The home, the only one in the state that provides months of intense, residential behavioral health care for children 6 to 12, is unique, and endangered.
Run by Cutchins Programs for Children and Families, a Northampton–based nonprofit, Three Rivers, which can house up to 12 children at a time, is funded by the state’s Department of Mental Health. It’s among an array of mental health services on the chopping block in Governor Maura Healey’s budget proposal for the coming fiscal year.
A proposed 7 percent increase in the department’s budget won’t be enough to cover the cost of growing demand for services, higher payroll costs, and rate increases for providers without accompanying cuts, state officials said.
“It’s hard to believe that 7 percent over last year’s budget can’t cover everything that we do today, but it can’t,” said Brooke Doyle, the department’s commissioner, at a hearing Monday before the Legislature’s Joint Committee on Ways and Means.
Other potential casualties of DMH service cuts include two residential care programs for adolescents with private rooms that give transgender clients added safety, community-based mental health services for youth and their families, and half the agency’s case managers, who coordinate care for roughly 7,000 people statewide, according to SEIU Local 509, which represents the workers.
Derick Jenkins, a case manager in Lynn, described the job as “the backbone of mental health services” in Massachusetts.
Demand for services, and the acuity of need, are straining the state’s ability to provide mental health care, state officials said Monday. Over the past year, DMH served about 29,000 people, including 4,100 youth. Meanwhile, state decision makers face the threat of massive reductions in federal Medicaid spending that could prompt cuts far deeper than those proposed for DMH. The Healey administration has made clear the state can’t compensate for a huge loss in federal money.
DMH’s proposed budget prioritizes its consistently overcrowded psychiatric hospitals and increases to payroll and provider rates, said Doyle. Healey set DMH’s budget for the next fiscal year at almost $1.28 billion, up $82.7 million from the current year.
“That is the kind of Faustian choice here,” said Danna Mauch, chief executive of the Massachusetts Association for Mental Health, an organization that advocates for mental health access. “We have a workforce crisis so we absolutely need to attend to the rate increases for contracted services. At the same time we have a lot of unmet need.”
The Legislature will vote on a final budget proposal in the coming weeks.
A 2023 state mental health survey found almost half of adolescents and nearly a third of adults in Massachusetts reported psychological distress. People in mental health crisis with nowhere else to go are also a driver of hospital overcrowding statewide, health experts have said. As of the last week of March, hospitals participating in a Massachusetts Health and Hospital Association weekly tracker reported 50 children were languishing in hospitals while waiting for a bed with a behavioral health provider. That’s down from hundreds during the height of the pandemic.
Healey’s budget initially included a proposal to close Pocasset Mental Health Center, one of two adult residential mental health programs on Cape Cod, but that plan was paused and will be reviewed after an outcry from its patients and caregivers.
On Friday, 83 percent of DMH’s union members supported a vote of no confidence against Doyle because of the budget proposal. The administration issued a statement Monday expressing confidence in her.
Two years ago, Massachusetts announced a Roadmap for Behavioral Health Care Reform, including a help line and health centers to make it easier and faster for people in need to get mental health care. The state’s budget woes, a result of tax revenues that aren’t keeping pace with costs, could eliminate continuing clinical and residential care options for some patients once they’re past an acute crisis, Mauch said.
Belt tightening is needed, said Senator John Velis, a Westfield Democrat and cochair of the joint committee on mental health, substance use, and recovery, “but my position is, not on the back of kids and their behavioral health concerns.”
DMH’s case managers coordinate services, including psychiatric and therapeutic support, housing, social service programs, and medical care, for people whose mental health challenges complicate their ability to remain well in their communities. For some clients, that support may mean the difference between independent living and hospitalization, a stay in a psychiatric facility, or even death.
Kelsey Foley, another Lynn case manager, works exclusively with children ages 10 to 22 and their families. In some cases, she said, she’s watched teens who couldn’t manage public high school recover and eventually attend a vocational school or college.
Case manager cuts are expected to save about $12 million.
The reduction would change how DMH delivers case management, Doyle said. Some people would still receive support from a single case manager, but others could be handled through a team approach. Other possible changes include open office hours and proactive outreach.
Underutilization is driving cuts to the youth residential programs, Doyle said. An emphasis on early intervention, improved home services for kids, parents’ reluctance to send their children to Western Massachusetts, and persistent workforce shortages that leave the homes unable to staff all their available beds contribute to high vacancy rates, Doyle said.
The programs collectively cost DMH more than $15 million and have, at times, been just half full.
“That makes it not sustainable to continue to pay for 50 percent utilization,” Doyle said.
The two program executives said their censuses have steadily increased recently, and there is unmet demand for the intensive care they offer. Doctors often don’t know the programs exist, and don’t refer patients who would benefit, or are stymied by DMH’s complicated, often months-long referral process.
In a state with so few options for children’s mental health care, the programs should be made easier to access, not eliminated, said Tina Champagne, Cutchins’ chief executive.
Molnar, Tay’s mother, works in special ed, but until her child was referred to Three Rivers this year, she didn’t know the service existed.
“We should have been pointed in that direction a year to a year and a half earlier,” she said.
Tay still has a long journey ahead, Molnar said. But they are making friends at Three Rivers, and its staff has been remarkably effective at heading off mood swings.
“We’re just so glad,” Molnar said. “We finally found the right place where people are listening to us.”
Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.
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