National Association of Social Workers

Budgets Balanced at Expense of Mentally Ill

Tucson Tragedy Draws Attention to Weaknesses in States’ Behavioral Health Systems

“This is one of the most damaging periods in states’ history, and we don’t know exactly when it’s going to be over.”

By Matthew Malamud, News Staff

Credit: John Michael Yanson

A perception persists that people who are mentally ill pose an increased threat of committing violent acts; three-quarters of Americans view the mentally ill as dangerous. Tragic events like the attempted assassination of U.S. Rep. Gabrielle Giffords, D-Ariz., by suspect Jared Loughner in Tucson, Ariz., stoke those fears. Loughner allegedly is mentally ill.

But data collected by the National Institute on Alcohol Abuse and Alcoholism confirm that serious mental illness — such as schizophrenia, major depression or bipolar disorder — alone is not a significant predictor of violent behavior. (Researchers have found that people with serious mental illness who also abuse alcohol or drugs may be more likely to commit violent acts.)

In fact, violent acts committed by people with serious mental illness comprise an exceptionally small proportion of the overall violent crime rate in the U.S. They are more likely to be the victims of violence, not its perpetrators.

In the aftermath of the Jan. 8 Tucson tragedy, the media’s focus on Loughner’s mental state and whether authorities could have prevented the shootings exposed vulnerabilities in the nation’s mental health care system, prompting many to call on states to boost funding for mental health services.

Funding drought: A new report by the U.S. Substance Abuse and Mental Health Services Administration documents a nationwide decline in behavioral health care spending as a share of all health care spending, from 9.3 percent in 1986 to just 7.3 percent, or $135 billion out of $1.85 trillion, in 2005.

Most states — still reeling from the recent economic recession — are looking to make further cuts to their health care expenditures, not increase them. By law, states must balance their budgets, the bulk of which is dedicated to health care expenditures.

In a report titled “Grading the States 2009,” the National Alliance on Mental Illness said of the mental health care system: “Long fragile, fragmented, and inadequate, it is now in serious peril,” owing in part to the recession’s impact on state budgets.

NAMI’s first attempt at evaluating states’ mental health services came in 2006. At that time, the nation’s grade was a D (“F” being failing). Three years later, that grade was unchanged; although it should be noted that Gifford’s state of Arizona had improved from a D to a C.

The report notes that mental health care is countercyclical — demand for services tends to increase as the economy declines. This is evident in last year’s higher-than-expected enrollment in Medicaid, which pays for more mental health services than any other source.

According to the Kaiser Commission on Medicaid and the Uninsured, for every 1 percentage point increase in unemployment, 1 million more Americans enroll in Medicaid and an additional 1.1 million become uninsured.

“Although research shows that failing to adequately fund mental health services results in a need for significantly greater expenditures down the road, many states are still choosing to cut immediate costs by limiting access to needed services for people with serious mental illnesses,” NAMI’s report says.

Despite demand, state mental health program directors have seen their budgets shrink by more than $2 billion over the last three years. While some states have cut funding for mental health services as much as 20 percent, others might resort to cutting as much as 40 percent, according to Elizabeth Prewitt, government relations director for the National Association of State Mental Health Program Directors.

“What is happening is they’ll make cuts, but the fiscal situation continues to deteriorate and they have to go back in,” Prewitt told NASW News. “This is one of the most damaging periods in states’ history, and we don’t know exactly when it’s going to be over,” she said, noting that historically, states’ recoveries lag behind the nation’s.

Although state mental health programs have tried to make do with less by trying to rein in administrative costs, furloughing staff and instituting hiring freezes, Prewitt said that kind of trimming around the edges hasn’t been enough to avoid an effect on services.

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From March 2011 NASW News. © 2011 National Association of Social Workers. All Rights Reserved. NASW News articles may be copied for personal use, but proper notice of copyright and credit to the NASW News must appear on all copies made. This permission does not apply to reproduction for advertising, promotion, resale, or other commercial purposes.