Will DHHS restructuring harm the mentally ill or increase efficiency?

Posted March 21, 2012, at 9:01 p.m.

AUGUSTA, Maine — The stories of Mainers with mental illnesses and disabilities came one after another Wednesday during a legislative hearing on the LePage administration’s plan to restructure the Department of Health and Human Services.

In testimony that continued into the evening, some praised the department’s focus on efficiency while many others worried the reorganization could leave Maine’s needy in the lurch.

Several DHHS employees slated to lose their state jobs spoke out against the reorganization plan, which the administration says will streamline the sprawling department into an organization that better serves Maine people.

The restructuring bill, LD 1887, calls for eliminating 33 “intensive case managers” who work with some of the state’s most mentally ill and potentially dangerous residents. It would shift their services to the private sector and transfer $925,000 of the program’s money to the Corrections Department to serve inmates with mental illness.

Another $1.5 million that funds intensive case managers would be reallocated to expand a statewide program that tackles homelessness among the mentally ill.

The move is not expected to save money.

Bobbi Bard, an intensive case manager at DHHS, told members of the Legislature’s Health and Human Services Committee that she and her colleagues work with residents deemed too costly, time-consuming and dangerous by other social service workers.

One of her clients nearly killed a pastor at a psychiatric center and is now in jail, where he is shackled and escorted by three to four guards whenever he leaves his cell, Bard said.

“If the ICM program is dissolved, there will be no safety net for all these clients and for the people of Maine … This proposal does not save the state money, but could potentially cost the state millions,” she said.

Department officials stressed that intensive case management services would not disappear, but rather be privatized.

The reorganization bill consolidates four DHHS offices into two and reorganizes another. It seeks to merge the Offices of Substance Abuse and Adult Mental Health Services and combine the Offices of Elder Services and Cognitive and Physical Disabilities Services.

The Office of Child and Family Services would reorganize and link together its four major service areas, including child welfare and behavioral health.

The proposal cuts 91 positions across various levels and creates 55 jobs for a net loss of 36 positions. Several of the jobs under the ax are vacant.

The bill is expected to save $750,000, though DHHS officials have said its aim is not to cut costs.

Reorganizing the department would eliminate duplicative work, integrate care across residents’ lifetimes and make DHHS’ web of services easier to navigate, said Bonnie Smith, deputy commissioner of programs.

“With such limited resources, we cannot afford to spend one dollar more on bureaucracy or ask our providers or consumers to repeat information, call another number or experience a delay that can be prevented through the development of a more efficient system,” she said.

Eric Haram, board chairman of the Maine Association of Substance Abuse Programs, said the reorganization could lead to better health for DHHS clients.

“The department’s proposal should create obvious efficiencies to drive improvements, build consistent, integrated services and ensure higher outcomes through clear lines of communication, coordinating functions and the development of a continuum of integrated services,” he said.

The bill will require approval by the Legislature. Several speakers at Wednesday’s public hearing questioned whether the DHHS restructuring can be undertaken so late in the legislative session, which is scheduled to wrap up in mid-April.

Paulina Klimek-Cornett of Portland, speaking on behalf of an advocacy network for people with developmental disabilities, said the group has had little time to learn about the reorganization plan.

“We feel that mostly we have unanswered questions, with the biggest one being how is the proposal of restructuring departments going to affect our services?” she said.

The bill also would eliminate a division within DHHS that advocates for the intellectually disabled and autistic. The work of the Office of Advocacy would shift to the Disability Rights Center, an independent Augusta-based organization.

If approved by the Legislature, the restructuring would mark the first substantial overhaul of DHHS since it formed in 2004 through a merger of the Department of Human Services and the Department of Behavioral and Developmental Services.

The Health and Human Services Committee will hold a work session Thursday afternoon on the DHHS reorganization bill.

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