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Subscribe to RSSDozens of states have slashed spending on mental health care over the last four years, driven by the recession's toll on revenue and, in some cases, a new zeal to shrink government.
But that trend may be heading for a U-turn in 2013 after last year's shooting rampages by two mentally disturbed gunmen.
The reversal is especially jarring in statehouses dominated by conservative Republicans, who aggressively cut welfare programs but now find themselves caught in a crosscurrent of pressures involving gun control, public safety and health care for millions of disadvantaged Americans.
In many states, lawmakers have begun to recognize that their cuts "may have gone too deep," said Shelley Chandler, executive director of the Iowa Alliance of Community Providers. "People start talking when there's a crisis."
About 30 states have reduced mental health spending since 2008, when revenues were in steep decline, according to the National Alliance on Mental Illness. In a third of those states, the cuts surpassed 10 percent.
As a result, nine state-run psychiatric hospitals were closed and another 3,200 beds for mental health patients were eliminated, dramatically reducing treatment options for the poor and people in the criminal-justice system. Thousands of patients were turned onto the streets.
Making matters worse, the cuts came as unemployment was rising, causing more people to lose private insurance and forcing them to shift to public assistance.
The steepest drop by percentage was in South Carolina, where spending fell by nearly 40 percent over four years — an amount that Republican Gov. Nikki Haley has called "absolutely immoral."
Now Haley, who took office in 2011, has pledged to bolster a mental health system that dropped case workers, closed treatment centers and extended waiting lists. She also wants to expand remote access to psychiatrists through video conferencing.
Both Pennsylvania and Utah have put aside plans to scale back their mental health systems.
And Kansas, which cut mental health spending by 12 percent from 2008 to 2011, this month announced a new $10 million program aimed at identifying mental health dangers.
"I don't think we're well set as a state at all to be able to deal with these intensive cases" of mental illness, acknowledged Kansas Gov. Sam Brownback, usually an avid proponent of downsizing social programs.
The sudden pause reflects anxiety from last year's shootings in a Colorado movie theater and a Connecticut elementary school. Although little is known about the mental health of either gunman, the attacks have shaken state legislatures that, until recently, didn't intend to consider more social spending. In some cases, gun-rights advocates are seeking mental health reforms as an alternative to more gun laws.
Jon Thompson, spokesman for the Republican Governors Association, said many budget-cutting governors are having second thoughts, including whether to reform mental health policies "to further invest in the safety of their citizens."
South Carolina eliminated 600 full-time case workers and closed five treatment centers. That led to an increase in the number of people with mental illness in jail in Columbia — so much that it now exceeds the patient total at the city's public psychiatric hospital.
"We've been unable to maintain those preventative measures to keep people out of jail," said Bill Lindsey, director of South Carolina's National Association on Mental Illness.
During former Gov. Mark Sanford's term, the fiscal pressure was inescapable. The recession cut state revenue by more than $1 billion from 2008 to 2011.
"It wasn't really Sanford's fault," said former state Rep. Dan Cooper, Republican chairman of the House Ways and Means Committee. "There just wasn't enough money to go around."
Revenues have since recovered somewhat, and are projected to be at levels last seen in 2008.
In Kansas, under then-Gov. Kathleen Sebelius, a Democrat, state psychiatric hospitals began treating only the most dangerous cases. Caseloads at the Johnson County Mental Health Center near Kansas City rose from the recommended 15 per caseworker to more than 30 in 2010.
Tim DeWeese, the center's clinical director, said one of his patients who had finished college and gotten a job and an apartment became homeless after his doctor visits were cut off.
"It came crashing down all the way," DeWeese said.
Oklahoma also cut mental health programs in 2010 and 2011. But Republican Gov. Mary Fallin, a conservative elected in the GOP landslide of 2010 on a promise to cut spending, reversed course last year after grim warnings about the effect on public safety, and after several teen suicides in Oklahoma City.
"There just weren't enough resources," said Harry Tyler, director of the Mental Health Association of Central Oklahoma.
Fallin approved a 20 percent budget increase and has pledged to make mental health a priority again this year.
"You'll see more emphasis on being able to identify people that might have mental health challenges," she said.
Tyler said he would encourage Fallin to provide more money for screening teenagers who could endanger themselves or others.
New Jersey Gov. Chris Christie, another Republican, has promised to fully implement a new program under which people are required to take medication and attend therapy if a judge believes they pose a risk.
Mike Hammond, executive director of Kansas' Association of Community Mental Health Centers, said his state's governor is looking for new ideas on mental health care.
"I think he's realized what's happening in our system," Hammond said.
To be sure, Republicans have not given up on keeping state government lean and taxes low. And some party members question how much mental health spending will be approved.
"I'm not telling you she gets the money," former South Carolina GOP Chairman Katon Dawson said of Haley.
Ty Masterson, Republican chairman of the Kansas Senate's Ways and Means Committee, acknowledged the same conflict: "There's obviously tension there."
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It's great if mental health help is available. I still don't think that the ones that really need it will use it. If parents were more intune with their kids, that help would be found regardless.
In any case, it can't hurt.
Lisa, it's so true that there is a general lack of awareness about the benefits to mental health services. Parents need to feel that it is in their child's best interest to seek help while they are still young. KidsPeace deals every day with kids in crisis: and we are familiar with the stigma and the difficulty some people have accessing the proper level of care.
Republicans and some democrats have been against spending that helps both ordinary people and the afflicted for 33 years. What are the odds that will change?
Gun worshipers will jump at any alternative to regulating their gun ownership, even something that should have never been cut. Republicrap "lawmakers" that shout their Christianity from the highest soapbox wring their hands at the possibility of cutting any social program that may give destitute people a hand. What these people forget to think about is we have guns too, when you become so frustrated in inequality they will take what they want, from anyone they believe can afford it. Real democrats NEVER agreed with the "downsizing of the mental health system", false democrats may have, they were wrong!
It's way too easy to turn your back and hope it "goes away". It was far easier for my parents to ignore the fact that their youngest had emotional problems, than to admit it and seek help. The "embarrassment" is harder to take than admitting it. THAT'S what has to change!
Since the recent shootings, I've read many stories of parents with mentally disturbed children with no resources to help those children. These people actually have private insurance, but so many cuts have been made to mental heath coverage, they are stuck trying to deal with those children themselves. The problem is that a mental heath issue is still a health issue, just like cancer. These people have an imbalance of chemicals in thier brain and need treatment. It is just as wrong to cut coverage for mental health as it is to cut coverage of asthma.
So true..My husband falls in the spectrum of was laid off and we lost insurance. For the short time on medicaid he had to go off his bipolar and anti-psychotic meds because they would not cover them. He also went from 3 sessions per month with therapy and mood management to only 4 paid visits per year..
His meds with no coverage to keep him stable are over 2k per month.. Talk about a mess. Expensive meds to keep you sane have prices to make you crazy.. How about big pharma not be able to charge more than 100 bucks per pill..
None the less we sought out insurance to pay out of pocket for but then he was denied for preexisting conditions..
Now we have him on cheaper meds that he has to take more of and they make him a zombie.. I hope to have good insurance again..
This is correct. I work in mental health and know that in order to get real help, it is nearly impossible. Most of the people I see are those who have had serious issues that have had the police involved. Then they get taken to ERs and placed on 72 hour holds. They are then referred to local services and get in the mental health system. The care is decent but it means you no longer have control over your child's health. it is a sad reality but the truth is until the child or adult does something serious, there are few private resources that provide comprehensive care. It is a flawed system to say the least and it just makes it more difficult for the mentally ill person to recover and build a good life for themselves when they are already so far gone.
Go ahead take rights away from people with mental disorders. Keep the rights of people who want to be armed. Both groups need psychiatric help to understand how irrational their behavior is.
How, exactly, is providing more services for the mentally ill taking away their rights?
These are the rights that could be taken away. It's incredibly easy to argue that this is a slippery slope with very dire consequences. On top of that, there are the questions about implementation. How will the judge decide if there is a risk? To whom are these people a risk, themselves or the population at large? Who decides that? What is the punishment for not attending or taking medication?
Cognitve therapy, pysciatric drugs and inpatient and outpatient facilities are sorely needed throughout the nation.
The shootings are only the tip of the iceberg. If you view or read stats on the current prison population, a large number have serious mental health issues. 1 in four Americans are said to have a mental disorder. We have to start to roll back the trend that started in the 70"S , of relying on mainly on meds to manage this problem. Personally, I have witnessed incredible changes in individuals who have done due diligence and had the full spectrum of treatment modalities. It is very expensive, but, it is cheaper than incarceration . If loss of life or suicide is avoided, who can put a prince on a human life? And finally, if we can wrap our minds around how this is turning our nation into a armed fortress, is it not worth the effort and cost to live in a peaceful society, as we once did?
Steve,
You make great points.
The problem is that for every politician and public servant concerned about long term fiscal problems of housing people who committed crimes because of mental health problems that could have been treated, there are twenty who see the profit to be made in attorney fees, court costs and privatized prisons, not to mention the money that will have to be found for expanded budgets to include more bodies in the justice system.
And while there are layoffs now, when it comes to their perceived safety, people will soon start approving tax hikes to pay for law enforcement, especially with the new restrictions on how they will be able to protect themselves and their families.
My gawd. Yea, use more tax dollars for "mental health" aka big-pharma solutions which are already raking in billions over the promotion of "One in Four" have mental health problems.
25%???? Doesn't that wave a flag for you?
And the solution? DRUGS which themselves have the major liability of increased suicidal and homicidal actions. Get real, and take a look. The psychiatric/big pharma solution has NOT improved the problem at all, and the numbers only seem to get higher and higher, and the big-pharma/psych base rake in more and more profit.
The Marketing of Madness.
google selection bias
Forgive me if I'm overgeneralizing, but I wonder if someone who doesn't believe in mental illness or medication doesn't have anyone close to them that has a severe mental illness. Most of the people I know that feel this way do not, or refuse to accept that someone close to them does have a mental illness.
Granted, mental illnesses can be over diagnosed, but that doesn't mean that they don't exist and cause serious impairment in many people. For those people, often a combination of both medications and good therapy are necessary for reduction, or even remission, of their mental illness.
There is actually debate in the medical community on how real the increase in suicidal thoughts while taking antidepressants is. (). One thing to remember is that a majority of the time antidepressants are given to people with depression, in which suicidal thoughts, attempts, and suicide are always a risk. This risk is especially high in someone with severe depression.
Sadly, one of the mechanisms where use of antidepressants might appear to trigger overt suicidal thoughts or attempts, is that they increase a person's energy and motivation before they start to alleviate other parts of depression. Where they might have had thoughts of suicide before, they might not have had the energy or motivation to act before.
Another reason that a person might become suicidal or erratic after starting an antidepressant is that sometimes a person won't realize that they have bipolar disorder rather than just Major Depression. Antidepressants given to someone with uncontrolled Bipolar Disorder can become manic or even depression and mania at the same time.
Even if there is a real increase in suicidal thoughts and actions related to antidepressants, that's actually an argument for making sure that someone is severely depressed is under the close care of a good psychiatrist and psychologist. In more severe cases hospitalization may even be necessary.
The sad truth is that there just aren't enough psychiatrists, therapists, and good inpatient hospitals out there. Having good insurance helps, but it can still be very hard to find a dr or therapist. Many don't take new patients, or can't get a new patient in for weeks or even months.
And there are fewer and fewer beds at mental hospitals every day. Even people actively suicidal or in danger to others find that beds might not be available for days or without going long distances away. When they do find a place for inpatient care insurance companies fight tooth and nail not to pay for stays. The staff at a hospital literally fight every couple of days, if not every day, to convince the insurance companies to not discharge people still in serious need of help. Someone without insurance has even fewer options.
The reality is that for many people medications (along with therapy) can help a person function in society and in many cases save their life. In my case I would probably be dead if I wasn't on a combination of meds and therapy that keeps me stable. Before these medications I alternated between mania and soul crushing depression. I've spent more time in mental hospitals than I care to think about.
Ever since I've been on these medications and (to a lesser extent) found a good therapist I became stable and happy for the first time in over a decade. Trust me, I'd give up the medications if I could. They're expensive even with insurance and who wants to take medications for the rest of their life? Unfortunately, I've tried multiple times to go off or decrease my medication. Each time I started sliding into depression within weeks.
One final thought: One of the arguments for no funding mental health care is that it's expensive. What tends to get overlooked is that someone who is moderately to severely ill will have a much harder time contributing their full potential to working or going to school. It's a lot cheaper to treat people with mental illness and increase the number that can contribute full to society than it is to not treat them and have them working under capacity at a job or even impaired enough to be unable to work. It's also cheaper to treat them than have them end up in jail plus still unable to contribute.
Our state did away with the state-run mental health institutions in the late 1980s. There was a building boom in prisons right after that, so it's clear where the people ended up. I don't know of anyone who could afford to place a loved one in a private in-patient care center, and insurance does not cover that--assuming that a family actually has insurance. After a child turns 18, they can't be forced to take medication, either. Mental health issues have been swept aside for a full generation.
Don't know where you live essie, but I notice they didn't mention slashed budgets in Texas. Hard to slash something that doesn't exist. That's okay, the lege here is happy to execute folks with or without mental issues -- even innocent ones.
I've been waiting to see when this contradiction surfaced: Those who oppose gun control say that mental health is the issue not guns.
But aren't these the same people who champion cutting government funding for public mental health? They scream "address the mental health problem!" when we talk about gun control, but scream "no more spending!" when we talk about addressing health issues.
Ya think? So which is it, ya f-in' hypocrits? Leave the guns alone or leave health care alone? Or do you want to ignore both problems and just go on having mass murders every other month?
This is SO on target. They want to have it both ways and we're realizing that they CAN'T. If they say Mental Health is the problem instead of ready access to firearms, then they need to get off their duffs and ADDRESS IT. If they say they don't want to address mental health, then they need to get off their duffs and come up with REASONABLE, RATIONAL gun control. There is NO MORE "We can't have gun control but we also can't have funding for mental health care for those who need it". ANY politician who advocates using a line similar to that needs to be denied a job in government. PERIOD.
just to be up front- I have no great love for repubs however I can see their point on both issues. We can need mental health care funding all day long but if we don't have the money, we don't have the money. Does this lead to people dying, yes every day people die and are permanently injured for want of a variety of things- healthcare, a warm home, proper food etc. The question is what can we do better with the funds we do have? Would gun control work? I doubt it, it was already illegal to murder people and already illegal for them to handle guns by the nature of their illness but it did not stop them, how is yet another law going to help? I am not sure this is a solvable problem at all- how many will die once they can no longer protect themselves? I bet more than was lost in any given shooting in any given year- so your just trading deaths at that point. We could try to do more with mental health care but no one wants to pay more taxes to pay for it and i am not certain we could even if we did. We can't pay our bills as it is. Even if we could some people will flat refuse treatment, then what? we decided it was inhumane to lock them up and drug them against their will. Which nasty do you choose? do you just accept that some deaths are inevitable and fewer will die doing nothing, do we violate people rights and bring back asylums, money would be the great painless answer but where are we going to get not only enough money to pay our existing bills but provide expanded coverage to babysit every single mentally ill person, do we ban guns and just accept those preventable deaths as ok, do we risk disarming and being attacked by a foreign nation- as Japan would have done in WWII if not for the threat presented by our armed populace.
aggrevatedofficeworker...
Yes, it's a tangled knot of a problem. But your post seems to basically say: "What we've tried so far hasn't worked and trying something else is too expensive, won't work and may cause even more deaths; so we should just do nothing." (Correct me if I've paraphrased your post incorrectly)
I refuse to allow my representatives to throw up their hands and say "We can't solve this problem". We can find some relief; there are actions we can take that are worth the effort and cost to reduce the death and destruction.
I agree that we can't stop anyone dying ever, but like hospital ERs, we must do triage and address big problems even if the solution impacts our ability to solve smaller problems. At this point I could Google and quote the number of mass shootings and total people killed by guns, but you don't need me to. They have been spewed over the media ever since Sandy Hook and it's obvious that the number of gun deaths are significant.
My question is how many people a year don't die because they had a gun? And I mean "don't die" as opposed to "don't get robbed"... there's a difference between fending off a fatal attack and scaring off a would-be mugger/burglar. How many people (civilians, not cops or military) a year save themselves from dying? 100? 300? I doubt it's that many. I'd be extremely surprised if 1000 year actually stopped a murder because they had a gun.
And that's just if you take away ALL guns. We can have gun control that let's responsible owners keep their guns but still reduces the number of deaths because someone who has no business owning a gun gets ahold of one and takes a life... or 20.
Additionally...
I see several posts that assume that the mentally unstable will be prevented from getting a gun by involuntarily committing them to asylums. Addressing mental health issues doesn't mean start locking people away for any reasons that we don't do it already. We won't lock people up just to keep them from getting ahold of a gun.
Mental health parity laws are making sure that mental health treatment is handled exactly the same by insurance companies as any other illness, However, that still ignores the issue of when the states pay out medicaid, and the issues of mental health institutions. Prisons as places to put the mentally ill are not the answer as those who guard the prisoners are totally untrained and often unsuited to helping the mentally ill. Bringing back psychiatric hospitals can be either good or bad - depending on how they are designed and staffed and managed. Would be nice to learn that we treated the mentally ill with compassion, as well as confinement if needed.
Mental illness is an invisible disease that is often terribly misunderstood, the tragedy is that many times it can be very manageable with medication, support and understanding. I believe because of poor understanding and treatment of mental illness we tend to see more and more horrible tragedies unfolding. We have a mental illness epidemic in the world, unfortunately mental illness is too often so misunderstood even by the professionals, too many wind up homeless, addicted, dead or in jail. Families that need help and see the impending doom coming too often find that there is either no help or inadequate help. Because government cares more about special interests then the country,these problems will keep getting worse and all the gun control in the world will not solve it.
I agree that state and federal cuts in mental health care can have unintended (and violent) consequences, but the Aurora shooting and the Newtown shooting are unlikely to have been affected. The Aurora shooter seems to have been under mental health care already, and clearly it didn't help. He came from a decent family and was a grad student, so he was not some poor kid without any resources.
Ditto the Newtown shooter. His mother had so much money from alimony (according to info that was made public after the shooting) that there is no way she couldn't afford to get him help if she thought he needed it. She made more in a month or two from alimony than many make in a year. Whatever their problems were, they weren't from lack of resources.
The mental health issue is really complicated. The problem is that in many cases, nobody really knows what somebody is going to do. You know they are kinda nuts and maybe you are afraid that they might get violent, but you can't put somebody away forever until after the terrible thing happens. I'm not so sure that there's much that can be done to prevent people from going postal like this. There are so many people who seem angry and unbalanced who never actually do anything bad--and then some who seem a bit weird and than whammo! They go off the deep end. The fact that the Aurora shooter was reaching out and saying he was afraid he might be violent is a perfect example. Even if he had been locked up for a short time, he easily could have done this later. I don't know how much of a "cure" is really realistic.
One of the problems is that people who themselves have significant mental/emotional issues are often drawn to careers in psychology. In other word, the nuts are in charge of the lunatics.
There are people who can be labeled—for want of a better word—Empaths. These people should be identified in youth and encouraged to enter mental health fields. They are capable of judging the potential for violence, and also able to provide healing interaction.
This is a resource that is completely ignored.
GOPukes don't care about this issue, just their ideology.
There are a lot of people with mental health issues that lead productive lives with medication. That in itself is the problem. My daughter was diagnosed with bi-polar in her senior year of college. Thanks to being insured she got the right help and medications. She has not had a manic episode since starting her medications. About 3 years after this she became unemployed and her medication was going to cost her between 600 to 800 a month out of pocket. I was able to find her help with the drug companies to cover the cost until she was able to find a new job but in 2009 it was not a good year and it took her 9 months. However not everyone knows these programs are out there. They are not easy to enroll either. Her unemployment paid her rent and essentials and we helped out with the medication which was a hardship for us, but luckily only for a month until her assistance kicked in. She was living 2000 miles away and couldn't just move home. I wish something could be done to reduce the cost of these drugs - also you have to be monitored by a psy. and that is pricey. Unless you are insured - you have a choice of putting a roof over your head or taking meds.
So Lee, what's your solution?
On other threads I've seen people advocating for immediate execution of the mentally ill, "just in case..."
Well here in Arizona one would have to start with the state legislature. 80-90% have some type of mental retardation issue. It's a tough decision since we wouldn't be sure if any of the mother truckers can be helped and we could end up wasting time and money that could be used elsewhere.
so what would you do then???? Murder them??? talk about too many asses posting..
Where are all the senators who are so concerned for the safety of our citizens? They should be righteously pounding on pulpits and climbing on their soapboxes in every city in the USA. Every gun owner isn't mentally unstable. Every one who shoots people for reasons only they can know is mentally unstable. Drive through any city & you will be overwhelmed by the people living in boxes and under overpasses. This seems to be epidemic. Most of them need mental health services. They may not have needed help before they got there, but by the time they have adapted their minds have been injured. Come on politicians. Get off your high horse and do something for your fellow citizens. They need you and are being pushed aside so you can make some feel good noise about something that will never make any difference to anyone but your self & your hypocritical clique.
.. gee we didnt see this coming? really? it took the deaths of 20 children and 6 adults and those at the aurora theater..etc etc
so i wish they could tell me just how many died at the hands of psychos in 2012
Mental health care is already difficult to obtain. Rather than relying on the government to drive it, why not add mental healthcare to the Obamacare bill and require insurance companies to pay for it? That would free up governmental agencies to police the healthcare insurance companies and everyone would benefit from the additional required services.
obamacare does cover it, but not strongly.
let's see south carolina closes mental health services ( at a cost of ,lets say $6,000 per year for out patient services) and now there is an increase in mental health patients in the jails ( at a cost, lets say $20,000 per year of jail time). You people in south carolina sure know how to save money! Oh, Mr. Christie of NJ, so your going to MANDATE that people take meds. and get therapy. Is there massive funding tied to that, as oppossed to the decrease in funding presently underway in nj; considering it can take up to six months or longer to recieve treatment in NJ.