As long as funding for mental health and substance disorders is intertwined with the vagaries of states, and often their counties, local budgets are key to prevention, treatment and recovery. The way priorities get juggled can spell promise or defer troubles. States are meeting these challenges in different ways with a down economy, and some are relying on the injection of stimulus funds to save lives.
In California, where natives over 60 like to think they were born in an orange grove, and millionaires were supposed to underwrite spending for mental health, all is not well. Prop 63, the hope and the promise of dedicated funds for mental health, is on a special May ballot. The law which was passed by 53 percent of the voters in 2004 and intended for people with mental illnesses, must be amended by vote (unlike laws passed by the legislature). The upcoming, special election in May asks voters to raid the fund for $460 million over two years to help plug the deficit. Will that cripple the program? Probably not immediately, say sources. But if it passes, it delays getting services into the community and runs the risk of an annual converstion about something that was once resolved.
From New York, Glenn Liebman, director of the state's Mental Health Association, writes that advocacy efforts helped the legislature push back Gov. David Paterson's proposals to trim mental health services from the $132 billion budget. Basically they were able to halt a delay in plans to treat mentally ill prisoners held in isolation, and restoried cuts to SSI. Very important, Liebman writes, was
Rejection of the proposal to have anti-depressants no longer be part of the carve out for mental health medications. The Legislature has again taken the lead in restoring anti-depressants to the carve out and insuring that medication accessibility stay in place for individuals with psychiatric disabilities. In addition, the legislature rejected language that would have minimized the impact of physician prevails as a safety net for medications in Medicaid. We remain concerned about issues of step therapy (fail first) and will work with our colleagues in the advocacy community to insure that mental health medications are carved out of step therapy.
Research about New York, coincidentally appeared in this month's issue of Psychiatric Services and confirmed the importance of this accomplishment. The authors note "dually eligible individuals with depression experienced the largest treatment gap" when Medicaid shifted to Medicare after the 2003 change in law.
The opposite just happend in Iowa where one county just voted to save $280,000 by eliminating coverage for anti-depressants. This is slightly more than half of the total cuts, amounting to $473,000. Taking note, The Sun writes, "be careful you're not sawing off the board you're sitting on."
A notable New York accomplishment that not only saves taxpayer money but is definitely in sync with evidence is replacing the harsh Rockefeller drug laws requiring prison sentences for drug offenses with treatment. Now judges have more discretion for sentencing. Good work New York.
Louisiana, still not recovered from Katrina, needs mental health services more than ever despite a shrinking population in places like New Orleans. Now the parish is in heated battle over the intention of closing a psychiatric hospital when not enough of the community services have been re-opened. The problem spills over to other communities, such as Baton Rouge where patients go to the unlicensed board and care homes which are turning up. Makes you wonder how Gov. Bobby Jindal might use the money he thinks his state doesn't need coming from Washington.
To save about $6 million annually from its state hospitals, North Carolina is shutting 50 beds and contracting with local hospitals for 111 spaces. The state has been beset with problems arising from failed attempts to outsource services and suspicious hospital incidents including deaths.
Officials recently learned that the state hospital where accusations of staff neglect followed a suicide attempt, and threatened federal financing, passed federal inspection. Gov. Beverly Perdue said she will also support laws to disclose information, previously deemed private, about deaths occurring in state mental hospitals.
Stimulus funds? It's interesting to see how different states are making use of the recovery initiative. Hats off to Ohio which announced spending $1.5 million for a suicide prevention by fencing Akron's All-America Bridge.
What's happening where you live? If I've missed something in your local area, let me know.
