To close a gaping budget hole, Gov. Pat Quinn of Illinois plans to close psychiatric institutions and slash Medicaid, resulting in the elimination of acute-care options for thousands of patients. While behavioral health advocates favor fewer psychiatric hospitalizations, they demand that all savings from the closures be reinvested into the community, as is required by law. Otherwise, they argue, the only alternative for many patients in crisis will be hospital emergency rooms and jails.
In Illinois, a 2006 statute, the Community Services Act, requires reinvestment into the community of money saved when psychiatric facilities are closed. But mental health advocates say the state is now flouting this law by its planned closures, and are suing to stop this from taking place.
Gov. Quinn wants to close two institutions, put patients into community-based systems, and cut those as well. And, to make the situation a perfect storm, the proposal would also cut $2.7 billion from Medicaid.
In all, the mental health cuts proposed by Gov. Quinn on Feb. 22 from FY 2012 to FY 2013 total $58.4 million or 40 percent. The Governor challenged the legislature to fix the budget problem, which was precipitated by the state’s pension liability, in time to sign the new budget in May.
The Governor’s proposal originated in January with announcement of his plan to “rebalance” the state’s approach to people with mental health conditions and developmental disabilities by transitioning people from institutions to community care. “My administration is committed to increasing community care options,” he said. “The approach we are taking will allow for the safe transition of care for some of our most vulnerable citizens to community care settings.”
The sticking point is that only some of the savings from closing the two hospitals would go back into the community. This violates the Community Services Act, and on top of the cuts, threatens to decimate mental health treatment in the state, advocates say.
The first hospital to be closed would be the 75-bed Tinley Park Mental Health Center, due to be shut down on June 30. The center’s budget is $20.1 million; the state would reinvest only $12.9 million, saving $8.1 million. The advocates want that money to be reinvested in the community.
“Our view is that the law requires them to spend all of the money,” said Mark Heyrman, a University of Chicago law school professor who sued the state in February on behalf of advocates. “The law says they have to spend the whole 20 million, and then they have to come up with a written plan and consult with advocacy groups.”
The plaintiffs in Heyrman’s lawsuit are Mental Health America of Illinois, the National Alliance of Mental Illness of Illinois, and Lisa Gardiola, a patient formerly hospitalized at Tinely Park who would require readmission in the event of a relapse. The lawsuit was filed in the Circuit Court of Cook County in Illinois.
Heyrman, who is on the public policy committee of Mental Health America, says that if Tinley Park or other programs are closed, the people served there need to be treated elsewhere.
The plaintiffs are seeking to require the state to maintain and operate Tinley Park and restore the bed capacity until the state develops a plan, and shares the plan with advocates, to redirect any saved money into the community.
“Our lawsuit is designed to prevent the state from closing state psychiatric institutions and not substituting appropriate services in the community,” said Heyrman. He explains that the Community Services Act unintentionally had the effect of preventing closures. After its passage, the state stopped closing psychiatric hospitals because there was no longer any incentive to close them just to save money—at least until it got into fiscal trouble.
“The state’s past and present desire to close hospitals is not based on any clinical views about the value of community integration—it was and is driven by the desire to save money,” he said. “Since that law was passed, they can’t do that.”
In addition to Tinley Park, Singer Mental Health Center (Rockford, Ill.), with an annual budget of $14 million, is set for closure. Finally, the state is proposing to eliminate all funding for psychotropic medications for patients not on Medicaid. These medications make it possible for many people with mental illness to live in the community.
According to Frank Anselmo, chief executive officer of the Community Behavioral Healthcare Association of Illinois (CBHA), who testified before the state senate appropriations committee March 21, the budget proposal “demonstrates a disconnect” between the administration’s stated goal, which is to move people from institutions to community care and treatment, and the funding for that goal.
The reasoning behind this lawsuit is different from that of Olmstead, the 1999 Supreme Court decision which said that people can’t be put in an institution if they could be treated in the community at no extra cost.
“My suit is not an Olmstead claim,” Heyrman explained. “There is no violation under Olmstead in closing a state hospital and throwing all the patients into Lake Michigan.” Olmstead doesn’t require the state to provide any services; it says services to people with disabilities can’t be conditioned on their being in an institution, when at no greater cost they could obtain the same service in the community, said Heyrman.
The downsizing has already begun: Tinley Park housed 71 patients in January 2011, and 43 in October, according to Heyrman’s lawsuit, which notes the state has saved money already by reducing the occupied beds.