Friday, June 25, 2010

Apartment of Mental Health

City Budget: Agreement:

State Issues: Unresolved

Court Decision to Raise

Mental Health Expense

Day 86 without a budget.

86 - to ignore, cancel or get rid of, with prejudice; 86 - atomic number of radon, working our way up to uranium, which is 92. (July 1)

Mayor Bloomberg and the City Council agreed amicably on a budget last night after several days of intensifying negotiations. The Times reported on the process in a story by Javier C. Hernandez on pA25, headed straightforwardly, CITY COUNCIL AND MAYOR REACH ACCORD ON A BUDGET. The first two grafs:

"Faced with a sputtering economy and uncertainty in Albany, Mayor Michael R. Bloomberg and the City Council agreed Thursday night on a $63 billion budget that would slash at least 2,000 jobs but increase no taxes.

"The deal would mean painful cuts in a variety of city services, including the elimination of some senior centers and day care programs, and less money for education and adult literacy programs. But over all, spending would increase by $3.6 billion, or about 6 per cent, compared with the budget approved a year ago, because of rising pension and health care costs."

Note the contrast between the state and the city when it comes to the budget process. Here are some reasons the city did better:

1. Strong, consistent leadership by the elected executive and his experienced professional staff.

2. A relatively responsible, hierarchical but functioning unicameral legislature.

3. The absence of a $10 billion deficit, due to the mayor's putting money aside during the boom years rather than spending every cent that was available.

4. The willingness of unions to make adjustments in staffing to avoid layoffs of their members and closing of facilities.

5. The absence of diversions such as investigations and indictments in the executive and legislative branches.

6. The relatively lesser strength of lobbyists in influencing city government.

One depressing aspect of the municipal budget is that despite the layoffs, attrition and other reductions, total spending still rose substantially ($3.6 billion) because of mandated increasing costs for pensions and health benefits. These areas must be dealt with if the city and state are to emerge from the chronic budgetary imbalance they have suffered from for years. Some day, the pension system will have to go from defined benefit to defined contribution, as the great majority of pension plans already are.

Almost by coincidence, there is another story in today's Times, just two pages later, that describes a court decision which, if upheld as it is likely to be, will have a considerable financial impact every year on the New York State budget. The decision is reported by A.G. Sulzberger on pA27. The head: US APPEALS COURT LIFTS STAY ON RELOCATIING MENTALLY ILL. The lede:

"A federal appeals court has ruled that New York State must comply with a lower court's order to begin immediately transferring thousands of people with mental illness in New York City out of large, institutional group homes and into their own homes and apartments, where they will continue to receive specialized treatment and services."

The story quotes the executive directors of two advocacy organizations. It closes with a senior citizen adult home resident who said: "I'd be better off in a studio or one-bedroom. Once you get here, you sort of get stuck here." Earlier in the story, a spokesman for Gov. David A. Paterson, said that "the state, wrestling with severe budget deficits, was in the process of determining its next steps." The article does not identify the two judges on the Court of Appeals for the Second Circuit who made the decision. They are Pierre N. Leval and Debra Ann Livingston. Judge Leval, a senior judge, is held in particularly high regard. Judge Livingston, an appointee of President George W. Bush, was confirmed in 2007. She was Vice Dean of Columbia Law School from 2005 to 2006.

This case is a classic example of the unfunded mandates which make it impossible for state executives or legislators to balance budgets. It may well be beneficial for many people with mental illness to have their own apartments with visits from case management services, psychiatrists and nurses, as the plan would require. Others may do better in group homes. Much depends on the quality of the group home.

There is no question that this mandate will be expensive to fulfill. Nor is there any question that the state is severely financially stressed, and that it would be extremely difficult to incur additional expenditures. Nor is there any limit on the level of service that the Federal courts would eventually require for individuals who have mental problems.

There are fiscal consequences to every new law and regulation, and some legislatures have rules that these consequences must be calculated and stated. No such rule applies to court decisions, which are often made without regard to how the decrees will be paid for (except for tobacco companies). Nor is it considered what or other services may be adversely affected by additional expense incurred in this area.

We recommend that you read today's Times article in full here. Are humanitarianism and fiscal responsibility inconsistent? How should judgments be made when these objectives are in conflict? Does the fiscal condition of the state have any relevance when the needs or desires of persons with disabilities are considered?

1 comment:

  1. The Times story attributes the bulk of the $3.6 Billion budget increase to rising health care and pension costs.

    But the single largest increase was for debt service --- up by $1.94 Billion in FY 2011.

    Source: Mayor's Executive Budget.