In Virginia, a state agency charged with the protection and oversight of the disabled has filed a lawsuit charging that state-run mental hospitals are neglecting patients. In Florida, the North Broward Hospital District has stopped paying for psychotropic drugs for indigent patients. In Missouri, the state mental health department plans to shut down a treatment center and a psychiatric rehabilitation hospital to save money. In California, proposed cuts in the state's budget will force counties to shut down mental health facilities despite legal mandates to provide care.
From Maine to Oregon, from West Virginia to Texas, mental health services are being curtailed as bureaucrats and lawmakers try to stretch fewer dollars across an increasingly large, underserved population.
State tax revenues per capita declined 7.4% in fiscal 2002. In a Kaiser Commission on Medicaid and the Uninsured issue paper titled "Is the State Fiscal Crisis Over? A 2004 State Budget Update," Donald Boyd, Ph.D., and Victoria Wachino, MMP, wrote, "While the national recession was fairly mild, the falloff in state tax revenues was severe and led to daunting state budget shortfalls." They continued, "The big falloff in state tax revenue in 2002 means that it will take states some time to return to pre-2002 tax levels, and the recent modest growth in state tax revenues is far from sufficient to do that." Boyd is director of the Fiscal Studies Program at the Rockefeller Institute of Gov-ernment, and Wachino is associate director of the Kaiser Commission on Medicaid and the Uninsured.
The immediate future does not look much better, according to Boyd and Wachino. "As the Rockefeller Institute recently observed, 'States will probably have to cut spending and/or raise taxes in order to balance the fiscal year 2005 budgets they will begin to consider in a few months.'" They added, "And unless the national economic picture, and especially employment, picks up significantly, states will have to face these conditions for some time to come."
"The economic outlook in most states is very bleak," said Joel Miller, acting director of the National Alliance for the Mentally Ill's (NAMI) Policy Research Institute, in an interview with Psychiatric Times. "States are looking at projected budget deficits of between $65 billion to $85 billion. States are looking for ways to control budgets, and they're trying to balance their budgets on the backs of the most vulnerable populations."
"It's penny-wise and pound-foolish," NAMI legal director Ron Honberg, J.D., told PT. "What you save on health services you wind up spending on increased costs for law enforcement and corrections and services for the homeless. Criminalization of the mentally ill has now reached epic proportions. There are shortages of beds and cells. In Florida, law enforcement officials are going to the legislature and asking them not to cut mental health services because it places too great a burden on the system."
In one bizarre incident, a newspaper in Salt Lake City reported that one of the suspects in the sensational kidnapping of teen-ager Elizabeth Smart had been ordered into the forensic unit of the state mental hospital for treatment prior to facing trial, but was detained in a county jail instead because at least 10 other suspected criminals were lined up ahead of her waiting for beds in the hospital. The waiting list developed after the state closed one wing of the hospital in 2002 to save $1.7 million a year, according to the newspaper.