Admissions to halt at state mental hospitals

State psychiatric hospitals will stop admitting new patients tomorrow , and 170 Department of Mental Health staff positions will be eliminated in response to Governor Mitt Romney's emergency budget cuts announced earlier this month, according to private hospital groups briefed by state officials.

In addition to the freeze on hospital admissions, the cuts would do away with 37 percent of the staffers who provide care to hundreds of emotionally disturbed children and teens in their communities; cut dozens of inpatient jobs for nurses, aides, and psychiatrists; and reduce funding for medical school research, according to an overview circulated by the Massachusetts Hospital Association.

The mental health agency began sending out notifications on Friday that its hospitals, which have about 850 adult inpatient beds, would stop accepting psychiatric patients who would normally have transferred to them for longer-term care.

It aims to re open admissions when the patient population has dwindled enough to be cared for by a smaller staff.

"This is just a horrible Thanksgiving for people in the state who have mental illness," said Toby Fisher, executive director of the Massachusetts branch of the National Association on Mental Illness. "This will block up the entire mental health system."

Romney's spokesman, Eric Fehrnstrom, defended the cuts, and accused Department of Mental Health officials of resorting to a "Washington Monument" strategy to try to get out of reducing the budget: "You take something highly visible and shut it down, so the public will complain and funding will be restored," he said .

The agency should be able to absorb its 1.1 percent cut without reducing services, Fehrnstrom said.

"We think any good manager should be able to absorb a 1.1 percent cut through payroll and administration," he said, and budget specialists will work with the department "to put forward a more realistic plan."

Mental Health Commissioner Elizabeth Childs declined to comment, referring the Globe to the governor's office.

But mental health care providers and advocates for the mentally ill warned that the cuts would worsen waits and bottlenecks in a system that is already chronically strained.

There is a constant backup of 25 or 30 patients waiting to get into state hospitals as it is, said David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which represents private psychiatric hospitals and units within general hospitals.

Most of those would probably have managed to get beds in the near future, he said, but "because of this policy, they're not going to get in."

When access to state hospitals is blocked, psychiatric patients back up at all levels of care, he said.

Many remain in private acute-care hospitals meant for stays of only a few days, and that means more also get stuck in emergency rooms, unable to get a bed on a ward.

The patients at state hospitals tend to be the most chronically mentally ill, people whose illness has ebbs and flows, such as schizophrenia, treatment-resistant depression, or substance abuse. When the illness worsens, they need acute care, but then they tend to need longer-term placement for continuing care at a facility like a state hospital. In a final step, they get out, and often need further care in the community or in a residential facility.

Romney cut a total of $425 million from the state budget on Nov. 10, accusing the Legislature of casting the state into a spending crisis by irresponsibly tapping the rainy day fund.

Romney vetoed the rainy-day fund transfer, and the Legislature did not override his veto, leaving a deficit.

Fehrnstrom said the governor's cuts amounted to 1.4 percent of the state budget overall, while the cuts to the Department of Mental Health totaled only 1.1 percent, or about $7 million of a total budget of $640 million. Even after the cuts, he said, its budget would still end up growing by about $10 million compared with the previous year.

"We'll probably start with their plans to increase staffing by 107 people," he said. "At the end of the day, they probably won't be able to increase by that many people."

Advocates for the mentally ill and hospitals said that the department could ill tolerate even minor cuts, and that because the cuts come at mid-year, their impact is actually double, so they amount to annual cuts of $14 million.

"When you look at the growth of agency budgets over the years, the Department of Mental Health has been the stepchild in this administration," said Marylou Sudders, a former commissioner of the department herself.

"Those of us in the mental health community feel that for the first time, here's a budget that is very modest, but addresses some of the issues that we have been advocating for, for a number of years, all of which was undone and slashed," she said.

The cuts would also affect home services for people with mental illness so that they can live independently; and inpatient hospital staffing, including staff nurses and 16 psychiatrists on contracts.

That cut in psychiatrists translates into 267 hospital beds without the required level of physician staffing, the overview says, adding to the need to stop admissions to the hospitals until the number of patients drops.

In a statement, the Massachusetts Hospital Association warned yesterday that "patients could pose a danger to themselves or to others if they cannot be discharged to an appropriate setting."

Matteodo, of the private mental hospital group, said that Commissioner Childs had called on Friday afternoon to say all admissions to state facilities would be halted as of Wednesday, and, he said, she acknowledged that this was "very bad news."

"I obviously agreed with her, and said, 'You know, we were having a problem before this,' and she said, 'I understand, but I have to do my job.' "

The state Department of Public Health has been told to cut 1 percent from its budget -- about $5 million.

A spokeswoman for the agency, Public Health Commissioner Paul Cote, said last night that no final decision has been made on what programs will face reductions.

Stephen Smith of the Globe staff contributed to this report. Carey Goldberg can be reached at goldberg@globe.com.