Mental hell, continued

by Kristen Lombardi

To meet funding requirements, for instance, Henderson and her FSGB colleagues must guarantee one "billable" session per client per week. That means formal therapy and treatment plans for four families. But people sometimes benefit more from practical help. Recently, Henderson visited a client who was suffering from depression. The woman's gas service had been shut off and she was fretting about paying the bill -- immediately -- so her kids could take a hot bath.

"At that moment," Henderson says, "the woman wasn't interested in counseling, but I needed billable hours." Still, rather than turn the experience into a therapy session, she connected her client to services that could help her.

Henderson expects client care to languish further if FSGB gets what it wants in the contract dispute. She and fellow workers are angered by the agency's plan to formalize "unrealistic" productivity standards -- such as the one-billable-session rule -- that could be used to fire staff. Not even the most industrious clinician satisfies the requirement, workers claim. FSGB also wants employees to work nights and weekends, effectively putting them on call at all times.

Workers are particularly upset about the agency's proposal to take back its most prized perk: the seniority raise. For 20 years, clinicians have enjoyed this annual salary increase and a normal cost-of-living increase. To eliminate it, workers charge, would drain the spirit from an already strained staff. Some intend to quit if FSGB carries out its plan. As SEIU Local 285 representative Brian Wilder says, "The seniority raise is a promise at rainbow's end. To terminate it mid-stream is almost fraudulent."

The clash at FSGB is hardly isolated. Concerns about pay, job security, and client care have become focal points for mental-health professionals across the state. In addition to last fall's strikes, 300 workers at the Malden-based Tri-City Community Health Center were set to walk off their jobs in December. Negotiators managed to reach agreement shortly before deadline.

"Managers are feeling squeezed," says Michael Ripple of the Massachusetts Council of Human Service Providers, which represents 280 mental-health and mental-retardation clinics. "We're in a boom economy," he adds, "but the rising tide isn't lifting all ships."

Economically squeezed agencies are squeezing their workers in turn. Some clinics are slashing pay, benefits, and services. Even healthier clinics aren't immune to the low wages (less than $9 an hour) and high turnover rates (up to 66 percent) that characterize the field.

Richard Sherman of the National Social Workers Association says privatization could be successful if necessary resources existed. But, he notes, "commitment isn't there monetarily to match the philosophy." Mental-health spending has declined steadily as a portion of the state budget since 1990. According to the Massachusetts Taxpayer Foundation, the DMH accounted for four percent of the state budget in fiscal 1990, yet only three percent in fiscal 1999. Last year, mental-health programs grew eight percent while appropriations for human services, including the DMH, rose only 6.7 percent. Today, Massachusetts boasts the second-highest income per capita in New England; it ranks fourth in mental-health expenditures.

Every year, the call gets louder to fix the state's collapsing mental-health system. SEIU Locals 285 and 509 (which represent 2200 human-service workers at 200 clinics statewide) have joined forces with provider- and patient-advocacy groups to pressure the state legislature for change -- specifically, to boost reimbursement rates and agency contracts. Rallies have been staged, calls placed, letters written.

The unions have been most vocal in urging legislators to pay privatized outpatient clinicians from the salary-reserve fund, which was created to raise incomes of state human-services workers. For years, they've persuaded the legislature to allocate millions of dollars toward pay increases for workers who care for the mentally ill and retarded -- only to watch Governor Cellucci ax the funds. Last year, the governor partially vetoed the $28 million set aside for workers' salaries; the $6.5 million he cut was restored in an override.

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