EDITORIAL: Restore money for case management of mental illness

Feb. 16--Tennessee Gov. Bill Haslam and other politicians almost inevitably will say they are required to make the "tough decisions" at budget time. Unfortunately, sometimes they make the wrong decisions.

There is much good in the $33.3 billion spending plan Haslam presented to the Legislature last week, particularly regarding education, but he made a significant error by cutting case management services for some of the state's citizens with severe mental illnesses. The move amounts to breaking a promise to fill the treatment gap created when Lakeshore Regional Mental Health Institute closed in 2012.

Haslam should root through the budget for more funds in a less critical area. If he does not, the Legislature needs to step in to restore the funding.

In the governor's proposed 2015-2016 budget, the Bureau of TennCare would curtail Level 2 case management services. Level 2 case managers serve adults with chronic mental illnesses who are living in the community, not in institutions, but need help getting services and staying stable.

Level 2 services would be limited to three months after a "crisis," such as a stay at a psychiatric facility. After three months, the patient's managed-care organization would assess the patient to see if more case management is necessary. As many as 50,000 adults with serious and persistent mental illness receive Level 2 case management, advocates say. TennCare estimates enough clients will no longer qualify that the state will save $30 million.

"It's like having a patient with a bad kidney and saying, 'OK, we're going to pay for dialysis, but only for a few months,'" Helen Ross McNabb CEO Jerry Vagnier observed. "Nobody in their right mind would say that's a good course of medical treatment."

Before 2012, many of those adults receiving Level 2 services would have gone to Lakeshore. When Lakeshore closed, Commissioner of Mental Health Douglas Varney said the savings would remain in the area to pay for treatment at private facilities and for case management services. "This isn't about saving money but serving more people," Varney told Knox County officials when briefing them about the possible closure in December 2011.

This year's proposal would serve fewer people and shift costs, not save them.

People receiving case management services typically have been diagnosed with paranoid schizophrenia, bipolar disorder and other serious mental illnesses. According to the National Institute of Mental Health, such patients who receive case management services are more likely to keep taking the medications that allow them to cope with their conditions. The risk of patients being in accidents, becoming homeless or turning violent will be much greater if they stop taking their medications. They will be much more likely to end up in a hospital emergency room or jail, where the costs of treatment are much higher.

Crafting a budget is about setting priorities, and at the top of the list should be the health and safety of Tennesseans. The state of Tennessee needs to honor the commitment to its citizens with mental illnesses and restore funding for these life-saving services.

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