State Budget Cuts Slash Mental Health Funding

BY Betty Ann Bowser and lea and winerman  January 17, 2011 at 1:37 PM EDT

Over the past ten days, the story of 22-year-old Jared Loughner, the alleged gunman in the Tucson shootings, has unfolded on news outlets throughout the world. It’s a dark tale of a troubled young man who was growing increasingly out of control — yet it seems neither he nor members of his family realized he needed treatment from mental health professionals.

Until two years ago, there were a number of programs in his community that would have been available to Loughner and his family if they had sought help. Like many places around the country, Pima County had mental health programs for people through both Medicaid and at community health centers. But now those programs have been cut because the state of Arizona is wrestling with a massive budget deficit.

Arizona has long offered mental health services, such as case workers and prescription drug coverage, to residents who don’t qualify for Medicaid, but also don’t have private insurance that covers mental health services. But since 2008, the state has had to slash a whopping $65 million from that program, affecting as many as 28,000 people last year.

Who are they? Mostly residents who’ve been mentally stable for years, being treated with prescription drugs, counseling and group therapy through programs in the area. Now, thousands of patients have lost their case workers, their doctors and access to group therapy, and many have been forced to take generic medications because the state no longer pays for most brand name drugs.

Bill Kennard, executive director of the Arizona chapter of the National Alliance on Mental Illness, said the dramatic change in drug policy meant the formula went from whatever worked to an all-generic formula. So, Kennard said, a patient who finds that a more expensive drug works better for them now has pay for it himself, or switch to a generic drug.

Arizona is not the only place facing massive cuts to mental health services. Across the country, public programs for the mentally ill are on the chopping block because of huge state budget deficits.

Most of those affected by these new cuts are on Medicaid or indigent – and are persons with serious or persistent mental illness, according to Dr. Laurence Miller, who heads the American Psychiatric Association’s Committee on Public and Community Psychiatry.

Miller says nine states have closed down some public psychiatric units and substance abuse programs to save money, including Pennsylvania, New Jersey and Indiana. Mississippi closed 184 beds at its state hospital.

Funding mental health services has always been a challenge in statehouses across the country, Miller says. The lack of an advocating constituency and stigma, he says, are the root of the problem.

And although Medicaid spending in the states has risen, states all over the country have actually cut some Medicaid benefits. But they’re targeted – the new federal health care reform law and the economic stimulus legislation won’t let states cut eligibility requirements without losing federal funding. That means they’re cutting benefits wherever they can, including mental health.

But some analysts say that cutting mental health services now will eventually cost cities and states money, as more people who’ve been cut from these programs become unstable and find themselves in conflict with law enforcement.

In San Francisco, Dr. John Rouse, a psychiatrist at San Francisco General Hospital told The Examiner that “[i]t means more people in jail, it means more people pushing shopping carts down Market Street, it means more wasted resources because it makes it hard to intervene early and cheaply.”

The major provisions of the federal health care reform law are scheduled to take effect in 2014. If left intact, they’ll help solve some of these state budget problems, at least temporarily, as millions of Americans who cannot get mental health coverage through insurance or state programs today will have access to both under the law, and almost all of funding for the expansion of Medicaid will come from Washington for the first few years of implementation.

Between now and then, however, there is a rough road ahead for the nation’s poor — who also happen to be mentally ill.