and substance-abuse clients.

And just this month, 40 social workers and clinicians at the Family Services Association of Greater Boston (FSGB) in Jamaica Plain have taken steps toward another strike. If contract negotiations unravel, workers (represented by the Service Employees International Union Local 285) are set to halt work in September.

The strikes shed light on how the mental-health system in Massachusetts has failed those caring for the state's most vulnerable citizens. Workers, enduring pay cuts in the wake of privatization, continue to get squeezed. Privatized clinicians earn 17 to 40 percent less than their state-employed counterparts. Some juggle second and third jobs to supplement $20,000 salaries. Others do without pensions, health plans, and cost-of-living raises. The deteriorating conditions have forced workers to leave the field at rates as high as 70 percent. Qualified veterans are being driven away.

But the collapsing system hasn't hurt just workers. Clients, too, face a host of problems -- premature discharge, lack of access to programs, medication in lieu of therapy. The DMH wait list for basic services such as case management has hit 16,000, soaring from 13,000 over the past two years. As a result, advocates say, mentally ill residents wind up in jails, shelters, and on the streets.

People are starting to wonder if privatization isn't really a code for "no care." As Paul Ling, a vocal member of the reform group Advocates for Quality Care, puts it: "We've seen nothing but failure. Weld and Cellucci have backed away from the state's duty to care for mentally ill residents."

To Jeannine Henderson, an FSGB clinician, striking would have seemed unimaginable just a few years ago. Back then, she saw only her profession's reward: helping families trapped in cycles of violence, neglect, and abuse. Two years later, however, she's found herself feeding the bottom line rather than helping clients. "Work," she says, "comes down to what kind of money can be brought to the agency."

Page 1 | 2 | 3 | Next

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