A vicious cycle in mental health services is likely to get more vicious this week when Gov. Tom Corbett releases his plan to address a $3 billion hole in the state budget.
The cycle works like this: A bad economy leads to job layoffs and government funding cuts. Unemployed people lose their health insurance as well as their income, causing stress, anxiety and depression. The uninsured wind up seeking treatment for these problems from the public mental health system, even as its funding is being cut. Growing demand meets shrinking supply.
The scenario is already well under way. States have slashed $2.2 billion from their public mental health systems from 2009 to 2011, according to a new report, even as nearly 60 percent of them reported increased demand for community-based mental health care and crisis services.
"These services are at the heart of every public mental health system in the country, and a means of keeping people with mental illness out of more expensive psychiatric hospitals, emergency rooms, nursing facilities and jails," said Kevin Martone, president of the National Association of State Mental Health Program Directors, which presented the report Feb. 16 at a U.S. Senate briefing.
Jobless people are four times as likely as those who are working to report symptoms associated with mental illness, according to a national survey by Mental Health America in September 2009, when the unemployment rate was almost 10 percent.
The phone survey of 1,000 adults also showed:
• Those whose pay or hours were cut were twice as likely to report serious symptoms.
• Those with no work were twice as likely to use alcohol or drugs.
• Thirteen percent of unemployed people reported thoughts of harming themselves -- four times the rate of working people.
• Of those who had not sought treatment, 42 percent cited cost or lack of health insurance as the main reason.
"The survey clearly shows that economic difficulties are placing the public's mental health at serious risk, and we need affirmative action to address these medical problems," said David L. Shern, president of Mental Health America.
Pennsylvania's share of those $2.2 billion in funding cuts amounted to more than $33.8 million over the same three years, said Anne Bale, spokeswoman for the state Department of Public Welfare. That's a 4.6 percent reduction from the $728.7 million budget in 2009. She attributed the funding drop to budget cuts across the board.
At the same time, demand in the state soared from almost 300,000 people in 2007 to 487,000 in 2010. The increase, Ms. Bale said, mirrors the national trend -- the economic downturn means more people qualify for public services and also increases stress that sends them in search of help. In addition, she said, people are more willing to seek care as mental health treatment gains more acceptance.
In a given year, about 25 percent of adult Americans have one or more diagnosable mental conditions, 6 percent of them serious and persistent, according to the National Institute of Mental Health.
These range from disorders of mood (depression, bi-polar), anxiety (post-traumatic stress, obsessive-compulsive), eating or personality to schizophrenia, attention deficit or hyperactivity.
Even places that haven't had to reduce services yet for this population -- Allegheny County officials say they are on that list -- may be heading in that direction unless the money returns, according to Ron Honberg, legal director of the National Association for Mental Illness (NAMI) in Arlington, Va.
"States try to focus on nonservice cuts as much as possible, like staff and administrative expenses," Mr. Honberg said. "But now there's not enough of those left to cut. That means closures of community mental health centers, severe shortages of qualified staff, elimination of some needed services, in-patient beds, crisis intervention teams and crisis stabilization programs."
"The system is already underfunded in terms of supply versus need," said Pat Valentine, deputy director for behavioral health at the Allegheny County Department of Human Services. "We are very concerned about further cuts."
Less money means less access, and access is already a problem in rural counties with fewer resources. But even in Allegheny County-- considered a beacon of comprehensive and humane services compared to other parts of the state -- patients have to wait weeks to see a psychiatrist.
"Sometimes people have to experience a lot before they think they need help," said Christine Michaels, executive director of NAMI Southwestern Pennsylvania.
"Then they have to wait for an appointment, and meanwhile they may get worse.
"You have some clinics that aren't taking any new patients. The kind of help a community mental health center can provide on an emergency basis is limited, unfortunately. Those cases usually wind up in a hospital emergency room. But Allegheny County does better than a lot of other places."
Sally Kalson can be reached at firstname.lastname@example.org or 412-263-1610.