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A Nation in Crisis - Mental Health Care: Present & Future

MORE FACTS + OUR OPINION

Did you know that as part of the Affordable Care Act (ACA) that doctors and other health care providers are supposed to ask about guns in the homes of their patients? ACA states that this question needs to be asked especially if their patients show signs of certain mental illnesses or if they have a young child or mentally ill family member at home.

Database of Discrimination

The federal government wants to have a national database of all people (adults and children) with a mental health illness. This is discrimination at the very least. Why not a database of all people with cancer, AIDS, Alzheimer's or STDs?

We have just one question. What is the "real" reasonining behind this database - the hidden agenda?

President Obama's 23 Executive Actions in Gun Violence Reduction Measures

These actions came about after the tragedy at Sandy Hook. While many individuals have expressed opinions regarding if things would have been different if Mr. Lanza had received appropriate and timely mental health care treatment, Mr. Obama is choosing to primarily address guns and gun control. His last listed action (added almost as an afterthought) is regarding mental health care.

Mental health care needs to be up front not pushed to the back. Within Obama's executive actions, the first health-care related topic he addresses is emphasizing that doctors and health care providers need to ask patients about guns and teach them about gun safety.

The remainder of his thoughts on mental health care include Project AWARE (Advancing Wellness and Resilience in Education), which is to provide Mental Health First Aid to teachers and other adults who regularly interact with students to recognize young people who need help and ensure these children and their parents are referred to mental health services.

Project AWARE is a program doomed to failure. Anyone who works in the mental health field knows how complex mental health illnesses are - in fact, when it comes to determining the proper diagnosis and treatment for children, it is very difficult. Qualified, trained, knowledgeable, and experienced individuals need to be the ones to determine whether or not a child has a mental health illness - symptoms of illnesses often overlap or can be misinterpreted. A school teacher or staff member will not be able to make these distinctions. This can lead to further difficulties in finding appropriate and timely mental health services for children who need it as mental health care providers will have even less availability then they currently have as they may become inundated with referrals for mental health care services and evaluations from within the public education system.

Our Thoughts

We do not see ourselves as Republican, Democrat, Liberal, or Conservative. Our concern is the lack of public awareness regarding mental health care - especially for children.

We are deeply concerned with the current state of affairs regarding mental health care - the stigma still attached to mental health illnesses; the lack of access to appropriate, timely, and necessary treatment and services; and how tragedies with mentally ill people are used to further ones political agenda.

We believe that America needs to become more aware of what individuals with a serious mental illness go through and what their families experience. America needs to understand that many tragedies (whether of national significance or personal tragedies for an individual and/or their family) can be avoided if appropriate and timely mental health care services are available

1 in 17 people in America live with a serious mental illness such as bipolar disorder, major depression, or schizophrenia. About 1 in 10 children live with a serious mental health illness.

Between 2009 and 2011, massive cuts to non-Medicaid state mental health spending equaled almost $1.66 billion. Subsequently, states have cut vital services for tens of thousands of youths and adults who live with serious mental illnesses. These services included decreases and/or eliminations of community and hospital-based psychiatric care, housing, and access to medication.

THE IMPACT OF CUTS TO MEDICAID/MENTAL HEALTH SERVICES

Communities pay a very high price for cuts to Medicaid. Communities and states don’t save money, as cuts to services simply shifts the financial responsibility to community hospitals, emergency rooms, law enforcement agencies, correctional facilities, and homeless shelters.

Massive cuts to mental health services also carry the potential risk of impacting public safety. People who live with serious mental illnesses are no more violent than the rest of the population. In fact, it has been highly documented that these individuals are more often the victims of violent acts. However, the risks of violence among a fairly small subset of individuals may increase when appropriate supports and treatment are unavailable. The use of drugs and alcohol as a form of self-medication can also increase these risks.

Unfortunately, the public often focuses on mental illness only when a highly visible tragedy occurs. Examples of these events that put a spotlight on mental illness include the tragedies at Sandy Hook in Newtown, Connecticut, Virginia Tech, and Tucson/Rep. Giffords. However, less visible tragedies occur daily such as suicides, homelessness, arrests, incarcerations, and school dropouts. These personal tragedies also occur because of our failure to provide access to effective mental health services and supports.

MENTAL HEALTH CARE SERVICES FUNDING

The two primary, and largest, sources of state support for mental health services are Medicaid (a joint Federal-State program) and state general funds administered by state mental health authorities. In June of 2011, enhanced federal funding of Medicaid will expire causing significant reductions in federal support. In response, many states are proposing to make changes that will further erode vital treatment and support for mental illness. This is extremely concerning as state general funding of mental health care is the last resort and “safety net” for many children and adults living with a serious mental illness.

Between 2009 and 2011, states cumulatively cut over $1.8 billion from their budgets for services for children and adults living with a serious mental illness. The amount cut in a number of states is astounding. Below is a list of the ten states that cut the most in general funds from their mental health budgets in these years:

  • California: $587.4 million
  • New York: $132 million
  • Illinois: $113.7 million
  • Arizona:$108.4 million
  • Massachussetts: $63.5 million
  • Ohio: $57.7 million
  • Alaska: $47.9 million
  • Washington, D.C.: $44.2 million
  • South Carolina: $40.5 million
  • Nevada: $39.2 million

As states vary in the size of their overall budget, population, and the number of children and adults who live with a mental illness, it is important to further evaluate these cuts by percentages. Below is a list of the ten states with the largest cuts by percentage of overall state mental health care to general fund budgets in these years:

  • Alaska: 35%
  • South Carolina: 23%
  • Arizona: 23%
  • Washington, D.C.: 19%
  • Nevada: 17%
  • Kansas: 16%
  • California: 16%
  • Illinois: 15%
  • Mississippi: 15%
  • Hawaii: 12.1%

In the three years (2009-2012) that President Obama has been in office, the National Association of State Mental Health Program Directors (NASMHPD) states that America has seen the largest reduction in funding in public mental health since the de-institutionalization phase of the 1960s and 1970s. Furthermore, during President Obama’s first three years, overall, states have cut at least $4.35 billion in public mental health spending.

WHAT SERVICES ARE BEING CUT & WHAT THIS MEANS FOR AMERICA

The existence of appropriate services allows people with serious mental illnesses the opportunities to achieve recovery and independence. Lack of services and support often leads to worsened conditions with adverse consequences that can cost communities dearly.

For children and adults who live with a serious mental illness, the consequences can include more frequent emergency room visits, hospitalizations, homelessness, encounters with juvenile and criminal justice systems, loss of critical development years, premature deaths, and suicides.

In the beginning of the recession, states handled the mental health budget reductions by cutting state office personnel, reducing staff hours, and reducing other administrative expenses. As the recession deepened, this wasn’t enough. Budget cuts began to focus on eliminating or downsizing programs, services, and the professional workforce (social workers, psychiatrists, psychologists), and reducing eligibility for services

Since 2009 when President Obama took office, 3,222 psychiatric hospital beds are no longer available to patients. This is approximately 10% of all state psychiatric beds gone in just three years.

Additional specific services that have been downsized or eliminated include those that are the most essential to assisting children and adults who live with a serious mental illness avoid crises and move towards recovery. These services include:

  • Acute (emergency) & long-term hospital treatment
  • Targeted, intensive care management services
  • Crisis intervention teams and crisis stabilization programs
  • Assertive Community Treatment (ACT) programs
  • Supportive housing/assisted living
  • Targeted case management and clinic services for children and adolescents
  • Access to psychiatric medications

THREAT TO MEDICAID

The American Recovery and Reinvestment Act of 2009 (ARRA) provided federal fiscal relief to states in the form of a temporary increase to the federal Medicaid matching rate (FMAP). This resulted in an additional $87 billion in additional federal funds flowing into state Medicaid programs. This temporary increase in FMAP was scheduled to end in December of 2010, but Congress voted to extend it an additional six months through June 30, 2011, but at a lower rate. After June 30, 2011, the amount of Medicaid dollars from the federal government will draw down and most likely decrease significantly.

States may respond to this loss of federal Medicaid dollars in multiple ways. One of the most common, as well as most harmful, is to cut back on optional services currently available in state Medicaid programs. All Medicaid mental health services for children and adults fall into the optional category with the exception of Early Periodic Screening Diagnosis and Treatment (EPSDT) for children.

FUTURE CUTS TO THE FUNDING OF MENTAL HEALTH CARE SERVICES

In addition to all of the cuts and reductions that have already occurred, President Obama’s proposed Fiscal Year 2013 budget cut $142 million from The Substance Abuse and Mental Health Services Administration (SAMHSA) bringing it down to $3.4 billion. Another $54 million may be eliminated through “non-program related activity”. Mental health block grants remained the same as Fiscal Year 2012. Suicide-prevention programs are reduced by $10 million to $48 million.

Using the excuse of the “fiscal cliff” charade, President Obama’s proposed budget was never passed. As part of this, President Obama and House Speaker Boehner have been discussing long-term cuts to Medicaid, which underwrites services for more than 60% of people in the public mental health system. Mental health advocates like Sarah Steverman, the director of State Policy for Mental Health America, believe the result could be disastrous. Ms. Steverman is quoted from an MSNBC interview, "As there’s a decrease in coverage or a decrease in providers, the longer people have to wait for appointments, the less likely to get the help that they need. It’s always been a problem and I think we’ll see an even bigger problem if we do have cuts to Medicaid."

In a July 15, 2012 presentation, Joel Miller of the National Association of State Mental Health Program Directors stated that approximately 33% of all newly-insured people under the Affordable Care Act Medicaid expansion have behavioral health conditions. About 50% of this group could have a serious mental illness.

According to the National Alliance on Mental Illness (NAMI), if sequestration takes place, there will be at least an 8% cut to resources that people with a mental illness depend upon, including special education and related services, supported housing grants, and mental health research.

CONCLUSIONS

All of the information presented in this article is based upon facts. There is no political agenda or affiliation - only a need to increase public awareness about the current state of affairs regarding mental health care services. If the public was more aware of the national crisis regarding mental health care, and was more informed about mental health illnesses in general, they would more easily be able to see where blame should be placed. It is people, not objects that create tragedy - people who choose to ignore the importance of providing appropriate services to those who are in need.

Given recent events like the tragedy at Sandy Hook, it is shocking that this horrific tragedy would be used to focus on a political agenda of gun control instead of looking at the bigger picture - the lack of appropriate and timely mental health care services. Could this tragedy and many others be avoided if children and adults had access to appropriate, timely, and necessary mental health care treatment?

REFERENCES

If you are interested in learning more about these issues or are just curious about where our facts were obtained, please see the list of references below:

  1. The Numbers Count – Mental Disorders in America
    Author: National Institute of Mental Health
  2. The Impact of the State Fiscal Crisis on State Mental Health Systems: Fall 2010 Update
    Author: T. Lutterman of NASMHPD Research Institute, Inc.
  3. Under Obama, Billions Cut from Mental Health Programs
    Author: LaRouchePac/Lyndon H. LaRouche, Jr.
  4. FULL DETAILS: Fact Sheet on the President’s Plan to Reduce Gun Violence
    Author: Fox News Insider
  5. State Mental Health Cuts: A National Crisis – A Report by the National Alliance on Mental Illness. March 2011
    Authors: Ron Honberg, Sita Diehl, Angela Kimball, Darcy Gruttadaro, and Mike Fitzpatrick
  6. Mental Health: A Report of the Surgeon General - 1999, pp. 408-409, 411
    Authors: U.S. Department of Health and Human Services
  7. States Consider Medicaid Cuts as Use Grows- New York Times, February 18, 2010.
    Authors: K. Sacks and R. Pear

 
   
   
   
   

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