At least thirty-six states increased funding for mental
health services during 2013, according to a recent
report by the National Alliance on Mental Illness. And last week, Vice President Biden announced
that the federal
government was adding $100 million in new funding for mental health
services.
So have we turned the corner on our nation’s mental health
funding crisis, as many of the accompanying news headlines seemed to imply? Or are these initiatives more a token gesture
aimed at mollifying the mental health advocacy community in the aftermath of
the Sandy Hook massacre, as
others have suggested?
I think that – with a couple of notable exceptions in
Connecticut and Texas – the initiatives tend more toward tokenism than real
change.
Consider the national initiative. On the face of it, $100 million sounds like a
lot of money. But it still represents
only around 3 percent of the Substance Abuse and Mental Health Services
Administration (SAMHSA) budget, the agency which provides most of the direct
federal funding to state and local mental health programs.
If the $100 million were distributed equally throughout the
country through SAMHSA, it would provide for only a modest increase in
community mental health budgets. But this
is not what the Administration has in mind.
Instead, half of the money has been promised to community
health centers through the Affordable Care Act to help them support the mental
health services they have been required by law to provide for the past
generation. And the other half will be given
to the Department of Agriculture (yes, Agriculture) to provide loans to rural
community mental health centers and for telemedicine and other programs through
the USDA community facilities direct loan program.
So the “$100 million for mental health” doesn’t look quite so
impressive anymore.
But the truth is that funding mental health services has
always been more the responsibility of the states than the federal government. In fact, the total SAMHSA budget is still one-third
less than the amount states cut from mental health services - $4.6 billion –
between 2009 and 2013.
So did the state increases this year actually restore the
dollars that were cut?
Not exactly.
First of all, there are the fourteen states – including Florida (48th in spending coming into the year), which has developed an unflattering reputation in recent years for both vigilante violence and lack of compassion toward people with behavioral health needs – that either reduced mental health funding or held it level, in spite of
overwhelming popular support for better mental health services. And of the states that did increase funding, the
increases were often modest ones.
For
example, Ohio
cut $93 million over four years, and then added back only $50 million this year. The $50 million made for a good headline, but
Ohio’s funding is still far behind where it was five years ago. And in Idaho – the lowest per capita spending
state – Governor Butch Otter promised millions in new funding for mental health
in early 2013. But when the legislative
dust settled, the
increase was only 3.6 percent for community mental health services and 2.3
percent for psychiatric hospital services. There was no change in the
funding for community psychiatric hospitalization.
And looking forward, some lower-spending states are still
not looking to do too much. Utah, for
example, has always put a premium on health, but does not spend highly on
mental health. Utah’s Governor is recommending only a
one-time, $1.5 million increase in FY2015 for mental health promotion and
mental illness prevention. This is
better than nothing, but not enough to make a significant difference – especially
if the commitment lasts for only one year.
And as NAMI noted in its report, when the issues became a
little more controversial or complicated, fewer and fewer states took them on.
Only twenty-five states plus the District of Columbia decided
to move forward with Medicaid expansion this year – an expansion that will help
adults with mental illnesses in particular.
Only thirteen states made significant improvements to their mental
health systems. Just ten improved school-based
mental health training and/or services. And
only five enacted legislation to improve early identification and childhood
mental health screening.
On the plus side, there are the two exceptions. Connecticut – which felt most keenly the
impact of the Sandy Hook shooting – led the way in passing comprehensive legislation
to improve mental health service systems.
And Texas – which has long been near the bottom of states in funding
mental health services – led the way in providing new funding for mental health
services.
But we still have such a long way to go. And for most of us around the country, we
have not really made much progress in the past year.
Paul Gionfriddo via email: gionfriddopaul@gmail.com. Twitter: @pgionfriddo. Facebook: www.facebook.com/paul.gionfriddo. LinkedIn: www.linkedin.com/in/paulgionfriddo/
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