Find state funds for mental health care that works

good treatment programs need more state backing

January 2, 2012 

A home, effective treatment and a chance to contribute to the greater good — that's what it takes to recover from mental illness.

Against the odds, people rebuild their lives after the devastation of illnesses like bipolar disorder, schizophrenia or depression, but finding effective treatment and wraparound services is key. Kentucky has some outstanding programs, but the dollars haven't increased since 1995. In fact, the dollars have shifted to the justice system.

Thanks to professional support, self-determination and a safe home managed by New Beginnings Bluegrass Inc., many people are on the road to recovery. New Beginnings, a non-profit agency, supplies housing and support services in Fayette County for people diagnosed with mental illness. From New Beginnings' success rates, we can learn how housing and treatment work and assist individuals to become productive citizens.

Consider the example of Peg. For more than 20 years, she survived a hellish existence trapped in the revolving door of jail, homelessness and hospitalizations. Now she is living a rewarding and independent life surrounded by friends, her pet and a support system, which includes treatment from the Bluegrass Mental Health-Mental Retardation Board. Today, Peg regularly gives back to the community by volunteering at Saint Joseph Hospital, her church and the National Alliance on Mental Illness.

According to a recent report by NAMI, Kentucky maintained state spending for non-Medicaid mental health services from 2009 to 2011. However, the state still shortchanges mental health, ranking 46th nationally in per capita spending. Nationwide, cuts in 2012 totaled $1.6 billion. NAMI appreciates the efforts of Gov. Steve Beshear and the Kentucky legislature to maintain the mental health safety net, but in this distressed economy, more people than ever need help.

The NAMI report "State Mental Health Cuts: The continuing crisis" (www.nami.org/budgetcuts) describes threats to Medicaid, the largest payer for public mental health services. Following the loss in June 2011 of "enhanced" federal Medicaid matching funds, part of economic stimulus legislation, Kentucky's budget was squeezed by an estimated $159 million.

To meet fiscal challenges, Kentucky Medicaid is moving to a managed-care approach where the state pays a set "capitation rate" for every person enrolled in Medicaid. NAMI is worried. Kentucky is saving money by contracting with for-profit, managed-care companies, but does this just push the problem downstream? Will community mental health providers be squeezed to enable the for-profit companies to meet the terms of the contract?

Lack of mental health funding leads many who don't get the care they desperately need to fall into the criminal justice system. According to a recent report from Clinical Psychiatry-News, more than 800,000 people with severe mental illness are jailed annually in the United States.

Mental illness is a disease, not a crime. It is wrong to allow the criminal justice system to be the default mental health safety net simply because we don't have the will to adequately fund mental health services.

The Kentucky Department of Public Advocacy reports that a large percentage of its clients appear to be suffering with some form of mental illness. This illness can take the form where the person is not competent to stand trial, or was not well enough at the time of an event to appreciate the criminality of the actions. Further, many clients still suffer from mental illnesses, but those illnesses do not qualify under the legal definition of insanity. However, their mental illness can many times explain the criminal action. Also, the Kentucky Department of Corrections runs a separate psychiatric facility in La Grange for offenders with mental illness.

On average, it costs taxpayers from $16,000 to more than $30,000 a year to house an inmate in a Kentucky prison.

Ginny Vicini, executive director for New Beginnings, reports that 40 percent of the people in its program had a history of incarcerations before moving into New Beginnings. In the past three years, none have been reincarcerated.

While best practices exist in some regions, the lack of adequate funding continues to plague operations. Efforts to spread good models to more communities are on hold.

Kentucky needs to strengthen effective mental health programs. People's lives hang in the balance. We have moved from de-institutionalization in the 1970s, to trans-institutionalization today. How humane is it to allow lives to be wasted in prisons instead of funding Kentucky's mental health budget?

GG Burns of Lexington is an artist and mental health advocate for the National Alliance on Mental Illness Kentucky.

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