It’s no secret that community-based mental health and substance use treatment services are underfunded, but less widely known is the extent of the problem. Since 2009, the height of the Great Recession, state funding for these services has fallen by $4.35 billion. And yet the prevalence of behavioral health disorders has remained fairly constant. What happens when support for these services drops so drastically and the need for them stays the same?
Costs and responsibilities shift from the health sector to institutions neither designed nor equipped to treat patients with behavioral health and addiction illnesses, according to a recent post in the blog for the Vera Institute of Justice.
“Police, indigent defense systems, the judiciary, correction facilities, and parole officers have become de facto mental health service providers,” writes David Cloud, program associate for Vera’s Substance Use and Mental health Program. “When people with chronic behavioral health needs lack access to care in the community, they are more likely to end up in hospital emergency rooms, police cars, jails, or prison. This reality is behind the gloomy fact that Rikers Island in New York City and the Los Angeles County Jail house more people with mental illness than any hospitals.”
All this is another way of saying that the quality of care for people with mental illness and substance abuse problems deteriorates.
The Affordable Care Act offers some hope. Through Medicaid expansion and other means, it can enable state and local governments to strengthen community health services for a substantial portion of the population – uninsured childless adults – who now only receive care in emergency rooms or jails. “The bottom line is that cuts for community mental health budgets mean rising costs elsewhere,” Cloud writes. “Governments should remain aware of the clear difference between cutting and shifting costs, especially when the latter can be more expensive in both dollars and quality of life.” Read the full post here.
Susan Gilbert is The Hastings Center’s public affairs and communications manager.