State Mental Health Cuts: a National Crisis

From the National Alliance on Mental Illness

The tragic shooting of Congresswoman Gabrielle Giffords and the killing of six innocent citizens in Arizona focused national attention on the state of the public mental health system in Arizona and other states. Many asked how a tragedy like this could happen again, with chilling references to Virginia Tech. How did Jared Loughner fall through the cracks when the signs of a serious psychiatric crisis seemed so clear?

For NAMI, the National Alliance on Mental Illness, what happened in Tucson is all too familiar. Even during the best of economic times, youth and adults living with mental illness struggle to access essential mental health services and supports. Services are often unavailable or inaccessible for those who need them the most.

One in 17 people in America lives with a serious mental illnesses such as schizophrenia, major depression, or bipolar disorder. About one in 10 children live with a serious mental disorder. In recent years, the worst recession in the U.S. since the Great Depression has dramatically impacted an already inadequate public mental health system. From 2009 to 2011, massive cuts to non-Medicaid state mental health spending totaled nearly $1.6 billion dollars. And, deeper cuts are projected in 2011 and 2012. States have cuts vital services for tens of thousands of youth and adults living with the most serious mental illness. These services include community and hospital based psychiatric care, housing and access to medications.

Download the report

To make matters worse, Medicaid funding of mental health services is also potentially on the chopping block in 2011. The temporary increase in federal funding of Medicaid through the stimulus package will end on June 30, 2011. Medicaid is the most important source of funding of public mental health services for youth and adults, leaving people with mental illness facing the real threat of being cut off from life-saving services. Communities pay a high price for cuts of this magnitude. Rather than saving states and communities money, these cuts to services simply shift financial responsibility to emergency rooms, community hospitals, law enforcement agencies, correctional facilities and homeless shelters. Massive cuts to mental health services also potentially impact public safety. As a whole, people living with serious mental illness are no more violent than the rest of the population. In fact, it is well documented that these individuals are far more frequently the victims of violence than the perpetrators of violent acts.

However, the risks of violence among a small subset of individuals may increase when appropriate treatment and supports are not available. The use of alcohol or drugs as a form of self medication can also increase these risks.

Unfortunately, the public often focuses on mental illness only when high visibility tragedies of the magnitude of Tucson or Virginia Tech occur. However, less visible tragedies take place everyday in our communities—suicides, homelessness, arrests, incarceration, school drop-out and more. These personal tragedies also occur because of our failure to provide access to effective mental health services and supports.

This report documents the state-by-state funding changes for public mental health services since 2009 for youth and adults living with serious mental illness. These cuts are likely to worsen in 2011 and 2012. The report also describes how states have chosen to implement these funding cuts. The report concludes with policy recommendations, focused on the steps that should be taken to ensure that valuable public resources are spent wisely and effectively. Crisis should be used as a vehicle for change, not as an excuse for abandoning some of our nation’s most vulnerable citizens.

Funding Changes by State

• State Mental Health Expenditures FY2009-FY2011 (Alpha)
• State Mental Health Expenditures FY2009-FY2011 (% High to Low)
• Changes in Numbers of People Served in State Hospitals 2007-2009
• Changes in Number of People Served by the State Mental Health Authority (SMHA) 2007-2009
• Projected Loss of Federal Medicaid Funds FY 2012

Methodology

Fiscal information for this report was derived from state budgets and fiscal documents from FY2008 through FY 2011 and consisted primarily of state general fund expenditures excluding state Medicaid allocations. Wherever possible, reporting is limited to dollars spent on inpatient and community mental health services for children and adults and does not included expenditures for developmental disability or substance abuse services. However, due to variations in state budget reporting, some expenditures for substance abuse or developmental disabilities may be included in a few states.

Sources for service utilization data include the SAMHSA Uniform Reporting System (URS)  and publications from the National Association of State Mental Health Program Directors National Research Institute (NRI). Examples of the impact of state budget cuts on service systems and individuals were drawn from media coverage and from individuals who courageously shared their personal stories with NAMI.

Find out more

• Grading the States 2009
• About Mental Illness
• About NAMI