APA, Advocacy Groups Decry MH Budget Cuts

APA Medical Director James H. Scully Jr., M.D., had a question for members of the press at the 2003 annual meeting last month in San Francisco.

He told them, “Our science is better than ever. People can recover. Mental illness is a disorder of the brain. Psychosis is bad for the brain.”

Scully then asked, “Why can’t we get these messages out?”

The occasion was a press conference that APA sponsored with the National Alliance for the Mentally Ill (NAMI) and the National Mental Health Association (NMHA) to describe the impact of state budget cuts in Medicaid on people with mental illness.

Outgoing APA President Paul Appelbaum, M.D., said that the three associations are united in their concern about the future of the mental health system and intend to be a “formidable force in advocacy.”

He told the audience that Medicaid is the source of more than 20 percent of funds spent on all mental health services and provides more than 50 percent of the money directed to the public mental health system.

Every state has cut or plans to cut financial support for Medicaid.

“The hospital emergency room has become the safety net,” Appelbaum said.

NAMI President James McNulty told the group that a person suffering an acute psychotic episode often must spend three or four days in a hospital emergency room, waiting for an inpatient bed. “Our members have to deal with the consequences of the crumbling system,” he said.

“Medicaid is the lifeblood of community programs,” he said. “ERs are full. Outpatient is jam-packed. Psychiatrists must see patients faster. Patients arrive in greater distress and suffer more as a result of the cuts.”

In response to a reporter’s question about competing state and national budget priorities, Scully said, “That’s a game politicians play. They say, ‘Do you want schools or health care or a bridge?’ Don’t let them make us choose among them. There is enough money for all.”

Appelbaum pointed out that cutting treatment programs does not save money. “People do not stop getting sick,” he argued. Instead, costs are shifted from the mental health system to the correctional and social welfare systems.

Incoming APA President Marcia Goin, M.D., told the audience to consider what happened in Los Angeles as a result of decreasing resources for mental health.

A couple of decades ago, Los Angeles County had approximately 2,500 public psychiatric beds, she said. Now, there are 330.

Six years ago, as a result of a grand jury investigation, the county was ordered to improve mental health treatment in its jail or close the facility. The result is a 100-bed psychiatric hospital in the jail. Another 2,300 inmates receive psychotropic medications and evaluations.

“However, it’s not cost-effective,” Goin said. More important, it’s tragic when a person can receive good mental health treatment only in jail and is subject to relapse upon release because of lack of services.

She said that a priority for her presidency will be the collection and dissemination of data that demonstrate the effects of cost-shifting when services are cut.

In May 2003, on behalf of APA’s Assembly and Board of Trustees, Herbert Pardes, M.D., a former APA president and former director of the National Institute of Mental Health (NIMH), wrote Thomas Insel, M.D., the current NIMH director, requesting that the institute make mental health economics and service systems research “one of your highest priorities.”

Specifically, APA asked for an assessment of the financial, social, and human costs of inadequate mental health treatment on other health, social service, criminal justice, work disability, and educational systems; of cost-shifting between the public and private components of the mental health system, and of the cost-benefit and cost-effectiveness of current and emerging mental health treatments.

Thompson and McNulty echoed Scully’s contentions that progress had been made in mental health treatment and that people can recover.

Thompson said, “[Until the cuts] we were on track for improvements in community psychiatry. Our patients were starting to get access to housing. They were being included in planning. We were treating people with dual diagnoses and starting to connect with primary care doctors.”

He pointed out that the country was under a Code Orange security alert, creating more stress and greater need for mental health services.

Appelbaum said, “Our security as a people depends on more than inspecting container ships at our ports or making people take their shoes off at airports. It depends on how well we take care of each other.”

Reuters News Service, which provides copy to newspapers throughout the country, reported the press conference with the headline, “U.S. Experts Warn of Dangers in Mental Health Cuts.” ▪