More than two-thirds of states cut mental health funding from their general fund budgets over the last two years, according to a report released by NAMI last week. New York’s Governor Cuomo submitted a budget that strips education in that state of more than $1B in funding in the coming fiscal year. California’s Department of Mental Health is being reduced to a paltry 19 employees in order to transfer oversight and control to the local county level. Kentucky cut mental health spending by 47 percent, Alaska 35 percent, and South Carolina and Arizona both 23 percent. We still don’t have a 2011 Federal budget! All of this cutting is happening at a time most experts would agree should be devoted to figuring out how to preserve the best of our public mental health, substance abuse, child welfare and developmental disabilities programs and systems in relation to the Reform law’s expanded view of community-based programs, schools-based programs, screening and early intervention and prevention.
How?
The operative challenge facing these fields is one of rapidly wrapping our heads around the following simultaneous “drivers”:
- Making very deep budget cuts (and the accompanying reductions in workforce)
- Absorbing or mitigating sharply increased demand (due to two long wars and long, deep, unemployment-riddled recession)
- Building infrastructure and capacity for school and community-based programs inherent in the reform law
- Implementing Parity in commercial health plans and Medicaid managed care plans
- Defining and implementing “Essential Benefits” – particularly among looming Health Insurance Exchanges
- Building capacity to participate in Accountable Care Organizations
- Preserving the best of our systems of care for use in Health Insurance Exchanges and expanded Medicaid populations
The list goes on and all or most of it is both counter-intuitive and – in some cases – mutually exclusive. We cannot absorb nearly 50% decreases in funding AND build capacity for Medicaid ACOs. We cannot serve an epidemic of behaviorally-based disorders like obesity in children and PTSD in our returning service men and women WHILE shuttering and dismantling clinics and programs. We cannot prevent mental health and addictive disorders (most of which are preventable) by the onset age of 14 if we decimate prevention and healthy lifestyle program funding. Frankly, health insurers should be nervous. They are about to absorb 32 million uninsured Americans 2-3 years after their pulicly-financed treatment shrivels up. I don’t think that’s what they agreed to.
Drastic cuts in mental health and addiction treatment spending necessarily and unequivocally translate into costs shifting to emergency rooms, schools, law enforcement, local courts, jails and prisons. These cuts amount to an act of mass-delusion and deception whereby unsuspecting voters fail to understand how it is that they will pick up the tab on the interdiction and institutionalization side of the equation. Passing the buck will not work. It didn’t then and it won’t now.
For providers and care managers who have the wherewithal and money to move quickly and adopt new business models, the future is bright. For small, non-profit providers and those who rely on public funding sources such as Federal Block Grants, state and county programs, the future is terribly uncertain and most likely involves some rapid strategic partnerships and immediate attention to joint ventures or mergers.
For the public, the result will look a lot less like community services and a lot more like health insurance and managed care. A lot more emphasis on health and a lot less on human services. Hopefully, some of these dire predictions can be avoided but it honestly doesn’t look good from here.
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