Missouri's public mental health system budget suffered massive cut in the early 90s under the Ashcroft administration. Our state psychiatric facility in Nevada and a number of wards around the state were closed, throwing ill consumers into the community rather abruptly. Our underfunded community mental health centers, housing providers, group homes and residential care facilities scrambled to accommodate the sudden influx of new customers. Money and resources, diverted from the state's mental health budget, failed to follow these high need consumers into the community.
Missouri suffered the predictable results of an underfunded, inadequate mental health system; significant increases in the jail and prison populations, a rise in suicide rates, growth of the Medicaid population and increases in homelessness. The relative prosperity of the 90s somehow missed Missouri's mental health system.
It was no coincidence that NAMI's membership grew throughout the 90s. Dismayed by a system that failed those most in need, a system that rationed hospital and community care, consumers and family members became a significantly more active force in the state's decision making process. In 1996 NAMI was credited with influencing the legislature to grant the Department of Mental Health its largest budget increase in history.
Although Missouri's mental health budgets continued to increase, vital mental health services continue to receive a smaller percentage (6.7%) of the state's overall budget than they had in the 70s and 80s (9%).
In 1997 NAMI initiated dialogue with its colleague organizations to address the fierce competitive atmosphere among grassroots entities. This dialogue evolved into a coalition of groups interested in addressing statewide mental health concerns. Our Federation of Mental Health and Substance Abuse Advocates, which meets monthly, serves as an umbrella organization for advocacy.
In April 2002 and after September 11, Missouri, like most states, began to experience severe financial deficits. A round of state budget cuts in May and again in October treated mental health services with relative kindness. However, advocates were alarmed when a third cut, contained in our Governor's 2003 state budget proposal, could reduce the state's mental health budget by approximately $118 million, $92 million of which would come out of community based services!
Recognizing the importance of these services, our Governor proposed to restore the $92 million by transferring that amount from our state's reserve (or rainy day) fund. This proposal has been met with extreme controversy. Some contend our Governor is holding children and adults "hostage" in order to leverage passage of his proposal to use reserve funds to balance our state's fiscal 2003 budget.
I would be remiss not to mention how partisan politics have affected our situation. A new term limit law will kick in before the 2003 legislative session replacing a full 2/3 of our House members. The fate of Missouri consumers is being decided in an atmosphere of fierce competition and political posturing.
Missouri's poor and disabled are burdened with one of the nation's most punitive set of Medicaid rules, with an income eligibility limit that has not been increased since 1974 (74% of poverty) and a cash and resources on hand limit ($999 per individual) that is the nation's lowest. NAMI advocates were a driving force in the passage (September, 2002) of three small, incremental increases in the income eligibility limit to begin in July 2002. Our state's deficit threatens the funding of these increases.
At the same time, Department of Social Services officials and legislators are aggressively searching for ways to reduce Medicaid spending. Constant vigilance and swift response has fought off medication fail first policies and heavy restrictions placed on the use of new and brand name psychiatric medications. Advocacy has moved a proposal to eliminate $80 general relief payments and to require impoverished Medicaid consumers to pay a portion of their medical bills in cash onto the back burner. Still, these and similar proposals can spring to life at any time. In times like these, merely keeping the services, care and safety net (albeit minimal) in place can be called a victory.
As our 2002 session passes its half-way mark, the following has been achieved:
- Restoration of $92million to the state's mental health budget for community services and reduction of a planned $26 million "core" cut.
- Restoration of funds to cover increasing our state's income eligibility limit for theelderly poor and disabled receiving Medicaid to 80% of the federal poverty limit.
- Restoration of the state's general relief program for disabled poor who have not qualified for SSDI. (This was, however, limited to one year).
- Avoidance of additional restrictions on new and brand name medications.
- House passage of a full parity bill.
Vigilance and strong citizen advocacy will be needed to maintain these achievements over the next 6 weeks, when our session ends. Any are all of these provisions could be affected by the hotly contested decision to use of some of Missouri's reserve fund dollars.
Here's what seems to be working for us:/p>
- Rapid, widespread communication. Frequent email updates sent from the state NAMI organization and major NAMI affiliates. Inclusion of non-NAMI peers, colleagues and friends in communications. We find ourselves serving as the legislative information system for a number of smaller organizations. Cast your net as wide as possible.
- Frequent faxes to supplement email. For most part, updating the grassroots via mail is too slow. This does not mean we fail to use regularly scheduled newsletters (state and affiliate). We make sure NAMI's grassroots are "in the know".
- Working within a coalition of various mental health interests, but realize not all mental health interests may care to work this way. Cultivate relationships with mental health interests not represented in your coalition.
- Cultivate relationships with disability and social service/poverty advocacy groups (disability councils, catholic charities, Paraquad).
- Convince a high profile newspaper to take on the issue as a "cause". Write frequent editorials, encourage grassroots members to do so as well. Develop a media strategy.
- Match the location of key legislative decision makers and your membership and affiliate development efforts. Strengthen NAMI in areas where key decision makers reside. We find the Family to Family course effective and have found a couple of teachers willing to travel and stay overnight in order to teach and develop an area. NAMI cannot afford to be weak in key decision maker's districts.
Whether these strategies will ultimately produce the results we need remains to be seen. Consumers and their families are at risk, the perils are serious and numerous. We are, however, pleased with our initial results and plan to maintain the abovementioned efforts.