Despite the prevalence of mental health issues in the United States, federal and state budget cuts have led to decreased funding for many mental health services for the people who need it the most.
Utah was one state recently in the news due to mental health service budget cuts. Over 2,000 patients were no longer assisted by the nonprofit organization Valley Mental Health. Budget cuts have meant that the agency could only keep coverage for the most severely mentally ill patients, and the other patients were transferred to other providers.
Even though the patients in Utah are luckily able to receive similar services elsewhere, many have to make major adjustments after having the same therapist or support group for years.
States like New York are trying to find solutions to the budget problem. A New York Times article reported that the state of New York currently runs a mandatory outpatient program for people with severe mental illness who are using services from the mental health care system. The article added that costs to the system and Medicaid have dropped at least by half.
The program was developed in response to Kendra’s Law, which was created after a woman named Kendra Webdale was killed when she was pushed onto subway tracks by a man with untreated schizophrenia. Patients are monitored by caseworkers who make sure they go to therapy and take medication.
Treatment Advocacy Center, a nonprofit organization, states on its website that assisted outpatient treatment is a viable option in the face of state budget cuts. This type of treatment for people with mental illness helps prevent costly re-hospitalization and a cycle of arrests.
Wendy Brennan, the executive director of the National Alliance on Mental Illness of New York City (NAMI-NYC Metro) said in an email that as part of budget cuts in New York, health care funding does have to be reduced, and currently NAMI is helping with the state with the redesign of Medicaid. They are moving from a fee-for-service system to a managed care system for people with serious mental illness.
“NAMI-NYC Metro is hopeful that the cost savings for those high needs Medicaid users will come from integrating physical and mental health care, which has been traditionally fragmented and poorly integrated for this population,” Brennan said.
She said that adults will be transitioning to managed care in New York on January 1, 2015, and children will be moving to managed care on January 1, 2016.
“We also strongly advocate the inclusion of peer-led education and support services led by families members who have a loved one with mental illness and people with mental illness themselves,” she said.
“These services help reduce the stigma of mental illness and in turn, result in families and those with mental illness obtaining treatment earlier and participating more fully in their own care and that of their loved ones to promote recovery.”
There are other health care issues that New York is having to work through as well. In regards to clinics, state licensed clinic providers are finding that current rates “are not sufficient to sustain service delivery,” so rates are having to be restructured.
“NAMI-NYC Metro is concerned that clinic access will be reduced for those with the highest behavioral health needs,” Brennan said. “Additionally, the reimbursement rate at clinics is lower for patients with private insurance, making it less likely that providers will treat them.”
And although people with low income will have more access to mental health coverage due to the Affordable Care Act, there will likely be a shortage of providers, and they won’t be as willing to take private insurance potentially, which will actually cause access challenges.
“Very poor and working poor New Yorkers will find it increasingly difficult to access behavioral health services,” Brennan said.
Although she believes it will be nearly impossible to find behavioral health specialty care that is available, Brennan does have another solution for this problem.
“Pediatricians and primary care doctors must receive better training and the tools required to treat, identify, and refer - when necessary - to behavioral health providers,” she said. “The entire orientation of the medical profession must change.”
“Good health and overall well being must include good physical and mental health,” she added.
“Pediatricians and primary care doctors will have to screen for mental health as part of the annual checkup. These doctors must also be equipped with tools needed to treat mild mental health conditions, and to have the judgment required to make appropriate referrals to a specialist when needed.”
Despite the current state of mental health services, the future could hold more promise. According to the Office of Management and Budget, the fiscal year 2014 budget proposal includes more funding for prevention and treatment services for mental health.
Sources:
Office of Management and Budget. The White House. Improving Mental Health Prevention and Treatment Services. Web. September 2, 2013.
http://www.whitehouse.gov/omb/budget/factsheet/improving-mental-health-prevention-and-treatment-services
Healy, Jack. The New York Times. Mental Health Cuts in Utah Leave Patients Adrift. Web. September 2, 2013.
http://www.nytimes.com/2013/07/25/us/mental-health-cuts-in-utah-leave-some-feeling-adrift.html?_r=0
Cummings, Bruce. The Salt Lake Tribune. Valley Mental Health’s side. Web. September 2, 2013.
http://www.sltrib.com/sltrib/opinion/56607402-82/health-mental-optum-services.html.csp
Brennan, Wendy. Email interview. September 1, 2013.
Belluck, Pam. The New York Times. Program Compelling Outpatient Treatment for Mental Illness is Working, Study Says. Web. September 3, 2013.
http://www.nytimes.com/2013/07/30/us/program-compelling-outpatient-treatment-for-mental-illness-is-working-study-says.html?pagewanted=1&hp
Treatment Advocacy Center. State Budget Cuts. Web. September 3, 2013.
http://www.treatmentadvocacycenter.org/problem/state-budget-cuts
Treatment Advocacy Center. Assisted Outpatient Treatment – Frequently Asked Questions. Web. September 3, 2013.
http://www.treatmentadvocacycenter.org/component/content/article/1336
Reviewed September 3, 2013
by Michele Blacksberg RN
Edited by Jody Smith