Missouri psychiatric treatment center for youth closing under state budget woes

July 11--In seventh grade, she dealt with being bullied at school by secretly cutting her body.

"I thought, 'This is what the bullies do to me, why don't I do it to myself?'" said Sarah Boyer, now 17. She spoke last weekend while on leave from the state-run Cottonwood Residential Treatment Center in Cape Girardeau, Mo., where she has been getting psychiatric treatment since March.

Last month she and others at Cottonwood got the news that the youth psychiatric facility will close because of state budget cuts.

Those who track the mental health care industry in Missouri said the closure of the state facility is yet another blow for the mentally ill in Missouri, who are being squeezed out of critical services.

Boyer says Cottonwood needs to be saved so it can save kids like her.

Her descent into mental illness happened rapidly. At first, Boyer said, the cutting relaxed her. Then she began cutting deeper. That scared her. It made her realize that killing herself could be easy. Yet she kept it a secret. It led to clinical depression and thoughts of suicide.

In eighth grade, she let the truth slip. When her parents intervened, she became violent. Her mother, Donna Boyer, said she feared she would have to give up her daughter to the state because she could not control her. Or that her daughter might end up in a juvenile detention facility after harming someone else.

"We were in a horrible, vicious circle," Donna Boyer said. "We could not keep her at home and keep her safe and keep us safe."

Now, after more than a dozen emergency hospitalizations and three unsuccessful stays at private treatment programs in St. Louis and St. James, Sarah Boyer said she has been properly diagnosed and is improving. She credits long-term treatment at Cottonwood. Her goal is to be released in time to attend summer band camp.

Cottonwood is one of just two facilities in Missouri where mental health treatment for kids is offered on a long-term basis, regardless of ability to pay. According to state officials, most mental health inpatient programs in Missouri average 30 to 90 days. In many cases, private insurance pays for short-term stays. In contrast, the average stay at Cottonwood is six to nine months.

Budget cuts imposed by Gov. Jay Nixon would shutter the facility by year's end. Cottonwood staff was given the word on June 24; new admissions were immediately frozen.

The news came the same day Nixon struck parts of the 2015 state budget and froze $1.1 billion in spending because of a revenue shortfall of $300 million to $350 million. Cottonwood won't be resurrected even if revenue improves. That's because Missouri could lose another $300 million next year in sales tax revenue, because of tax breaks awarded by the Legislature. Nixon has said the state could have a budget shortfall of nearly $800 million in the 2015 fiscal year.

Keith Schafer, director of the Missouri Department of Mental Health, said the decision to close Cottonwood was purely economic. The 38-bed facility was among more than $34 million in budget cuts within the Department of Mental Health, which spends about 10 percent of Missouri's annual budget.

"We seem to be in an era where there is a general desire for reduced government influence and fewer government programs. And unfortunately Cottonwood is a victim of that new culture," Schafer said.

Other mental health programs cut include autism services, substance-abuse treatment for ex-cons and inpatient mental health crisis services for adults. Cottonwood's closure is expected to save $2.4 million annually.

Dave Dillon, a spokesman for the Missouri Hospital Association, said the pending closure marks the "worsening of a problem in Missouri that we've seen over the course of a decade if not longer."

The state's disinvestment in mental health services, and the Legislature's refusal to expand Medicaid to help support the private sector, has amounted to a mental health crisis in Missouri. There are not enough residential or acute treatment slots for children or adults, he said.

Therapist Jeanie Dale said Cottonwood is the facility of last resort for kids with major psychiatric disorders.

Prior to Cottonwood, Donna Boyer said her family traveled from Kennett to Wentzville from their home in the Cape Girardeau area to find psychiatric hospital care for her suicidal child. Once, after their insurance ran out at a St. James residential facility, the family was told to come pick up Sarah in an ice storm. The family drove her to St. Louis County to the one acute care hospital bed they could find.

Boyer said the savings in closing Cottonwood are minimal compared to what Missouri will pay when kids in dire need of psychiatric care are repeatedly turned away.

"Is it cheaper than putting them in jail for the rest of their lives?" she asked.

Juvenile officers from Southeastern Missouri circuit courts have signed a petition in favor of keeping the facility open.

"Eventually they are going to end up in adult prison because they didn't get the right mental health treatment as a child," said Tommy Campbell, the chief deputy juvenile officer for Dunklin County in the state's Bootheel.

Campbell said four kids in his court jurisdiction are at Cottonwood right now. Last year a kindergartner in his court needed treatment there, he said.

"I guess our state is now going to ask me to tell these parents who barely have money to go to the grocery store to find gas money to go, what, 150 miles to see their kid at another facility, if there even is one that will take them," Campbell said.

Cottonwood is one of two state-run children's mental health facilities. The other, the 16-bed Hawthorn Children's Psychiatric Hospital in Pagedale, will remain open. It is an acute care facility, though it does offer beds for longer-term treatment. Ideally, Hawthorn patients would step down to Cottonwood for further treatment before transitioning home.

Schafer said Hawthorn, about a two-hour drive from Cottonwood, could handle some of the kids who would have been admitted to Cottonwood. Additionally, the Department of Mental Health identified 56 facilities in Missouri, mostly nonprofit children's agencies and some private hospitals, that could provide 1,900 residential treatment slots for kids.

But several Cottonwood therapists said the Hawthorne facility constantly has a waiting list. Many of the other places cited by the state rely on insurance, which typically cuts off coverage after 30 days. Some of the facilities don't take all insurance. At least one facility appeared on paper to be a homeless shelter.

Schafer said his hands are tied. He is fully aware that mentally ill children in Missouri will have fewer options and shorter treatment stays at these facilities. And he said he understands what Cottonwood has meant to mentally ill children from rural southeastern Missouri.

"It means that they were closer to their families, and that's a distinct advantage in keeping the kids and the families connected," he said.

Nancy Cambria reports on child and family issues. Follow her on Twitter @nanecam.

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