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Covering mental illness

Boston Capital

Covering mental illness

By Steven Syre

Globe Columnist / June 28, 2011

If health care costs too much, what do we need to change to get prices under control?

This is a very tired but obviously unresolved question that gets a lot of attention everywhere, including this space. Progress is difficult, in part, because nearly every practice and institution has its well-organized defenders.

But a few services have been squeezed relentlessly throughout the debate. Exhibit A: mental health, one of the great money-losers of medicine and a practice with declining financial support. Resources for a group of patients with only a faint public voice have been drying up dramatically over the past several years. This can’t be part of any good blueprint to reshape health care and the way we pay for it.

In truth, funding for mental health is squeezed from two directions. The weakness of the broad economy hurts the ability of state government to support all kinds of services, including mental health. Meanwhile, most hospitals are under pressure to slow the increase in overall medical costs and can afford fewer financial losers.

“Acute hospitals are experiencing enormous financial pressure overall, and historically mental health has been a drain,’’ says David Matteodo, executive director for the Massachusetts Association of Behavioral Health Systems in Belmont. “The pressure on hospitals in general points them to areas that aren’t making money.’’

As it happens, the annual cycle of official reports aimed at controlling the health cost spiral is just hitting its stride, and this week is chock full of public hearings by the Patrick administration and Attorney General Martha Coakley. One topic sure to come up in a panel discussion scheduled for today is cost-shifting, the practice of underwriting one medical service with the fees from another. This is the way a good deal of private mental health hospital care is subsidized.

Gary Gottlieb, the chief executive of Partners HealthCare, tells anyone who will listen how the high cost of general services at his famous hospitals — Massachusetts General and Brigham and Women’s in particular — help cover the cost of expensive services a community needs but won’t or can’t pay for in full. He will surely tell some version of that story.

The cost-shifting story is obviously true but far from a complete answer to all the questions about why Partners hospitals can and should charge much more than others. For today, I’ll stick to the part about it being true.

Gottlieb likes to highlight two expensive services that benefit from cost-shifting, burn units and mental health. Everyone sees the necessity of facilities to treat the relatively small number of patients with severe burns. The same isn’t necessarily true for mental health services.

To its credit, Partners has increased the number of psychiatric hospital beds by more than 10 percent over the past decade. It has lost $59 million on psychiatric services in its last fiscal year alone and $248 million over the past five years.

The broader statewide trend is distinctly negative. There are about 10 percent fewer psychiatric hospital beds in Massachusetts compared with a decade ago.

Cambridge Health Alliance, fighting for its financial life in recent years, eliminated 18 of 34 adult psychiatric hospital beds and closed 14 of 20 spots for adolescents and children. Tufts Medical Center eliminated all 12 of its psychiatric beds for kids last year.

Meanwhile, state government continues to debate whether to cut support for mental health further. Governor Deval Patrick’s original budget proposal for the fiscal year ahead would cut the number of state-financed continuing care psychiatric beds from 661 to 501, according to National Alliance on Mental Illness. The state paid for 831 beds five years ago.

Health care reform is a subject for debate all this week. Part of that discussion should be about some of the most vulnerable patients and how to care for them.

Steven Syre is a Globe columnist. He can be reached at

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