Plain and simple, the recent cutbacks at the Adult Mental Health Division are the result of five years of incompetent stewardship in triaging funds for people with mental illness in need of publicly funded services. The recent budget shortfall is actually a godsend by putting the spotlight on a system in disarray and in need of, say, another court order? Let's review the recent history.

Back in 2002, the mental health budget was a sleepy $80 million, about half of which paid for State Hospital services, with the other half supporting community mental health centers and services delivered by community-based agencies. Then, the equivalent of a mental health funding surge commenced.

The ACCESS line, a good thing, came on line, serving as a conduit to increase the number of people served by this public system from around 5,000 to 15,000. Community-based case management expanded from a couple hundred clients to a several thousand.

More money was also directed at housing, a very good thing. The court order was subsequently lifted. And the rising tide of state revenues together with a belated waiver to allow the state to access Medicaid dollars worked to build a prodigious budget, nearly 250 percent larger than just six years earlier. Perhaps not mental-health parity, but more funds to meet the needs of the seriously mentally ill in our state, a tremendous thing, indeed.

But like the events of the mortgage market, Adult Mental Health officials apparently thought that budgets would also rise without fail, thereby covering the risky assumptions they made in opening the floodgate of services. Or maybe they didn't think at all.

Last year, little attention was paid to the overspending by AMHD, by $10 million to $20 million, even when they needed an emergency allocation from the Legislature. While some advocates had been telling the state to be more judicious about whom to serve and what to deliver, it seemed bureaucracy and the lack of a new Adult Mental Health director allowed problems to fester.

The fee-for-service model implemented by AMHD for case-management services and a source of much of the overspending was also fraught with problems from Day 1. Case-management authorizations went from inflexible to permissive to highly permissive and now back to draconian. Each time, the state just could not seem to get it right, with grave impacts on the budget and now potentially on the lives of the people served by the system.

Providers complained that the fee-for-service model also made them spend too much time checking if workers were making quota and less time ensuring that clients were being served appropriately. For some, the situation became opportunistic, allowing millions to be billed for services that had no clinical benefit. Calls of fraudulent billings become the dirty little secret among community providers, some nonprofit, some not-so-nonprofit. The gravy train ran circle-island. And it literally became "Case Management Gone Wild."

So, where does it take us now? A system that is broke only eight months into the fiscal year. Mass layoffs of mental-health workers. A one-size-fits-all utilization management system. No strategic direction.

The recent moves by AMHD do not address the core problems the media and the Legislature still need to help bring out in the open. More questions need to be answered. Who is being served? How many can be served with the given budget? How much money is allocated to different services? How equitable and clinically appropriate or needed are these services? Exactly how many sentinel events?

In general, the details of the entire social service system need much more scrutiny and sunshine — not just mental health. More service and outcome reports need to be made available — for homeless services, housing services, employment services and similar publicly supported human services. The media needs better access to this information, and the public should demand it.

Michael Ullman is a nonprofit consultant who managed several AMHD cases from 2002 to 2004. He wrote this commentary for The Advertiser.