Calling Fitch to Account on his Mental Health Numbers

Paul Anderson submits this post:

I’ve heard plenty of talk on here about George Fitch’s brilliant money cutting schemes for Virginia, but not much analysis of what he’s actually going to cut. I’m impressed with some of his plans (especially the emphasis on subcontracting state services to private contractors, much like Clinton), and not so impressed with others. For example, Fitch has claimed that we can save a boatload of money by cutting expenditures at mental health facilities.

According to a recent Bacon’s Rebellion article:

By way of specifics, Fitch points to the treatment of the mentally ill. The state pays $100,000 a year to treat a mentally ill patient in an institutional setting. By moving patients to local community centers, the state can cut costs down to $30,000 – and improve the quality of care.

$30,000 per patient is way less than $100,000 per patient…sounds good, huh? Here’s the problem: I spoke to a friend who has worked in mental health her whole life, and they found this blanket statement to be a bit misinformed.

It can cost less to house people in community centers, but not much less (the numbers he’s using are patently false).

Also, a great deal of the current residents in state facilities are forensic patients. They require more security. There are not comparable places to house them in the community. Jail is not the place you want them. For mental rehabilitation services, my friend told me that community care costs range from $50,000-$120,000 depending on the need. That is slightly less than institutional care (according to Fitch, $100,000 per patient).

As for other cost cutting measures: Lately, the state has been trying to reduce beds to save money, but now there is uproar all over the state, particularly in northern Virginia that there aren’t enough psych beds. This is largely due to the fact that private hospitals are getting out of the mental health business. They make more on medical or surgical beds.

He also fails to face a political reality. There have been repeated attempts to close state facilities. These attempts are always opposed by local politicians, families who use the facilities, and especially employees, because they are a major employer in communities around the state. It just won’t happen.

The state has a responsibility to provide these sort of mental health services, one way or the other, because as I explained, the private sector doesn’t want to do it. We can move some non-forensic patients into community care centers, and sometimes that saves money, but sometimes it’s just not a good fit for the patient or the surrounding community). But the $30,000 figure that Fitch is using just isn’t realistic.

My main point? When politicians throw out these magical cost cutting numbers, sometimes they haven’t done their homework. You want to cut things? Fine. But it’s going to take tough choices, not easy ones.

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  1. Jim Bacon Avatar
    Jim Bacon

    As the author of the Fitch column, I do believe that Paul makes a legitimate point here. I did not press Fitch on the numbers he cited — and I should have. If the potential savings were as large as he suggested, surely someone would have noticed by now.

    There’s no question in my mind that Fitch gets the big picture right. But he needs to be careful with the details. If his campaign ever takes off, Jerry Kilgore’s fact checkers will make mince meat of assertions like this one. It won’t take too many comments like this one to undermine his credibility.

  2. Will Vehrs Avatar
    Will Vehrs

    Paul, good post. One thing you didn’t mention was the availability of beds in community centers–I’m sure that would quickly become a “state v. locality” bone of contention.

    One the one hand, we want candidates who speak broadly of cutting the cost of government or not raising taxes to identify how they’d save or what they’d cut. On the other hand, as soon as they identify specifics, we sharpshoot them on the details.

    Fitch gets credit for identifying specific areas. Like most politicians, he’s probably overselling some of his proposals, but even you acknowledge that in this case, there may be some savings.

    What I’d like to see is a candidate who says what Fitch is saying, then says “Joe Jones” is going to be his point man on this, that Joe Jones is going to get the best minds available to find savings and recommend cuts, and that those recommendations are going to be implemented even in the face of bureaucratic and special interest pleadings.

    Too often we buy into the candidate without knowing his team or his approach.

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