OP-ED: Illinois Budget Impasse Impact: A Behavioral Healthcare Autopsy Report

OP-ED: Unlike the warnings two years ago directed at Illinois lawmakers about human services program closures and employee layoffs at the beginning of the Illinois budget impasse, now the warnings have ended.

They have been replaced by autopsy reports.

Since the budget stalemate began, more than 1 million Illinois residents have lost access to critical human services. 1 million.

More specifically, regarding behavioral healthcare, 80,000 people in Illinois have lost access to needed mental health services and more than 24,000 fewer residents have been admitted to addiction treatment services.

In the past, governors from the executive branch and lawmakers from previous General Assemblies had determined critical human services were best delivered at the local level by the private sector as Illinois moved away from expensive state-operated institutional models to community level care.  As those decisions were made, policy makers turned to our community providers and other human service provider organizations to carry out the policy of providing government services more effectively and efficiently. And the private sector delivered.

Yet, the executive branch and the legislative branch have walked away from community care providers who delivered their goals, evidenced by year-after-year of budget cuts and financial starvation of crucial behavioral health programs.

Currently, lawmakers and the governor are making impossible, no, absurd, demands: accept months or sometimes years-long wait for payments of services delivered. The wait has financially brutalized our agencies. We’ve exhausted our reserves. We’ve sapped our lines of credit.  We’ve drained our staff. Our employees, who are on the front line of providing care to those with substance abuse and mental health disorders, arrive at work each week wondering: is this the last day?

Have you the merest notion of how such uncertainty disables a workforce?

To heave insult on top of injury, providers and their staff often hear some lawmakers and policy makers in the executive branch refer to human services as a “drain” on the General Revenue Fund. A drain?

Well, let’s be clear: when your local human service agency lays of staff – staff who pay taxes, buy homes, cars, furniture, groceries, sodas, sandwiches, etc. from your districts’ local businesses – those businesses, local chambers of commerce, and lawmakers’ districts suffer.

As of last March 2016, more than 1,000 mental health and substance abuse clinicians alone had lost their jobs. That doesn’t include case workers or administrative staff. The number of job losses has only grown in the last 12 months as the impasse has grinded forward.

The budget crisis is both a human service crisis that strikes at vulnerable citizens of Illinois and it’s an economic crisis that undermines local business owners and lawmakers’ constituents and communities and local economies.

The budget standoff and its impact are ravaging communities across the state from those who receive care, their families, the agencies that provide the care, to the local businesses that earn their income from serving them.

Without the adoption of a FY 2018 budget, the autopsy report that community behavioral healthcare providers deliver next year will only be more gruesome.

Jessica Hayes, Vice President, Board of Directors, Illinois Association for Behavioral Healthcare

IL Mental Health, Addiction Treatment Advocates Want “Quick, Responsible” Budget Resolution

(Springfield, IL) – Illinois Association for Behavioral Health CEO Sara Moscato Howe today issued a statement calling on Governor Bruce Rauner and the four legislative leaders to act “quickly and responsibly” in order to produce a full Fiscal Year 2017 state budget.

“With the FY 2017 stop gap budget expiring at the end of December, the Illinois Association for Behavioral Health urges both the legislative leaders and the governor to approve quickly and responsibly a full-year state budget that reverses the budget cuts that have been imposed on mental health care and addiction prevention and treatment in recent years,” Howe said.

showe@ilabh.org

Top Advocates Launch 1st of 3 Illinois Mental Health Policy Forums on August 30

(Springfield, IL) – As Governor Bruce Rauner’s Administration embarks on a “transformation” of the state’s of health and human services programs, Illinois’ top behavioral health care advocates will roll out the first of three mental health policy forums at the end of August that will aim to help shape state policies.

The Community Behavioral Healthcare Association (CBHA), the Illinois Association of Rehabilitation Facilities (IARF), and the Illinois Association for Behavioral Health (IABH), in partnership with the Behavioral Health + Economics Network (BHECON) led by the National Council for Behavioral Health, will host the first of the series of behavioral health forums on August 30 in Normal.

“The state’s planned ‘transformation’ of Illinois’ health care system prioritizes behavioral health services, which promote overall health and lower health costs,” said IABH CEO Sara Moscato Howe. “The state’s effort will align with our behavioral health policy forums, forums that we expect will provide a platform to help shape’s the Administration’s policies going forward.”

The August 30 forum in Normal, “Illinois Behavioral Health Pre-Transformation: Where Are We Now and Where Are We Going?,” will provide a scan of the current system in Illinois. Presenters will discuss Illinois’ current system of care along with future considerations, such as:

  • Range of treatment options and care settings for individuals with acute, chronic and mild needs;
  • Specialized services available to children and adolescents;
  • Services for co-occurring mental health and addiction disorders;
  • Financing and payment reforms; and
  • Policy reforms that ensure individuals access to care at all stages, including prevention and early intervention.

Speakers from a diverse array of industries will also discuss creative approaches to integrating care, the impact and cost savings of a housing-first approach, how early intervention and prevention programs could be implemented across the state, and how available resources drive capacity, according to Howe.

“In Illinois, the burden of untreated mental health conditions and lack of access to substance use prevention and treatment falls on hospital emergency departments, jails, prisons, child welfare systems, schools, communities, and families,” said Howe. “That burden and the policy solutions will be the centerpiece of the forum series.”

This initial forum is expected to lead discussion towards fundamental questions:

  • What is our vision for a comprehensive, high-performing delivery system in Illinois?
  • Where are current gaps in care that create poor health outcomes and increase expenditures in the system?

The next planned forum in Normal will be on October 6.

“Throughout the three forums, participants will hear from experienced executives and clinicians from community clinics, state agency representatives, legislators, and educators,” said Howe. “They will share innovative approaches to address the continuum of care and share data from economic research on the impact of community-based care.”

The date of the third forum in Normal remains to be determined.

sara@ilabh.org

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Cash Reserves Exhausted, Hispanic Drug Treatment Agency Closure Looms

Illinois’ budget impasse is driving a suburban non-for-profit substance abuse treatment agency, which serves mostly Hispanic residents, to close all offices by July 1.

Without payment from the state on the $59,326 owed, the Elgin-based Latino Treatment Agency will begin to shut down two agency facilities by June 15 and the final office by July 1.

“Given the State’s inability to release the $59,326 owed to the Latino Treatment Agency from our state grant, we will be unable to provide services to our clients, mostly from the Hispanic community, if we do not receive these State funds by July 1,” said agency executive director Adriana Trino. “More than 160 clients will be terminated from services by July 1.”

Trino says that the agency, which has been in operation for more than 30-years, has cut salaries and exhausted bank lines of credit and cash reserves in order to maintain services to its 160 Hispanic clients spread through out Cook, DuPage, and Kane counties.

“We have cut our expenses; we have accumulated debt; and we have reduced salaries of every staff member,” Trino said. “We have exhausted cash reserves and our line of credit in order to remain afloat.”

The $59,326 owed to agency is on top of $60,690 cut from the group’s $273,008 budget by the Rauner Administration in August 2015.

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Op-Ed: Proposed Rauner Budget Fails to Meet Mental Health, Addiction Health Care Needs

OP-ED: Illinois has a staggering behavioral healthcare challenge and it needs a budget to meet that challenge.

Recent data from the federal Substance Abuse and Mental Health Services Administration underscores the need for a strong, well-funded community-based system of addiction and mental health services in Illinois.

Between 2010 and 2014, the behavioral healthcare challenges, such as depression, suicide risk, drug and/or alcohol abuse, for Illinois men, women, and children have mounted.

  • About 105,000 adolescents’ ages 12-17 report having at least one major depressive episode, while only 38% received treatment for their depression.
  • 355,000 adults 18 and over report ‘serious thoughts of suicide’; while ~363,000 qualified for a Serious Mental Illness (SMI) diagnosis.
  • Of the 1.53 million Illinois adults having ‘any mental illness’ (AMI) in the previous year, more than 55% did not receive mental health treatment.
  • Similarly, only 11.7% of the estimated 267,000 individuals 12 and older dependent on or abusing illicit drugs received treatment for their substance use disorder.

While behavioral problems and needs are clear, funding for addiction and mental illness prevention and treatment has been continually reduced by the Illinois General Assembly. In the past five years, the legislature has slashed state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%.

Meanwhile, an epidemic of heroin and non-medical use of prescription drugs has exploded across the state, forcing Illinois’ jails and correctional centers to become ill-equipped triage centers for individuals with mental illnesses and/or substance use disorders. Cook County Sheriff Tom Dart has repeatedly stated that the Cook County Jail is now the ‘largest mental health institution in the country’, and a majority of the individuals under his care are also there as a result of untreated addiction.

Over the past several years, Illinois has witnessed an expansion of mental health and addiction parity, the implementation of the Affordable Care Act, and a shift from state General Revenue Funds and Medicaid funding to a system of Managed Care funding, all of which has been implemented by providers in the trenches. At the same time, providers have borne uncompensated, additional expenses associated with implementation of Electronic Health Records and electronic billing. These changes have occurred while the legislature has almost annually imposed funding reductions on community providers, refused to raise historically low reimbursement rates, and left unresolved a Fiscal Year 2016 budget impasse that threatens to undermine our system of community-based care at its core.

While the staggering challenges to Illinois behavioral healthcare community providers continue to bear down, the policy prescription in the form of Governor Bruce Rauner’s proposed FY 2017 falls, let us say, short. In fact, the Governor’s budget proposal continues to move Illinois in the wrong direction, threatening to decimate the already-weakened safety net for Illinois’ most vulnerable citizens.

At a time when the need to prioritize state dollars for the maximum return on investment, reductions to the community behavioral health system are short-sighted and ill-conceived.

Data from national studies have concluded that addiction and mental health treatment not only produces measurable, positive outcomes, but also yields substantial savings to states. A 2014 actuarial study by Milliman found that $26-$48 billion could be saved nationally through effective integration of medical and behavioral services.

Additionally, several studies underscore the positive impact of addiction and mental health services:

  • A 2004 randomized trial studying employer costs found that ‘consistently-employed patients in an enhanced depression management program had 8.2% greater productivity and 28.4% less absenteeism over two years than employees receiving ‘usual care’.
  • The reduction in absenteeism and increase in productivity had an estimated annual value of $2,601 per full-time equivalent employee.
  • The state of Washington compared disabled Medicaid enrollees receiving SU treatment with the untreated population, finding that average monthly medical costs were $414 higher for those not receiving treatment, and with the cost of the treatment added in, there was a net cost offset of $252 per month or $3,024 per year. For individuals with opiate-addiction, cost offsets rose to $899 per month for those who remain in methadone treatment for at least one year.
  • The same study also found that prior to their SUD treatment expansion initiative, healthcare costs for Medicaid disabled clients with SUD problems were rising at a rate of 11% per year. Under the SUD treatment expansion initiative, the growth in healthcare costs was slowed to just 2.8% per year.

The solution is clear.

The Illinois General Assembly and the Governor must prioritize funding for addiction and mental illness prevention, treatment, and recovery support. Lawmakers and the Governor need to end the funding reduction cycle. Now. Instead, Lawmakers and the Governor need to close the gap between those needing behavioral healthcare and those receiving it. Lawmakers and the Governor need to invest in behavioral healthcare.

The governor’s proposed FY 2017 budget fails to do that.

The budget needs a do over.

Sara Moscato Howe, CEO, Illinois Alcoholism and Drug Dependence Association

showe@iadda.org

OP-ED: “Unbalanced Budget Response Act” Would Undermine Illinois Behavioral Healthcare

Eric_Foster_Hearing

Eric Foster, Vice President for Substance for Policy, Illinois Alcoholism and Drug Dependence Association

OP-ED: Illinois behavioral healthcare providers are faced with many daunting, financial problems uncertainties as they struggle to deliver quality mental health and addiction treatment services to fathers, mothers, and children in need.

The “Unbalanced Budget Response Act” would make their job worse.

First, since Fiscal Year 2009 through Fiscal Year 2015, Illinois eliminated state funding for addiction prevention, cut addiction treatment by 40% and mental health treatment by nearly 25%. In Fiscal Year 2016, Governor Bruce Rauner cut behavioral health providers by another 25%.

Second, over the past several years, behavioral healthcare providers have had to shoulder the vast implementation expansion requirements for the Parity of Mental Health and Substance Abuse Act, the implementation of the ACA, and the shift from state GRF/Medicaid to Medicaid Managed Care. Moreover, non-profit providers have had to absorb the additional expense associated with implementation of Electronic Health Records and electronic billing.

These herculean bureaucratic demands had to be implemented while simultaneously being hit by the legislature and governor with budget reductions in overall funding for services and no meaningful increase in reimbursement rates to actually cover the growing costs of doing business, such as implementing new mandates.

A recent report from the Illinois Partners for Human Services has found that stagnant reimbursement rates have had significant negative impact on the provider’s ability to cover basic operation costs. Low rates contribute to high employee turnover. Low rates blunt the expansion services to meet the growing needs of Illinois citizens. Low rates leave Illinois exposed to each new drug crisis.

The report also shows that in order to be current with cost of living, reimbursement rates for substance abuse treatment would need to increase by 27% and rates for community mental health services would need to increase by 16%.

Meanwhile, the “Unbalanced Budget Response Act”, Senate Bill 2789, would grant the governor the power to reduce rates unilaterally and without appeal. That authority to gut the last remaining financial life-line that has helped to keep Illinois’ limping behavioral healthcare system function would be an abrogation of the legislature’s own authority and of its own responsibility to the constituents to whom they serve.

Behavioral healthcare providers will be unable to sustain a service if they cannot cover the costs of rendering that service. Granting authority to arbitrarily reduce provider reimbursement rates would be a fatal blow to an already crumbling mental health and substance abuse treatment system.

The Illinois Alcoholism and Drug Dependence Association vigorously opposes this legislation.

Eric Foster, Vice President for Substance Abuse Policy, Illinois Alcoholism and Drug Dependence Association

Gov. Rauner Budget Cuts to Mental Health Jeopardize Jobs, Jails

Springfield resident Tim Mercier interviewed before he testified before the House Human Services Appropriations Committee on April 1 against Gov. Bruce Rauner's proposed budget cuts to Illinois mental health services, explaining how those services helped turn his life around.

Springfield resident Tim Mercier interviewed before he testified before the House Human Services Appropriations Committee on April 1 against Gov. Bruce Rauner’s proposed budget cuts to Illinois mental health services, explaining how those services helped turn his life around.

(Springfield, IL) – Governor Bruce Rauner’s proposed budget cuts to Illinois mental health care services would be a blow to job seekers and aggravate the burden on local and state law enforcement officials, says a top mental health advocate.

In Fiscal Year 2016, Rauner is aiming to slice $82 million out of the $459 million in state dollars for the Illinois Department of Human Service’s Division of Mental Health, a 18% cut, according to Illinois Alcoholism and Drug Dependence Association C.E.O Sara Moscato Howe.

“Governor Rauner’s budget would cut Illinois’ community mental health services budget for the seventh time in eight years,” said Howe. “After seven years of cuts, an 18% reduction will further shred the safety net, undermining individuals’ efforts to secure and maintain stable employment while continuing to convert Illinois prisons and county jails into mental health clinics with bars.”

Statewide, the Governor’s proposed budget cut would mean 7,473 individuals would lose access to mental health care, according to Illinois Alcoholism and Drug Dependence Association.

Funding for Illinois mental health care has been cut 32% by the legislature since fiscal year 2009.

Howe says that by further cutting mental health care funding even more Illinois residents will go without needed care. Of the 1.53 million Illinois adults having ‘any mental illness’ in the previous year, more than 57% did not receive mental health treatment, she noted.

Howe also warned that the reduction in funding for mental health care services treatment services would undermine employment opportunities.

“Cutting mental health care compromises a person’s opportunity to maintain a job or to be productive,” said Howe. “Any good, modern businessman knows that healthy employees are productive employees. It’s economics 101.”

Howe pointed out that a 2004 randomized trial studying employer costs found that consistently-employed patients in an enhanced depression management program had 8.2% greater productivity and 28.4% less absenteeism over two years than employees receiving ‘usual care’. Moreover, the reduction in absenteeism and increase in productivity had an estimated annual value of $2,601 per full-time equivalent employee.

Howe also said that youth in Illinois are at high risk for mental illness and suicide and more than a third are going untreated.

“Each year between 2009 and 2013, about 88,000 Illinois adolescents’ ages 12-17 report having at least one major depressive episode, while only 37% received treatment for their depression,” said Howe. “More disturbingly, Illinois has more youth, 12.4%, reporting a suicide attempt than a depressive episode, and given that the governor’s budget cuts $200,000 for teen suicide prevention, this problem only worsens.”

Meanwhile, Howe also spotlighted the alarm bells once again set off by Cook County Sheriff Tom Dart who said on April 7 in a media interview that jails are becoming “dumping grounds” for those struggling with mental illness.

“If for some reason people doubt what I’ve been saying about how the jails throughout the country — prisons as well — if they doubt that they have not become dumping grounds for the mentally ill, then I would suggest they come here,” said Dart. “They would see that the divisions for people without mental illnesses are either empty or half-filled. The ones for people with mental illness are filled to capacity, and the areas where we have the most acutely mentally ill people are always over capacity.”

Dart estimates that roughly 30 percent of the 9,000 inmates at the Cook County jail have some form of mental illness.

The sheriff is also warning that the $82 million budget cut to state mental health service proposed by Governor Bruce Rauner will only aggravate the problem.

“I don’t know how the system could sustain that. I mean, the providers that I deal with, the people that I hand folks off to who leave the jail, with the notion that we put a plan together for them to have them leave here and to have a support network in the community so they don’t come back,” said Dart. “Those providers, I don’t know how they’re going to be able to survive. They don’t have any money.”

Operation Snowball Naperville Walk Spotlights Drug Prevention

(Naperville, IL) – Operation Snowball, an award-winning leadership program empowering youth to lead drug-free lives, is holding a celebration walk in Naperville on Saturday, October 4.

“By participating and supporting the walk, participants will be raising awareness and showing support for alcohol and drug prevention in their communities and a commitment to help Illinois youth choose to live a healthy lifestyle,” said program director Mary Jo Davies.

According to the 2012 Illinois Youth Survey, binge drinking rose among 12th graders, Davie noted. The prevalence of binge drinking among high school seniors was 30.5% in 2012 compared to 23.4% in 2010.

Additionally, Davies said that the study revealed that more 10th grade youth are driving after using marijuana or other illegal drugs. Compared to 10th grade youth in 2010, more 10th graders in 2012 report driving a car after using marijuana or other illegal drugs during the past year (8.5% in 2010 vs. 10.9% in 2012).

“Operation Snowball, Inc., with more than 70 community and school-based Snowball chapters across the country, is a substance abuse prevention program focusing on leadership development empowering youth to lead healthy drug-free lives,” Davies stated.

The non-profit Operation Snowball is funded in part by a grant from the Skokie-based Cebrin Goodman Center an affiliate of the Lillian and Larry Goodman Foundations.

The walk will start at the Grand Pavilion and the event day registration begins at 9 a.m. The walk will begin at 10 a.m. Registration for this event is $20 for adults and ages 10-17 are $15. Under age 10 are free.

For more information, contact Mary Jo Davies, mdavies@iadda.org or 800.252.6301 extension 18.

Illinois Lawmakers Restore Illinois Substance Abuse Prevention, Treatment Funding

IADDA CEO Sara Moscato Howe

(Springfield, IL) — Both the Illinois House and Senate last week approved human services budgets for next year that virtually restored and, in the senate version, fully restored drug prevention and treatment funding that Governor Pat Quinn had proposed eliminating in his original budget plan.

The House Human Services budget, HB 3717, which passed 83-25, reduces Illinois addiction treatment funding 4.4%, lowering most line items by 1%, and cuts prevention services by 20%, slicing the main line item by 1%.

House Speaker Michael Madigan (D-Chicago), who spoke to the chamber after the vote, noted that this is the first time since 1991 that the House has passed a budget composed of multiple bills and in which the process was spearheaded by the five House appropriations committees.

Madigan also praised the bi-partisan effort, thanking the Republicans for working together to design the budget.

“The Speaker noted, however, that the work is not yet done,” said Illinois Alcoholism and Drug Dependence Association CEO Sara Moscato Howe. “There will still be negotiations with the Senate over their version of next year’s budget.”

On the heels of the House passing its human services budget—and not to be outdone by the lower chamber—State Senator Heather Steans (D-Chicago) released a new amendment, SA 4, to the senate’s human services budget, SB 2450, that dramatically improved Steans’ original proposal, which had restored only 50% of the Governor’s funding elimination.

Steans’ new proposal fully restored funding for addiction prevention and treatment to last year’s budget level with some minor increases in the prevention, meth awareness, addiction treatment services, and DCFS line items. The full Senate approved the revised plan 32-24.

“Clearly this is a major victory in our fight to secure adequate funding for addiction services,” said Howe.

The IADDA chief executive noted, however, that the Illinois budget for next year remains a work in progress.

“Both chambers still need to reconcile their different budget proposals before a final package can be sent to Governor Quinn for his consideration,” said Howe. “And the governor could veto budget lines that fail to meet his approval.”

“Yet, it is important that we take time to thank lawmakers, like Senator Steans and State Rep. Sara Feigenholtz, for their work on behalf of addiction health care during a difficult budget year.”

The legislature is scheduled to adjourn on May 31.

Illinois Youth Alcohol, Drug Prevention Group Wins $30,000 Federal Grant as New Report Says Teen Drug Use Zooms

(Springfield, IL) – April 8, 2011. Illinois’ leading youth alcohol, drug prevention group has received a $30,000 federal government grant to boost its prevention program effectiveness just as a new report released this week says teen drug and alcohol use is escalating as state governments slash prevention funding.

The Illinois Alcoholism and Drug Dependence Association, which obtained the money from the Center for the Application of Prevention Technologies, on behalf of the Substance Abuse and Mental Health Services Administration /Center for Substance Abuse Prevention, will use the competitive award for a year-long, comprehensive evaluation of its flagship prevention program, the Illinois Teen Institute program.

“We know this program works,” said IADDA CEO Sara Moscato Howe. “We have many individual success stories, but need a hard numbers assessment to evaluate and refine the program in order to more effectively deter Illinois teens from alcohol and drug abuse.”

The Illinois Teen Institute is an innovative program that develops Illinois youth as peer educators and advocates to their friends for alcohol, tobacco, and other drug prevention. The program develops community partnerships to support and encourage healthy teen lifestyle changes, and helps develop their leadership skills based on substance use prevention, touching approximately 5,000 Illinois teens each year, says Howe.

The new federal money comes just as a new report issued on Wednesday in New York by The Partnership Drug Free.org revealed there was a significant 67% increase in the number of teens who reported using Ecstasy in the past year, rising from 6% in 2008 to 10% in 2010. Similarly, marijuana use among teens has increased 22%, jumping from 32% in 2008 to 39% in 2010. Meanwhile, now 62% of teens said they had their first full alcoholic drink by age 15.

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