WASHINGTON — Mental-health advocates from coast to coast are seizing upon a rare and unexpected chance to stem the years-long tide of budget cuts and plug gaps in the nation’s patchwork mental-health-care system.
In the wake of the massacre in Newtown, Conn., lawmakers from both parties, along with notoriously tight-belted governors, are pushing to restore some of the estimated $4.3 billion in mental-health spending that was slashed from state budgets between 2009 and 2012. At the same time, they are weighing new initiatives, such as adding beds at psychiatric hospitals and improving treatment for inmates with behavioral disorders.
A year that could have brought another round of thinning resources and a spot far down the priority list of policymakers is shaping up quite differently in some statehouses.
In Minnesota, for example, legislators are seeking more resources for mental-health treatment programs in the state’s schools. In Pennsylvania, a Republican state representative is spearheading the effort to reclaim $84 million in funding that had been slashed from the most recent state budget, saying that adequate treatment is key to safer communities, “not a luxury.” In Virginia and other states, lawmakers have proposed funding “mental-health first aid” training to help teachers and first responders better spot people in need of help.
Wisconsin’s famously budget-conscious governor, Republican Scott Walker, this month proposed a nearly $30 million boost to mental-health spending in his budget, including funding for a program that allows counties to provide mental-health services to people in their homes. Colorado Gov. John Hickenlooper, a Democrat, proposed an $18.5 million effort that includes money for a statewide mental-health crisis hotline, walk-in centers and housing vouchers for the severely mentally ill.
In Delaware, Democratic Gov. Jack Markell’s budget includes funding for a sharp increase in the number of mental-health professionals working in middle schools. In South Carolina, Republican Gov. Nikki Haley has vowed to help revitalize a mental-health system that has suffered deep cuts in recent years, cuts she has called “immoral.”
“The difference now is that legislators know that people are paying attention to whether they are taking steps. That’s important. That gives us a lot of leverage,” said Darcy Gruttadaro, director of the Child and Adolescent Action Center at the National Alliance on Mental Illness. “We can start talking about who is putting their money where their mouth is. It’s a new day in that sense… . We will not squander the opportunity.”
The proposed changes are not just happening on the state level.
Since December’s shooting spree at Sandy Hook Elementary School, President Barack Obama has spoken publicly about the need for better and expanded mental-health care as part of a broader plan to reduce gun violence — even as he reiterated that the vast majority of people with mental illnesses never turn violent.
U.S. senators from both sides of the aisle have proposed legislation that would set standards for mental-health care throughout the country and open the door to more federal funding for treatment in schools and community-based organizations.
The wave of new attention, however, has not come without risk and worry. For starters, the enthusiasm among mental-health advocates has been tempered by the fact that their issues attracted a national spotlight only in the wake of another horrific mass killing. Some worry that the episode has deepened the mistaken impression that mentally ill people are more prone to violence, though research shows that is rarely the case.
“There’s some tension there,” said Jennifer Mathis, deputy legal director at the Bazelon Center for Mental Health Law, an advocacy group for people with psychiatric disabilities. “It’s a welcome opportunity to shine a spotlight on mental-health systems that have been broken for many years. At the same time, this context of creating solutions in the wake of the incident at Sandy Hook is not a good context for making mental-health policy.”
Mathis and others also worry that in their haste to act, lawmakers in the states and on Capitol Hill could end up doing as much harm as good. “Mental-health care, in a time of national crisis, is easy to get behind,” said J. Reid Meloy, a forensic psychologist and clinical professor at the University of California at San Diego. But that alone is not enough, he said. “It’s much easier to pass laws than to provide the funding to support those laws.”
Another problem: “There is a danger you write bad policy,” Meloy said.
That fear already has begun to play out in certain states, said Debbie Plotnick, senior director of state policy for the advocacy group Mental Health America.
“We’re very concerned about reactionary legislation … that impinges upon people’s rights,” Plotnick said, adding, “We’re seeing a push come out of these episodes to have more coercive laws.”
The gun-violence law recently enacted in New York is one example, some mental-health advocates say, of legislation that could have troubling consequences. It includes a provision requiring physicians, social workers and other therapists to report potentially dangerous patients to local health officials. That information would go into a state database that could be used to revoke a patient’s gun license or confiscate legally owned guns — a scenario some critics say threatens civil rights and could discourage some people from seeking treatment.
Another complicating factor is that not everyone agrees on precisely what changes are most needed. “There is no unanimity where you put very scarce resources,” said Robert Glover, executive director of the National Association of State Mental Health Program Directors.
There is broad agreement that the system remains woefully underfunded in much of the country. And there is little opposition to early identification and prevention programs for people with mental illness, as well as making more treatment available for young people — all principles supported by Obama, among others. Advocacy groups also are pushing the administration to spell out the specifics behind federal legislation that requires more expansive insurance coverage for mental-health services.
But certain issues remain divisive. Efforts in numerous states to make it easier to commit the most severely mentally ill patients against their will have troubled many advocacy groups but have pleased people such as Doris Fuller, who have long pushed for such changes as necessary to treating severely ill patients.
“We are seeing interest in reform in states that haven’t looked at it in a decade or more… . It’s certainly created opportunities that we have rarely seen before,” said Fuller, executive director of the Arlington County-based Treatment Advocacy Center. “We’re trying to improve the laws in such a way that legal barriers to timely and effective treatment are removed.”
Fuller said she realizes that many people in the mental-health community “are at odds with us.” But given the limited resources, the focus should be on those with the most severe mental illnesses — a population also at the highest risk for violence, she said.
Despite the disparate goals and legislative ambiguity, most mental-health advocates seem thankful for the spotlight, if only because of the hopes that it will bring more funding and attention to mental-health issues.
That would be a welcome change. The budget cuts of recent years have translated to fewer beds at psychiatric hospitals, fewer crisis centers and decreased access to treatment for low-income patients.
The tide, advocates hope, is beginning to shift. “It would be good if we could undo some of the damage of recent years,” Plotnick said. “We’ve had years of cuts, and they’ve been drastic. We’re seeing a rethinking of that. I wish it would turn on a dime.”