On being financially responsible: An open letter to the Tennessee legislature

Dear legislator:

I am involved in several different ways with the mental health system in Tennessee, but I write this letter not as an advocate or member of any group, but as a private citizen.  Many of the people I know have mental health issues in their life or in the life or someone they love.  Most of the people I know are very concerned about what the coming legislative debate and decisions about the mental health budget will mean for them and their loved ones.  It is a concern I share.

There are many good and committed people in the Tennessee mental health system.  This includes both providers and consumers.  People are trying hard to impact the lives of those in need in a positive fashion.  But despite their best efforts the system is, I and many others believe, on life support.  It is fragmented and inadequate to meet the needs of many of those most needing of its services.  Mental illness, according to some studies, affects as many as 1 in 4 adults during their lifetime.  Most of these people know and impact the lives of many others.  The health of our mental health system radically effects the quality of life of literally thousands and thousands of Tennesseans.

Over the last 4 years something over $40,000,000  in permanent funding has been cut in funding for mental health programs that before the cuts was skeletal in many parts of the state.  Plans I recently heard indicate that as much as $5,000,000 in permanent funding may be eliminated in the next budget.  Against this efforts by advocates, consumers, providers and many of you have helped to restore about $31,000,000 in one time funding to lessen the consequences of these cuts.  Many of the most valuable services offered by the department, services that are instrumental to keeping people out the hospital, out of jail, and out of the streets are included in these one time funds.

More and more of the mental health system has to be reinvented each year.  The system is becoming more unstable and eventually it seems inevitable it must fall.  No business of any size can exist not knowing if the next year it has to be reinvented.  The one time funds have saved lives, but as a way of doing business they plant the seeds of  the further impoverishment of an already impoverished system.  It is time to make a commitment, not just to  mental health, but a continued commitment to mental health that gives us a solid foundation to build on and improve the system.

I am asking you to be financially responsible.  This is much more than a debate about the cost of any specific services.  It is as much a discussion about the cost of the consequences of mental illness.  You have a choice about the services you fund.  You do not have a choice about the consequences that must be faced.  Not to understand this is not to be realistic and not to be responsible.  Often in trying to save money on services, the cost of consequences are passed on to local communities who dont have a prayer of being successful.

The equation is not simply a matter of what you decide to do costs.  It is equally and even more importantly a matter of what you decide to not do costs.  More people fall through the cracks when there are more cracks.  It is that simple and that complicated.

The disasters of mental illness have been catalogued many times.  In Tennessee more people die from suicide than homicide and car accidents combined.  Our jails are becoming our biggest mental health centers.  Services for children are inadequate and we are helping to create a population who will be tortured by mental illness their entire adult lives.  The financial effects on business are massive.  I dont know how you even put a number on the widespread misery and suffering all this entails.

We can help people with mentally illness.  I have seen it in my own personal life and in the lives of many others.  I have also seen what happens when we dont.

I am not asking you to be wasteful or extravagent.  I am asking you to apply a new measure of  responsiblity that looks at the real costs.  Life is more than the short term financial bottom line.  What we do right now drastically effects the future we create.  It is time for all of us to get our head out of the sand and take a realistic look at where we are going and take positive and responsible steps to create the future all of us want for ourselves and our children.

Fund the mental health system on a permanent, recurring basis.  Every year in January begins a new “mental health season”  as we many people fight to preserve the services and help they need.  Please make this the last “mental health season.”

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8 thoughts on “On being financially responsible: An open letter to the Tennessee legislature”

  1. I agree with Larry’s post. The cuts to mental health care have been inhuman. As a member of Physicians for a National Health Program, we feel that “Health Care is a Human Right”. We are still working for meaningful and moral health care reform- check out our website at http://www.pnhp.org.
    Art Sutherland, MD
    TN Coordinator and National Board Member PNHP

  2. I see many mental health service providers doing a lot of good work with the limited funding available to them. I also see some service providers who are not delivering but still billing and dragging the present system down. Expensive anti-psychotics that produce more side effects than good results are the standard. Please address the cost and effectiveness of these over prescribed drugs. That’s where the money is being wasted the most. That wasted money could fill the gap that is the cracks that Larry Drain speaks of so often.

    1. I am sorry, but you misunderstand my point. The amount of services offered are simply inadequate both in number and scope. Attempts to further deplete an already skeletal budget can only lead to catastrophe for people who have no other resources to fall back on. You say, “I also see some service providers who are not delivering but still billing and dragging the present system down.” I assume you are trying to say that mental health funding is being wasted on medication and that is a major part of the problem in Tennessee. That is not an accurate assumption. Like you I have considerable doubts about the unquestioned use of psychotropic medication, but other than the medication costs of the behavioral health safety net no department of mental health funding is used to purchase medication. Medication is payed for by insurance companies and what they spend does not affect what the department of mental health spends. It is two very separate piles of money. Medication does not affect the amount of money spent on peer support centers, on crisis stabilization units, on intensive A&D outpatient treatment or any of the other programs that are funded by the $31,000,000 in temporary funding that are fighting for survival this year. That is a decision made by legislators who ignore the costs of the consequences of mental illness. That is the real point of my post. Prescription costs cannot fill the gaps. It simply doesnt work that way. You also make the remark “….Expensive anti-psychotics that produce more side effects than good results are the standard.” That is your opinion, but it is one not shared by many based on their own personal experience. I know, and I think you know also, many, many people who would in all likelihood not made it without medication. I share many of the doubts you have and have seen many of the same articles and studies that you have read, but the personal experience of many of the people I know contradict those studies. Many people I know would regard your statement as a vast overgeneralization. I dont think it is a simple black and white thing. But back to the original point. Being realistic about mental health means treating the costs of the consequences of mental illness as important and basic as the costs of mental health services. We dont do that. Until we do we will always being telling those with mental illness they cost too much and we dont have enough money to help them.

  3. I apologize if I spoke in too general of terms. I guess my observations from 35 years of treatment by the Department of Mental Health you refer to, Tennessee’s, has left more than a bad taste in my mouth. The services I received up until I …took control of my illness have been dismal at best. They have been inadequate. If it weren’t for Medicaid money which is not TDMH money, I would not be here.Medicaid, not TDMH funds pay for Psycho-tropic medication management plus minimal psycho therapy. Medicaid money, not TDMH funds pay for my 1 hour per month therapy sessions.Federal Block Grant dollars, not TDMH funds, pay for Behavioral Health Safety Net and Peer Support Center funding according to the year n question, not TDMH funds.

    I say that the present delivery of services as pertains to the TDMH need to be examined and fine tuned. Not just give them money to carry on with what everyone agrees is a failing system of care.If it weren’t for the things that I do for myself to better my outcome, my quality of life wouldn’t be 20% of what it is.

    I say fully fund all aspects of Crisis Services, the Behavioral Health Safety Net and the Peer Support Centers. The rest of the TDMH programs and expenditures need to be gone over “line by line” and decisions made by our new Commissioner of Mental health, Doug Varney, to determine weather they need more or less funding.

    If it’s not a “Value” and producing the proper “Results” or as the Department says, “outcomes”, back off those areas. Increase the areas we know produce good outcomes. Peer Centers, BHSN and Crisis. We need transformation and growth, not more of the same failing and inadequate system.

  4. The TDMH talks “Consumer input and consumer directed services” out of one side of their mouth and out of the other side they “didn’t even get 1 single comment from the whole State of Tennessee concerning their distribution of over $8,000,000 in Community Block Grant Funding this year. To say there needs to be improvement and not just toss them the same funds without changes seems to be realistic.

  5. In response to Larry’s comment of:”The salaries of all the people who you mention are TDMH funded. The mental health centers you mentioned would not exist without TDMH funding. Block grants are one stream of funding for the TDMH. Peer support centers for example are parti…ally payed for by both block grant funding and state funding. The block grant does not exist apart from TDMH and my guess is that very few programs receive total funding from the block grant. It is $8,000,000. The rest of the 140-150 million dollars in funding does come from the department. Most of those programs are inadequately funded. Trying to judge their “value and results” on that basis is like trying to judge how well a car goes 150 miles with no gas in the tank.

    The department actually has multiple smaller demonstration programs throughout the state they have been unable to generalize throughout the state because they have no funding. You say fund the crisis centers, the peer support centers and behavioral health safety net. I agree but none of these have any meaning without the rest of the system.

    Where I live it is impossible to judge much about the value of anything because by and large there is nothing. What programs would you like to see canned. I am not really sure about that. I think all programs are already judged by their results. The department will tell you they are consistently eliminating contracts to providers who dont show results. I know that for a fact from my experience. And anything that survives has to be able to prove results.

    You may not agree with all programs. I certainly dont. I also think peer support and other things should get a lot higher billing. But my opinion about anything doesnt make it so. It makes it my opinion. The system is inadequate because it doesnt have enough services and enough different kinds of services particularly in some parts of the state.By the way as part of the budget process I believe everything is already gone over line by line.”

    I SAY:I agree the DMH needs funds to operate on. BUT, I want to hear about improvements and transforming the current system of care from this, as you yourself have called it, “A failed system”. The TDMHDD just rocked along during the years of ple…nty and now that times are hard they aren’t prepared to make do just like everyone else with less resources. Maybe the DMH should take a WRAP course and develop an action plan for times like these. We were in a mess this year with the present funding. So with the same funding for next year, which is what I hear you and others asking for, we’ll spend another year in a mess with the same “failing system of care”.
    I believe my time is better spent asking for “Change”. There’s a novel idea. Where have I heard that word lately?
    The Democrats have run the show in Tennessee for the past 8 years and now they want business as usual in the DMH for the next year and I say, “I don’t think so.”
    We need change. We need more peer delivered services that are “cost effective” and produce “real results”.
    And like it or not, the medications are the elephant in the room.
    Respectfully,
    Dennis

  6. You said, “By the way as part of the budget process I believe everything is already gone over line by line.” I keep hearing 6% “across the board cuts.” that doesn’t sound like line by line decisions. The Democrats for 8 years have sat in Nashville while the state of Tennessee had over $1,000,000,000 (1 Billion Dollars) in reserve, and let people die. Let services be minimal. Let the same ol same ol go on year to year. I don’t understand how someone could be satisfied with another year of this failed system. I see how state employees can be satisfied with it. I see how people it doesn’t effect can be satisfied with it, but I don’t see how advocates can be satisfied with it.

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