Too many people and not enough money...

Too many people and not enough money. Two years ago, the State Department of Mental Health expected patients to begin leaving the state's mental institution in large numbers. The background for such expectations was optimistic: ,improved treatment techniques, increased support services in community mental health programs, continued breakthroughs in the use of drugs to aid in treating the mentally ill. And if the projections based on those great expectations were larger in. that central office in Lansing than the hospital superintendents dealing with day-today actualities thought realistic, the objectives were agreed to be desirable. It was a "wait-and-see" situation. But the rosy projections have faded. They began fading. almost a year ago when it became evident that there was a growing disparity between the numbers of patients in the hospital and the numbers of patients the state had expected to be in them. Listen to how Dr. Vernon A. Stehman, Ypsilanti State Hospital superintendent, describes what's been happening at that institution. Ypsilanti State Hospital, located in York Township, serves an eight-county area: Washtenaw, Jackson, Lenawee, Hillsdale, Monroe, Livingston, Shiawasee. and Genesee. Dr. Stehman believes that the situation at Ypsi is probably more acute than at others in the state's nétwork of 26 institutions for the mentally ill or retarded. "It was our intent at Ypsilanti a year' ago to reduce our patiënt population to a point where we could approach a ratio of ' 1.3 staff per patiënt." With that kind of ratio hospital care could be improved in line with the intent l of Michigan's new mental health code. "But our patience census has not dropped. "We aren't moving toward that goal ; now; tira are moving away from it. "Our census increased' by 10 patients in October and by seven in November,"; he says. "We have approximately 960 patients in the hospital now." Movements out of the hospital had been fairly steady in the past, he says. "We were averaging 20 to 30 a month out into nursing homes and other after-care facilities." In an October 'interview Dr. Stehman was already saying, "Our patient populations have been dropping slowly - not as fast certainly, as has been predicted." This past week, the picture was even more grim. "The reduction of patients in the hospital has slowed down to a point where we have a negative balance in terms of the projections. "This is probably related to the fiscal situation. The history is that when the economic situation is grim, hospital populations tend to increase." And if more sick people are coming into the hospital, the problem is compounded further by the fact that patients who have improved enough to bé released to those planned community health and after-care programs can't leave. "We have over 150 patients who are ca pable of leaving the hospital," Dr. Stehman says. "They are ready to be referred for placement and are being pro cessed to move out." What's holding them up? , In Dr. Stehman's eyes the problem' lies . with the Michigan Department of Social Services, the agency whose responsibility it is to lócate after-care placements for patients, That agency, caught in its own financial squeeze in the state budgetary crisis, has not been able to pro vide such placements. Lack óf money is also an omnipresent problem at Ypsilanti State Hospital. The original budget was predicated on a population of 650 patients at the facility for this year. "That budget was based on projections we didn't - couldn't - reach," Dr. Stehman says. "And the problem is further compounded by the severe budgetary crisis the state is in now. "The governor has no choice but to cut back the budget. "That means we take cuts, too. With the budget figure I'm likely to have to opérate for the rest of the year, it seems i íairly certain that it wül mean a significant number of lay-offs of staff - possibly over 100. Sotne of the lay-offs will come in service (maintenance) and support áreas, Dr. Stehman says, but most of them will come from treatment. "I don't see how we can do it without sharply limiting pur services - closing our admitting ward, limiting admissions, combining wárds. "How and in what way depends on my analysis of the problems in relation to the dollar figure I get. But I will have. to do it, because I have no other choice." "In October the governor said he didn't want massive lay-offs, because he feit the, staff could be reduced by attrition. But subsequent projections of state revenues .indicated that attrition wouldn't pick up enough. "Attrition in direct nursing care on the wards hasn't been sufficient. That means ' I will have to lay off other positions in order to maintain minimum acceptable coverage on the wards. I don't plan to lay-off any nurses or nurse attendants, 4 because ward coverage is both essential and a critical issue." This may make it necessary to combine wards - where there were three wards there will now be two. The staff from two wards will cover the same number of patients that were formerly covered on three. This, of course, will abolish some joBs, Dr. Stehman concedes, but present nursing personnel will not lose jobs because of the critical shortage that already exists in that área. "If a nurse's job is abolished in one área, vacancies in other áreas will allow me to transfer her there." What does this combining of wards mean in terms of providing adequate treatment? "If you take a three-ward census of 110 patients and move them to two wards, you get 55 to 60-bed wards," Dr. Stehman says. "Space that was used for dayrooms in the past, will now be made into sleeping facilities.