With deep cuts to her department proposed in the Minnesota House and Senate Omnibus bills standing in sharp contrast [PDF] to Governor Mark Dayton’s budget proposal, Piper’s been sounding the alarm about how multimillion-dollar reductions could affect mental health care in the state.
“We should start from a position of, ‘How do we make government work for people who need our help?’ ” Piper said. “The governor comes from that perspective in his budget. But now we’re faced with legislation that that doesn’t make an investment in mental health care and further cuts our programs and services. This is incredibly frustrating to me at this point in the session.”
Gov. Mark Dayton’s budget proposal includes a $44.6 million operating adjustment for DHS in the coming biennium. This is money, Piper said, that is needed “just to ensure essential services and for DHS to maintain the staff it has.” The governor’s proposal also includes $22.8 million slated to boost staffing levels at Minnesota Security Hospital and $70.2 million in bonding to fund Phase 2 of the facilities upgrade at the hospital.
In contrast, the Legislature has no funding for an operating adjustment and a $19.7 million reduction in the DHS central office.
“We don’t understand the need or rationale in this level of divestment,” Piper said. “There is real money and gimmick money in these cuts. Some of the real money has clear impact on the direct care and treatment system that DHS operates. There are also potential impacts on the larger mental health system in Minnesota.”
Minnesota’s mental health system is already stretched thin, Piper said. She believes that further reductions could only harm the very people her department seeks to help.
But budget-cut proponents argue that the cuts are limited to DHS administrative staff, not direct mental health care services.
“I don’t think one less person with mental health issues will be served under my bill than are already served now,” said Sen. Jim Abeler, R-Anoka, Human Services Reform Finance and Policy chair. “We did make some suggestions that state government could be leaned up a bit on the operations side. I don’t think we reduced the number of direct service people that will be there working with clients. We realize we need to keep that intact, but we do also think that the state could administer more efficiently.”
As the 2017 session works its way to a close, Piper and her allies are doing all they can to make the public aware of their concern that parts of the mental health care system that were funded at historic levels in 2015 and 2016 are now be at risk.
Piper looks at the situation with a cynical eye. Legislators behind the cut plans are “looking for funding to cut from all of the agencies so they can fund a big tax bill,” she said. “I don’t think it’s a broader issue about mental health care. I think they are trying to leverage the department as a negotiation chip in a way that does a disservice to the work we’re doing as an agency and the million-plus Minnesotans we are serving every year.”
‘Every program is still totally intact’
Abeler said he doesn’t resent Piper for going public with her concerns about his proposed budget cuts. After all, she’s just doing what she’s been hired to do.
“The commissioner’s job is to rattle the saber for the governor to help the negotiation process and build public perception that we’re ruining the world — and without their wonderful ideas everything will stop,” he said. “My job is to extract the most value out of the money we have to help the most people in the best way.”
Abeler insisted that the cuts, which were championed in large part by members of his party, largely focus on central office staff at DHS. Support for statewide mental health care in the 2015 and 2016 sessions was bipartisan, he added, and legislators haven’t forgotten that.
“We didn’t repeal anything that was created in 2015 or 2016,” he said. “Every program is still totally intact. I was careful. We are going to serve the same or greater number of people in the mental health system this year as we did last year.”
Sue Abderholden, executive director of NAMI-Minnesota, said that administrative staff cuts are more palatable to the public than cuts in direct service staff at state-run hospitals and mental health facilities.
“The central office and administration at DHS are taking the biggest hit,” she said. “Everybody understands why we need direct care staff, but people don’t always understand why we need so much staff in the front office.”
But, Abderholden added, administrative staff is essential. They help run — and distribute funds — to many key mental health programs. “Without them, many important things just don’t happen,” she said.
One step forward …?
Abeler said that the cuts are not a step backward for the Minnesota’s mental health system, but rather an attempt to streamline the way one of the state’s largest departments runs.
“If you analyze the budget target you’ll see that the emphasis in both the House and Senate has been on a heavy set of tax cuts and some retrenchment in the Human Services and state government environment and some modest investments in education and higher ed and judiciary and jobs,” he said. “We are not interested in cutting mental health services.”
Wendy Burt, vice president of communications and public relations for the Minnesota Hospital Association (MHA), said that member hospitals are concerned that cuts to DHS funding, no matter what form they take, could set progress back for Minnesotans with mental illness.
“There was really pretty significant investment in mental health in 2015 and 2016,” Burt said. “But that money wasn’t over-generous: It was really needed to make up for the disinvestment in mental health that had occurred over the last couple of decades in the state.”
In April, MHA sent a letter [PDF] to state legislators, encouraging them to continue their support of statewide mental health services. Cutting budgets could have a serious impact on key mental health support programs.
“In our communications to legislators we have urged them not to retreat from that investment because we’re trying to make up for a couple of decades of not investing in mental health at all,” Burt said. “We don’t want to lose ground.”
Hiring lag time
While mental health advocates don’t want to see deep cuts to DHS budgets, some have expressed concerns that the department hasn’t moved quickly enough to fill staff positions at the statewide network of short-term acute psychiatric hospitals, known as community behavioral health hospitals (CBHH). These programs were a major funding priority in the 2015 and 2016 legislative sessions.
“Some CBHHs are still at 63-64 percent of census for staffing and beds,” Abderholden said. “We are trying to figure out what’s going on here. We want to understand why it has taken DHS so long to spend the money they were given and fill those positions. They got all this money last year, and at Anoka at least, according to the latest public data [PDF], staffing has gone down.”
The need for more staff at state-run mental health facilities was a theme in prior sessions; legislators supported that concern with funding. But it has taken time to fill the needed positions, despite job fairs and hiring campaigns.
Abderholden asks why it has taken the department so long to make the needed hires. “I don’t think they’ll use up all the money that was appropriated from last year,” she said. “The staffing has taken more time than we were told it would. We don’t want to see us go backward, that’s for sure.”
Piper said Abderholden’s criticisms of CBHH hiring rates are to be expected.
“Sue’s been a long-time critic of state-operated services, so it’s not surprising that she would criticize our hiring practices,” she said. “We have about 200 of the 240 positions filed now, but I will admit that we have had a difficult time. It’s been a slower recruitment process than we anticipated.”
Mental health workforce shortages combined with challenging working conditions have made hiring at state-run facilities tougher than anticipated, Burt said.
“There are significant mental health professional workforce shortages. It takes time to ramp up and hire folks for those positions. These are hard jobs to fill. To cut back when we are trying to solve a systemic shortage of mental health care in the state just doesn’t make sense. It is not the time to cut those budgets.”
Adam Rees, president of Duluth-based Essentia Health System’s Central region, explained that the sluggish ramp-up in filling these positions is understandable. “Once you actually get the funding, it takes a good year plus to fill positions,” he said.
Over the last few months, things have begun to look up on the hiring front in his region. Recently, Rees visited the CBHH in Baxter.
“In 2015 the State Legislature approved funding to increase their staffing levels up to 16 beds,” he said. “We recently achieved that. I was invited to visit them and hear the good news about that increase. I said, ‘I applaud you for that achievement, but it is still a drop in the bucket.’ Our state’s mental health system is in crisis, and this is no time to cut back.”
Abderholden cautioned that while it is still important to support the CBHH system, it is also important that the Legislature support other mental health services, including essential programs like supportive housing, mental health crisis teams, first-episode psychosis supports and assertive community treatment teams.
“It’s all important,” Abderholden said. “You could fully staff all of the CBHHs, but if that’s the only thing we’d do, we won’t have solved the problem. When we focus on this one issue, we are at risk of forgetting about the other things that are just as important.”
Piper has been concerned about the impact of budget cuts on her department since the House and Senate prepared their separate omnibus bills; since the bills have been through conference committee, she says the situation seems even worse.
“In some ways the conference report bill is more concerning than the two bills that they walked into conference with,” she said. “They’ve increased from the Senate position the cuts to Health and Human Services. They’ve also taken away some of the real cuts that they were going to make as part of meeting their target.”
If the conference report budget is approved, Piper said, DHS will “have to reduce our workforce by 300 or so.” And that impact will be larger than just the front office, she added: “About 210 of those cuts will be in direct care and treatment.” Two-thirds of DHS employees are involved in direct client care.
Other concerns Piper expressed included “no additional funding for Security Hospital,” and “no funding for our state sex offender program improvements. There are none of the investments that are needed to maintain or grow our mental health care footprint. There is no investment in group home funding.”
These reductions in investment are concerning because mental health care affects everyone, Burt said. That’s why her association has urged legislators to preserve existing funding levels.
“Mental health is a huge issue in every corner of the state,” she said. “It is rural and urban. It is small hospitals and large hospitals and health systems that are trying to work with a system that was band-aided for so many years.”
To rip the Band-Aids off now would be a dangerous decision, Rees insisted. “Even without the cuts, the situation is already bad,” he said. “We are facing a mental health crisis in Minnesota. We shouldn’t turn away when help is needed most.”