Governor’s Budget Short-Sited - Reduce Mental Health Services Now?

Date: February 3, 2025 - Letter to the Community

The Governor’s proposed 2026 budget cuts threaten disastrous results for Cape and Island residents with Mental Health illness. For the Department of Mental Health (DMH) to close the 16 inpatient psychiatric beds at Pocasset and reduce the case management workforce by 50% is more than a pothole in the departments Behavioral Health Roadmap. I’d say more akin to suspending bridge traffic in July.

Community Solutions is opposed to the closure of Pocasset Mental Health Center. Decreasing available beds anywhere impacts the entire system. Pocasset was 90% occupied in 2023, the last year data is available. This is not a quality issue, rather an expense issue relating to the limited services, 16 beds, versus the physical plant costs. According to DMH, “…their primary mission is to provide for early and ongoing treatment and services to adults with serious and persistent mental illness and children with serious mental illness or severe emotional disturbance and their families…” apparently not if you live here.

Rather than closing, DMH should look to add service offerings needed for the Cape Cod and the Islands. Behavioral Health treatment for adolescents and elders is difficult to find. Expanding Pocasset's capacity would be a better method to achieve cost efficiencies. Sharing the space with other providers might be another cost control option to consider. Over the past couple of years, few patients have been directly admitted to Pocasset from Nantucket, but for those who need that treatment, it's priceless and may not be available elsewhere. As a state operated facility, it has flexibility regarding insurance coverage and length of stay options for the patients they serve. Removing these services from the cape and islands is denying access and the opposite of equity.

But that’s not all, in the 2026 proposed budget, the governor seeks to reduce the DMH case manager workforce by 50%. Case managers do the daily work that keeps those with serious mental illness medically stable and secure. Their comprehensive assessments, early interventions, and facilitation to care access are what keeps children, families, and adults in the community. This reduction will inhibit DMH's ability to provide person-centered care and early interventions. Longer waitlists seem inevitable.

Currently these clinicians deal with caseloads that are more than stressed. A 50% reduction in staff seems likely to result in bad outcomes when only 170 case manager positions will handle all cases! Without sufficient case management, clients are at higher risk of falling through the cracks, resulting in more crises, emergency visits, and hospitalizations. None of which is cost effective and none of which is acceptable for our most vulnerable residents.

DMH received seven applications for children and adults in 2024 for Nantucket residents. During the past year, we have established relationships with the DMH southeast regional team. They visit the island routinely to ensure providers have a good understanding of how DMH can help those with severe mental illness. DMH representatives were last here on January 10th, 2025 and are scheduled to return on May 1st, 2025 to meet with NCH including the health center, JRI, Fairwinds, and CSBH. These conversations are important as system changes benefit individuals. Such a dramatic reduction in workforce will affect all levels of DMH and we fear our access to the southeast team will be limited.

Now is not the time for DMH to reduce services and close beds. Everyone agrees mental health needs are growing, and these stressful times seem unlikely to change that. Please contact Governor Healey’s office and voice your opposition to these proposals. Governor’s contact information 617-725-4005 and https://www.mass.gov/info-details/email-the-governors-office.

Sincerely, Rosemary McLaughlin