Monday, August 30, 2010

The New System: Saving Money and Lives

Imagine being sick, having no job, and no home. Then, imagine someone putting her hand out, helping you find a doctor, a job, a place to live, and welcoming you into a community of friends. “Crystal House has saved my life”, said James, about the center he attends daily. “I was homeless and I spent years in the state hospital before I found out about Crystal House. They’ve helped me get jobs and stay out of the hospital for over three years. “

Crystal House is one of thirty-two recovery and rehabilitation centers, or “Clubhouses”, across Massachusetts that provide a lifeline to more than 8,000 people each year who, like James, are affected by serious mental illness. Working side by side with staff, members of the Clubhouse participate in the activities that keep the centers running day-to-day, while learning to manage the symptoms of their illness. Clubhouses are voluntary programs focused on people’s strengths, built on the belief that work, supportive relationships, and the need to be needed, are central to people’s recovery. The center help members get jobs, housing, and health care. They provide a community of support and a place to go, a place to belong.

Now imagine losing all that. The state, who funds these centers through the Executive Office of Health and Human Services (EOHHS), is in the process of making changes in its contracting system, changes that may threaten the very existence of Massachusetts Clubhouses. “To lose Crystal House would be like losing my family”, said James.

Not only do the centers provide lifelines for people with psychiatric illnesses, but they have been saving the state significant money in the process. The current annual Clubhouse funding of $18.8 million works out to an average of less than $2,500a year for services to one person. For each day that James was in the hospital, it cost $1,000 per day. When a Clubhouse assists one member from being hospitalized for three days, it has already saved the Commonwealth money. For more than 8,000 people over the course of one year, that’s a huge savings.

Massachusetts has been funding human service providers to run Clubhouses since the mid 1980’s. Although the state periodically reviews contracts, there has been no system in place to ensure that this happens; the last time EOHHS reviewed Clubhouse contracts was 1995. In August, 2008, providers were thrilled when the Massachusetts Legislature passed Chapter 257, mandating that the state reform its system for purchasing services for its most vulnerable citizens. The law’s most important requirements have great potential to ease strained Clubhouse budgets, which have been level funded for fifteen years. Chapter 257 mandates that the state reimburse providers at a reasonable rate for their costs and to pay human services workers fair, livable wages.

Although Clubhouse providers are happy to finally have their contracts reviewed, the members and staff at the centers have reason to be concerned. The state plans to meet their mandates without providing any additional funding. In addition, EOHHS has made it clear that it will not require Clubhouses to adhere to the standards set forth by the International Center for Clubhouse Development (ICCD).

Like the other Clubhouses in Massachusetts, Crossroad’s budget and staff are stretched to the limit. It’s hard enough to run a business and keep up with the rising prices of food, gasoline and utilities; never mind working for 15 years without receiving a raise. The program’s transportation costs have grown by a third in the past fifteen years, In 1995 Crossroads staff provided services to 30 members a day. Now, with the same amount of money, it can afford only a staff of seven, but it serves twice as many. Most employees still make less than $30,000 a year, so turnover is high. Some Clubhouses in the state report staff turnover rates as high as 37%.

“We are hemorrhaging workers, stated Reva Stein, Executive Director of the Massachusetts Clubhouse Coalition, a non profit organization that advocates on behalf of the state’s 32 centers. “Clubhouses are based on the belief that relationships and work are the key to recovery. How can you build relationships if one third of your staff are leaving every year?”

In its report to the Legislature outlining EOHHS’s plan to revise the contracting system, the agency acknowledged the extremely high staff turnover caused by low wages. There have been other positive signs from the state. In March 2010, Secretary Judyann Bigby’s support of Massachusetts recovery and rehabilitation centers was encouraging. “We know that Clubhouses not only help individuals recover, but they are part of our economic engine as well… The earning power of members also shows that employers have tapped into a pool of talented, skillful, hardworking individuals who have overcome the greatest odds and found their strengths as productive employees.”

Yet, despite the EOHHS report and her encouraging words, the Secretary also stated this past year, that cuts to human services, as short sighted as they may be, will continue to be made. She acknowledged these cuts may save money now, but will cost the Commonwealth in the long run. If EOHHS does eliminate any of the 32 centers that assist the more than 8,000 people each year, the Commonwealth’s commitment to “Community First,” to serving families and individuals in the community, and not in institutional settings, will be severely weakened. Years of research and experience has shown that a lack of adequate community mental health services results in dramatic increases in recidivism rates at psychiatric hospitals, numbers of people incarcerated in our prisons and jails, and the numbers of people who are homeless; all much more costly than supporting people in the community.

The majority of Massachusetts Clubhouses are certified by the ICCD, which has developed a set of Clubhouse Standards; a sort of “bill of rights” for members and a code of ethics for staff and administrators. By meeting these standards a Clubhouse achieves certification by the ICCD. They are a basis for assessing the quality of the centers. Clubhouse Directors across Massachusetts are concerned about the state’s unwillingness to require certification. Although EOHHS officials remarked that the state would not preclude Clubhouses from following the standards, Kevin Bradley, Executive Director of Genesis Club in Worcester, was skeptical. “It leaves an opening for the state to require us to provide services in a way that would conflict with the standards. You can’t separate a Clubhouse from the standards; they define who we are.”

Last year, with the support of Clubhouses, 1,950 Massachusetts citizens with mental illness earned over $13 million as working, tax-paying citizens. Paula is one of them. She is working three days a week as a peer specialist at a clinic near her home, a job that she obtained with the support and encouragement of the staff and members at Crossroads Clubhouse. Like James, she credits the center with keeping her stable, staying out of the hospital and getting a job. “The support that I’ve received from the staff and members at the Clubhouse is the main part of my recovery. Day-in and day-out, being part of this community and the feeling of contributing something important, is what makes all the difference for me.” Paula has never felt better about herself, but at the same time, she is terrified of losing the very thing that has helped her achieve so much.

As EOHHS has labored to define its rate setting terms, the economy has worsened. At a recent public forum, officials from EOHHS and the Department of Mental Health suggested that “the decision to reduce the number of Clubhouses is definitely under consideration.”

This is what terrifies Paula. “If you limit the number of Clubhouses, you limit the number of people who can be served. I come here every day I’m not working to be challenged and to be supported. If this program goes away, what am I going to do?” she asked. “Where am I going to go?” Her concerns are echoed by many members across the state. James from Gardner, Brenda from Fall River and Dawn from Springfield, all share Paula’s fear.



“Not only are members afraid, so are the staff. We could lose it all,” worried Val Comerford, Director of Crossroads. We don’t know how EOHHS could possibly keep the same number of Clubhouses and raise staff salaries, and without the standards, the very thing that makes a Clubhouse what it is could be completely dismantled.”

As the Executive Office of Health and Human Services develops its new system for funding community mental health programs, it should pay close attention to Clubhouses and the standards that ensure the quality of their services. It makes sense that EOHHS and its fiscal departments closely examine just what Clubhouses do, and how to reimburse them for their work. It is important that while deciding how to allocate its limited dollars today, EOHHS is careful not follow a short sighted course. The current initiative to revise the funding system for these centers must keep in mind the desperate need to pay workers a livable wage, as well as the critical role that all 32 Clubhouses play, not only in saving the Commonwealth millions of dollars each year, but in saving the lives of many of the state’s most vulnerable citizens.

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