CONGRESSIONAL STAFF BRIEFING:
IMPACT OF THE ECONOMIC CRISIS ON
AMERICA’S PUBLIC MENTAL HEALTH SAFETY NET
February 24, 2010
NAMI, the National Alliance on Mental Illness, is grateful to Congresswoman Napolitano and pleased to participate in this afternoon’s briefing. As you know, NAMI is the nation’s largest organization representing children and adults living with serious mental illness. NAMI takes very seriously the challenges facing the public mental health system in all 50 states. We welcome this opportunity to join with other advocates who understand that all across America today mental health care is at risk.
I speak to you as a NAMI Board member but also from 30 years experience in government – as a legislator, head of the State Senate and Lt. Governor of Connecticut. Believe me, I understand the magnitude and challenges of the fiscal crisis facing almost the states. But I also know that when it comes to fiscal surgery, a scalpel is far more effective than a meat axe. Choices, often hard choices, have to be made but made prudently, wisely and humanely.
As you have heard from others here today, our states face a triple threat of budget challenges: declining revenues, increased demand for safety net programs and especially deep cuts to programs that rely on exclusively on state revenues such as mental health care not funded by Medicaid. Even as state economies begin to recover—and it cannot be soon enough—major state revenues will be late to return to pre-recession levels, and deficits will persist.
When it comes to investing in mental health care, prudence, wisdom and humaneness are hardly what’s happening state-by-state. Instead, real cuts—not reductions in spending growth but real cuts—risk the real progress we have made in mental health care. At a time when the need is greater than ever and we know more surely than ever that treatment works, state budgets are cutting the lifeline of wellness and recovery for millions of Americans with mental illnesses.
My own state of Connecticut is already feeling the pain:
• $31 million already cut this fiscal year from our Department of Mental Health and Addiction Services, elimination of 311 positions and legislative authority for the Governor to rescind $5 million more.
• Closure of Cedar Ridge Hospital and loss of 104 inpatient beds, with no assurance of reinvestment in community based mental health services.
• Termination of our state wraparound to Medicare Part D that covered co-pays and non-formulary drugs for low-income dual eligibles and individuals eligible for state prescription assistance program.
• Elimination of protections that I enacted so the state’s Medicaid preferred drug list could not deny the most effective treatment.
And more, much more, is in the works as the Governor and state legislature face ongoing multi-billion dollar state deficits. Proposed cuts now target $100 million in reductions from our aged, blind and disabled program along with monthly $20 co-payments for Medicaid beneficiaries and those dually eligible.
As you heard from Mr. Leclerc and Administrator Easterday, across the nation these cuts reducing frontline clinical staff, restricting eligibility for services, closing facilities and crippling county and municipal programs as well as services contracted to non-profit providers. These programs and services are very often last resort for under-insured and uninsured children and adults living with schizophrenia, bipolar disorder and major depression. For many, particularly adults with the most severe symptoms, there is nowhere else to turn. All this is compounded by high levels of unemployment and lost health care benefits as well as the men and women returning to our communities from extended combat tours—especially those in the National Guard—with very high incidence of serious depression, PTSD and family dissolution. Not to mention 194,000 homeless veterans already.
Please understand, every bit of my own budget experience tells me that cuts in mental health care funding are not savings at all. When investments in treatment, support and recovery are slashed, the costs to society and to government do not go away. Instead, the costs just get passed along far more expensively in terms of public spending and far less successfully in terms public health:
• Half of all lifetime mental illnesses begin by age 14 and, without access to early diagnosis and treatment, we end up paying much more for special education, private placements, substance abuse and juvenile detention.
• Without access to community-based treatment and support, we end up paying much more for secondary medical symptoms, homelessness, addiction, broken families, extended hospital emergency admissions, nursing home beds, jails and prisons.
• Without access to mental health care, our national and state economies lose billions of dollars every year in unemployment, under-employment and lost productivity.
• Without access to treatment and recovery, people with serious mental illnesses are sentenced to die 25 years sooner than the general population.
At NAMI we refer to this as “spending money in all the wrong places” as the burden of untreated mental illness is shifted and hidden but no less at taxpayer expense.
For many people living with serious mental illness, treatment adherence is always a challenge. This is made all the more difficult when core services such as medication management, intensive case management, acute inpatient care and outpatient therapy are severely cut. Untreated serious mental illnesses are all too typically accompanied by co-occurring substance abuse, loss of stable housing, loss of employment and family discord. As a result, homelessness, addiction and criminal behavior increase. Publicly funded emergency medical services, especially inappropriate but long and costly hospital stays, increase as a first resort when other care disappears.
Severe budget cuts mean severely less treatment and support for people who just get sicker and often get into trouble. Malcolm Gladwell accurately described all of this in a New Yorker article entitled “Million Dollar Murray.” Gladwell showed how the city of Reno, Nevada and surrounding Washoe County spent over a million dollars in less than two years on the adverse consequences of keeping a single individual with untreated serious mental illness chronically homeless.
What can Congress do to help? The federal government can and should play an important role in partnering with states to address this crisis in two major ways:
• First, extend the current higher federal match for Medicaid in the American Recovery and Reinvestment Act (ARRA).
• Second, increase funding for the federal Mental Health Block Grant above the level of $420 million at which it has been frozen without even an inflationary increase since FY 2000.
• Third, reject proposed deep reductions in HUD Section 811 funds for supportive housing.
As most of you know, the higher Medicaid FMAP level in ARRA expires at the end of the year. The House is already on record in support a 6-month extension as part of the jobs and economic recovery legislation that passed in December. NAMI is encouraged that Senator Rockefeller is planning to offer an amendment in the Senate but we need the leadership to be on board.
We need Congress to support the Mental Health Block Grant. This program has not received an increase, again not even for inflation, in a decade. The Block Grant is a critical source of strategic funding for state, county and local public mental health systems in meeting the need for treatment and support among those who are uninsured or indigent. The Block Grant is also one of the few sources of public funding where people with mental illness and their families play a major role in directing resources to key priorities through state Mental Health Planning Councils.
And now is not the time to slash federal funds for supportive housing. With wrap-around services, few investments have a higher return in terms of successful, sustained recovery from serious mental illnesses and avoided costs. HUD Section 811 grants to non-profits are a significant multiplier when matched by private and state funds as well as construction stimulus. Proposed increases under the McKinney-Vento Homeless Assistance Act are welcome but do not make up for the magnitude proposed cuts to supportive housing.
The face of mental illness in America is not the face of a stranger. It’s our co-workers and friends, our neighbors and families and sometimes ourselves. SAMHSA tells us that 10.6 million American adults already report unmet needs for mental health care. How many more will it be each day that the pattern of budget crisis and disinvestment continues to roll through the states?
Thank you for the opportunity to share NAMI’s concerns—the concerns of millions of Americans with mental illness and their families, Americans in every state and every congressional district across this land.
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