The Mental Health Minute

Articles and news about mental health issues

Despite rising need, mental health takes back seat

 

Here is just another of the plethora of articles out in cyberspace that state the effect of cutting mental health care when trying to balance or weed out the fat in the budget.  I keep pointing out here that the mentally ill are everywhere; they are your neighbors, your family, your employer, your taxi driver, or even your spouse.  Refusing to give these people any help does not make the illness go away.  Actually, ignoring the problem only makes the problem grow and spill over into other areas.

Please read this entire article from the Tuscon Sentinel.  This is a good article and has many points of interest.

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State spending cuts worsen with end of stimulus

TUCSON, AZ - JANUARY 13:  Pall bearers bring t...

Image by Getty Images via @daylife

Posted Mar 14, 2011, 8:39 am

Amy Biegelsen Center for Public Integrity

It’s been two months now since Jared Lee Loughner opened fire outside a Tucson shopping center, killing six people and wounding 13 more, and what’s come to light since leaves more than a few troubling questions.

Following the shooting, it was revealed that authorities had barred Loughner from Pima Community College, where he attended classes, until he was certified as fit by a mental health professional. Loughner apparently never sought professional help, and the questions the community college had about Loughner’s state of mind still resonate — what was going on with this young man, and is there anything the local mental health infrastructure could have done to change the horrible outcome?

The nation’s mental health infrastructure is not offering easy answers these days. Advocates say that in extreme cases like Loughner’s, it’s possible the public system may not have been able to do much to stop him. But mental health leaders are worried that soon, they may not be able to do much of anything at all.

Desperate to close historically cavernous budget gaps, states have cut $2.1 billion from their mental health budgets over the last three fiscal years according to a study from the National Association of State Mental Health Program Directors’ Research Institute. More slashing is expected in the coming weeks as states finalize their 2012 spending plans.

Meanwhile a new study from the National Alliance on Mental Illness finds that between fiscal years 2009 and 2011, more than a dozen states and the District of Columbia cut their mental health budgets by more than 10 percent.

But the fiscal reality may even be worse than those numbers make it appear. That’s because up to now, federal stimulus money has cushioned the blow by pumping $103 billion into the states through Medicaid since early 2009. The money has been keeping state-run health insurance programs afloat for the last two years, but it will end this summer.

Meanwhile, growing demands for help show few signs of abating, say mental health authorities.

The same economic crunch that has put states in the red has forced struggling Americans out of jobs, homes and insurance plans, creating more demand for the shrinking pool of public services.

“The safety net,” says Marylou Sudders, former Massachusetts commissioner for mental health, “is shredded.”

Big cuts

According to the federal National Institute of Mental Health, while ailments like depression occur in about one in four adults, roughly 6 percent of the U.S. population has a serious mental illness like schizophrenia or bipolar disorder. That’s nearly as many people as live in the New York metropolitan area, and it makes mental illness the leading cause of disability in the United States and Canada.

People with severe mental illnesses are more likely to have low incomes because their education was interrupted by the disease, says Elaine Alfano, deputy policy director for the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C. Employers are often hesitant to hire them, and their unexplained behaviors can alienate friends and family. Their conditions can be expensive to treat, which puts a hefty burden on the government if they qualify for public support.

According to the state directors’ survey, in fiscal 2010 and 2011 roughly half the states reported reducing the number of hospital beds in state run psychiatric hospitals. They’ve limited the amount of money they pass on to out-patient providers and cut staff everywhere. A third of states say they’ve had to reduce the number of people their programs serve.

Between 2009 and 2011, according to the National Alliance on Mental Illness, Alaska dropped mental health spending by 35 percent and South Carolina and Arizona both dropped by between 22 and 23 percent.

In the last two fiscal years Washington state cut 11 percent out of its mental health budget, dropping it to $278.5 million. The state’s proposed 2011-2013 budget proposes cutting another $42 million. Of that, $17.4 million comes out of community-based mental health services. Last year, the state served 144,000 clients through its community mental health system. The cuts would reduce that number by 26,000 — 18 percent fewer.

Scott Birdsong is the executive director of GUIDE Program, Inc., a nonprofit that offers mental health and other social services in Maryland, which cut its budget by $26.2 million between fiscal 2009 and 2011. In an effort to preserve programs, he says his staff has taken the financial hit.

“We’re all in the boat of subsidizing programs as the budgets continue to melt down,” he says. “In the last couple years our agency had to lay off about 20 percent of our workforce, 35 people, due to program closures or having to reduce personnel to make ends meet. Salaries have been frozen, fringe benefits reduced; executive staff have taken voluntary pay reductions up to 16 percent.”

In Missouri, over the past five years the number of full-time Department of Mental Health employees has dropped from 9,231 to 7,874. Four hundred more positions are likely to be cut in 2012. Accompanying the decreased mental health staff is a drop in in-patient beds, from 1,558 to 1,315 in the past five years.

Budget proposals in Texas would cut overall mental health money by $240 million, down to $2.07 billion, for the 2012-2013 budget cycle. That would mean a 20 percent hit for adult and children’s services; projections indicate that, as a result, more than 3,500 of the 53,400 adults now receiving treatment at one of 39 state-funded community mental health centers would be turned away. The number of children served would drop from 13,400 children to 12,200 this fiscal year and 11,455 in each of the next two years.

In Massachusetts, next year’s proposed budget pulls $2 million from child and adolescent mental health services, a reduction that is expected to affect 165 families; $3 million is slated to be cut from adult mental health services, impacting 2,000 adults, and $16.4 million worth of cuts would come from state psychiatric hospitals, closing 160 beds for those in need of hospitalization.

“Because we don’t have the facilities, more and more people are ending up in homeless shelters or on the streets,” says state Rep. Elizabeth A. Malia, who heads the Massachusetts legislature’s Committee on Mental Health and Substance Abuse.

“Housing isn’t available,” she says, “Crisis counseling and decent medical care isn’t there. Because of that, the number of people showing up in emergency rooms is at a crisis [level]. People can end up for days in an emergency ward because there is no room for them. We’re seeing the [prison] budget grow exponentially because the number of mentally ill people who are incarcerated is high and growing.”

Medicaid

The situation will be exacerbated further as federal stimulus dollars dry up this this summer. Some analysts are using the term “cliff effect” to describe the budget situation states face as they pull together spending plans for the next fiscal year, beginning in most states July 1.

When the stimulus bill passed in February 2009, it included an $87 billion boost to the amount of money the federal government gave the states for Medicaid. In August 2010, Congress approved $16 billion in additional funds. As a condition of accepting the stimulus money, the federal government required states to keep everyone in Medicaid that was eligible before the crisis. Those eligible for Medicaid are mostly lower-income children and their parents; not all low-income adults are covered.

A majority of mental health services are financed by Medicaid. In fiscal 2010, Medicaid enrollment growth averaged 8.5 percent in the states, significantly higher than the 6.6 percent growth projected at the start of the year, according to a report from the Henry J. Kaiser Family Foundation. Meanwhile, 20 states cut program benefits in 2010, and 14 plan to in 2011.

Medicaid is funded jointly by the state and federal governments. It doesn’t cover psychiatric hospitalization, but states can choose to use it to fund other kinds of mental health services from therapy and prescription coverage to case management and skills training, even “peer programs” in which people who are recovered from a mental illness help those who are still in treatment cope.

But on June 30, that federal stimulus money that was pumped into Medicaid will run out. Most state legislatures are still in session, hashing out their budgets, so just how states will adjust Medicaid in terms of who’s eligible and what services they can get is not yet clear. But it’s unlikely that mental health will escape more of the the budget ax.

Some states are already floating proposals. Now that the stimulus money is running out, and the mandate to maintain previous coverage levels is ending, some states are trying to return to minimum allowable coverage levels. Arizona, for instance, has signaled its desire to cut 280,000 “childless adults” it opted to cover under Medicaid in the past out of the program.

If the new health care law passed by Congress last year is implemented as planned, the federal government will eventually come to Medicaid’s rescue; everyone making less than a certain amount annually — childless or not — will be covered by Medicaid, as the result of a big planned boost in federal dollars. But that won’t happen until 2014.

A mismatch in supply and demand

In the meantime, though, state mental health budgets are shrinking while demand for their services climbs. The state directors’ survey says that half of the states report an increase in demand for community-based services, a third report a spike in the need for crisis psychiatric services and 18 percent have seen more people showing up in their emergency rooms with mental health related issues over the past coule years.

The demand for mental health programs combined with the cuts has created a backlog for providers. As staffing levels get cut, social workers have seen their caseloads increase, often leaving patients on…[click here to read the rest of this article…]

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March 16, 2011 - Posted by | Mental Health | , , , , ,

1 Comment »

  1. […] Despite rising need, mental health takes back seat (skwillms.wordpress.com) […]

    Pingback by Severe Lack of Psychiatric Resources in the US « Health and Medical News edited by Janice Flahiff | March 18, 2011 | Reply


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