A slew of cutbacks to state-funded mental health services, including tightening eligibility for new clients to exclude those with PTSD, borderline personality disorder and some forms of major depression, is meant to rein in "unsustainable" growth over the past decade, Health Department officials said yesterday at a briefing on the state of mental health services in the Islands.

Michelle Hill, deputy director of DOH, told lawmakers that the cutbacks, made largely since the start of the economic crisis, are designed to bring the Adult Mental Health Division back to its mission of serving the severely mentally ill in greatest need, while also putting new emphasis on whether the state can afford the services offered.

And she said more cuts could be in the future.

"None of us here have a crystal ball. How we will be visited in perhaps the next round of cuts is unknown to us," Hill told the state Senate Human Services and Health committees yesterday. "We are willing to evaluate all services" for potential cutbacks.

She added that DOH is trying to create a "sound structure" that can be sustained.

The briefing comes as advocates are increasingly raising concerns about how the state is getting services to the severely mentally ill, and yesterday lawmakers also said they were worried that some of those in need aren't getting help because of reductions.

After the briefing yesterday, advocates said the gathering only confirmed their concerns. "It feels like the system is changing rapidly. The safety net is being taken out from underneath everyone," said Marya Grambs, executive director of Mental Health America of Hawai'i, adding that she understands that the fiscal crisis is spurring everyone to cut back, but thinks mental health services are getting disproportionately hit at a time when need is higher.

"There are a lot of unanswered questions" about the future of services, she said.

Much of the discussion at the briefing yesterday, during which there was no testimony allowed from the public, was spent touching on recent cutbacks to mental health services. State DOH officials said the cuts, which range from eliminating certain services to reducing contracts, are largely aimed at finding the right size for AMHD.

State-funded mental health services have ballooned over the past decade, and much of that growth is thanks to a 1991 lawsuit filed by the U.S. Justice Department's civil rights branch over conditions at the Hawai'i State Hospital, a state-run psychiatric facility.

The lawsuit spurred a consent decree over the state's delivery of mental health services and treatment.

Last fiscal year, 15,722 people statewide got state-funded mental health treatment. That's nearly triple the number who were getting services in fiscal year 2003.

AMHD acting chief William Sheehan said the largely unchecked growth in clients needs to stop, and that the number of clients needs to be reduced. "We're going back to see what's sustainable," he said. "Finding the right balance is what we're about right now."

The changes to who is eligible for AMHD services are part of that effort.

Sheehan said eligibility was curtailed so services are limited to people with a "psychotic condition." Those who are no longer are eligible include people with anxiety disorders, post-traumatic stress disorder and obsessive compulsive disorder and those with mild major depression. Those with severe major depression are still eligible.

People with the now-excluded diagnoses already being helped by AMHD did not see their services cut.

DOH could not say how many fewer clients are being served because of the eligibility cuts or because of other cuts to services. But Sheehan did say that the number of new clients per month has declined by about 15 percent since the eligibility changes.

Those changes were made in July.

Other cuts have been made to case management, psychosocial rehab, client transportation and outpatient programs. And in fiscal year 2009, Sheehan said, AMHD spent about $152 million — more than $20 million less than it did the previous year.