Mental health: Coalition pushes for local control

It was standing room only on April 20 in one of the Capitol's smallest hearing rooms. Up for debate in the House subcommittee on delivery of services to the mentally disabled was the local response to declining state support for community mental health services. The question was whether the 14-member coalition would hold together or spin apart.

Few defend current services to the mentally ill and retarded. Both the League of Women Voters in Illinois and a gubernatorial task force studied services and concluded that no comprehensive system exists. Ann M. Kiley, director of the Department of Mental Health and Developmental Disabilities (DMHDD), describes the state's effort as "shreds of a system."

The coalition's initiative was being offered as an amendment to H .B. 849 by Rep. Andrew J. McGann (D-29, Chicago). "We know that we have a broken down vehicle," McGann told the crowd in room 122B. McGann should know. His subcommittee took 20 hours of testimony on the system's problems.

McGann took two impressions from the hearings that he held with Rep. Woody Bowman (D-4, Evanston). First, there is too little planning between DMHDD and community agencies. Second, someone needs to be charged with connecting clients to services. "Every hearing we had it would surface that the problem was case management," McGann said.

McGann's bill addressed those issues. It was drawn up by the Community Care Coalition, a group originally formed to push for restoration of money for community agencies after Gov. James R. Thompson's July budget cuts. The coalition failed to get any of that money put back, but its members reassembled earlier this year as the Community Care Coalition to push for a more comprehensive system.

Their bill would create the Comprehensive Community Mental Health Network Act of 1988, forcing within two years locally based planning, designating the local agency as case coordinator for a person entering or leaving state institutions, and offering incentives to agencies that keep clients out of state institutions. The bill would:

• Designate existing local agencies as the service delivery network with which DMHDD must work to serve the mentally ill and developmentally disabled and push service planning down to the local level. The networks would have to submit a needs assessment and service plan to DMHDD by October 1 of each year. The department must in turn incorporate local plans into a statewide plan by December 1.
• Require that all state and federal funds be distributed according to local service priorities. Of the money appropriated to community mental health services 87 percent would be distributed on the basis of population and poverty rates, 10 percent would be used to reward local agencies that keep clients out of state institutions, and 3 percent would be used for pilot programs.
• Require that DMHDD set up guidelines and minimum standards for services.
• Require that all placements in state institutions, other than court ordered, be through the service network and that the service delivery network act as case coordinator for persons so placed in state institutions.
• Extend basic services now not available in some areas.

Diana Nelson, executive director of the Mental Health Association in Illinois, told the committee that previous efforts had fallen by the wayside because of disagreements over who should do what. "The compromise that we have reached in this legislation is that what we have now in Illinois. . . remains in place. Power and money is to be shared and [no] group will usurp the authority of [another] group. What was there provides the network." And Nelson claimed there was no desire to end DMHDD's ability to run state facilities.

But the coalition also began to come apart at the hearing. Don Moss, executive director of the Association for Retarded Citizens of Illinois, voiced opposition to the inclusion of local mental health authority boards in the service network. Moss contended that the boards, which exist in some counties and can levy a property tax, are political entities and should have authority only over the money they raise.

McGann had promised no vote on the bill because few had the opportunity to review it. The parties left to see if differences could be resolved. When they reconvened on April 27 in a larger committee room in the Stratton Building, the advocates had reached a compromise. A change was made and the Association for Retarded Citizens dropped its opposition.

McGann moved the bill. Rep. Tom Ryder (R-97, Jerseyville) questioned putting the law on the books without the money to fund it. The Department of Mental Health and Developmental Disabilities opposed the bill on financial grounds. It estimates cost of the bill at $150 million to $300 million by 1994. But McGann pushed: "I think we have to start someplace." The bill cleared the subcommittee and later that afternoon the full State Government Administration Committee.

The bill was awaiting floor action in the House on May 12. The Community Care Coalition was hoping for continued success. "It keeps the issue alive and gives the coalition the opportunity to go forward," said Peter Rinn, executive director of the Illinois Association of Community Mental Health Agencies. McGann said he was encouraged that the community groups had worked out their differences and is convinced that action is needed: "We have to mandate community services. All of the hearings that I've held in the past two years have indicated that." And the notion got at least some support from DMHDD. "The department agrees with the principle that there should be a legislative mandate for the state to fund community services," DMHDD spokesman David Devane said.

There is agreement on what needs to be done. There is no money to pay for it. Perhaps the best measure of commitment to mental health this spring is willingness to raise taxes to pay for it.□

June 1988 | Illinois Issues | 31