5 Tips for Covering Mental Health Amid Recession, Budget Cuts

Last week, Detroit Free Press columnist Jeff Gerritt talked with me about how he reported a recent piece connecting years of mental health budget cuts to the increasing numbers of mentally ill people in prison.

Gerritt traced how the emptying out of state mental hospitals in the 1980s and 1990s, followed by years of lower-than-promised public  support for community mental health care and exacerbated by the recent prolonged recession, has created a system where the mentally ill wind up homeless or in prison because there's nowhere else for them to go.

Today, Rusty Selix, executive director of the Mental Health Association of California, offers tips on how you can examine the effects of mental health budget cuts on your community. Selix, a longtime mental health advocate, authored California's successful Proposition 63, which raised taxes on millionaires to fund more prevention and treatment for mental illness. At a time when many people aren't getting the mental health treatment they need, this is a high-stakes, high-interest topic to explore at the local level.

1. Begin at the county level (or large city, if it has its own health department). In California and many other states, counties are responsible for providing mental health services, and they manage county, state and federal money, including Medicaid, that funds those services. Selix suggests reviewing annual mental health budgets to see changes from year to year. "Then you also want to ask, what does this mean in terms of how many people you serve?"  Some states, including California have gotten Medicaid waivers that will allow them to change the ways they provide mental health funding to prepare for health reform's rollout – it's worth asking local officials how they'll be affected.

2. What's driving the cuts? Medicaid, the federal health program for the poor, pays for a lot of mental health services delivered at the local level. But its costs are rising faster than revenues. "States are always cutting in every way they can to reduce their exposure in Medicaid. They're not denying people eligibility. But they do things around the edges. They might make it harder to retain eligibility so people get bumped off. Or they impose copayments that generally people on Medi-Cal (California's version of Medicaid) can't pay. They try to eliminate cost increases for providers," Selix said, so fewer providers are willing to see patients. "These are the trends that we see nationally and in California."

3. If there are budget cuts, how are people affected? It's illegal to have waiting lists for mental health care for Medicaid patients, but "counties find ways of creating informal waiting lists," Selix notes. Here are some practices to look out for:

- Increases how often a hospital has to call Medicaid bureaucrats to keep a psychiatric patient hospitalized. "We're hearing it's as frequent as every eight hours."

- Lack of follow-up care after a psychiatric hospitalization. "People wind up back on the streets or back to some marginal housing situation, usually board and care until they deteriorate again."

- Stringent criteria for outpatient mental health programs. For some programs, patients must be hospitalized up to five times before being eligible.

4. Is there any money for prevention or screening? Selix wants to see health insurers pay for mental health screening to catch problems early, but are there any such programs for low-income or uninsured folks in your area?

5. Mental health media coverage is valuable. Reporting on mental health is valuable almost regardless of what you write, Selix believes. So many people have a personal connection with mental illness that simply raising the issue (and offering resources for help, of course) "is actually providing a significant service," he said.

Selix hopes the media will go beyond the "suicide by cop" horror stories to look at larger issues of how we care for our mentally ill.

"People see them, in every major city. Everyone can tell they're sick. Why isn't there a place for them to go? It's a unique disability that has never gotten enough attention. People have to seek health care themselves, but the nature of severe mental illness severe is that people won't seek the care," he said.

"It doesn't save money to neglect them – when you add up prison costs, hospitalization costs, police costs, it exceeds the cost of the best mental health programs. That's what we'd like to see more press attention."

Reporting Resources:

Mental Illness: Few Families Untouched: ReportingonHealth's guide to mental health sources and information online.

National Alliance on Mental Illness: Leading advocacy organization for the mentally ill.

Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long-Term Care Reform: Report from the Kaiser Family Foundation.

Oral History: Rusty Selix on the history of mental health in California.

Photo credit: OUCHCharley via Flickr

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