While the Obama administration is trying to hold the line on mental health funding, the same cannot be said about state governments. According to a new report by the National Alliance on Mental Illness (NAMI) two-thirds of states have cut mental health care funding in the last three years, with total cuts reaching nearly $1.6 billion. The cuts vary considerably in size, with Kentucky lawmakers cutting the most, at 47.5 percent.

Seventeen states did show increases in mental health funding over this time, but they were often small, with 10 of these states boosting funding by 4 percent or less.

"State mental health cuts are a national crisis," said NAMI Executive Director Michael Fitzpatrick, in a press release. "Some states are trying to hold the line or make progress, but most are cutting deep. This stands in stark contrast to the intense national concern about the mental health care system following the Arizona tragedy two months ago."

To many experts these cuts show a lack of foresight on the part of legislators. "It's all about the line-item budget today, with no consideration of long-term costs or the effects on individuals or the public," said Karen Sanders, associate director for publicly funded services in APA's Office of Healthcare Systems and Financing.

Fitzpatrick noted that cuts in mental health care funding eventually lead to increased prison and emergency-room costs as many people who can't access care end up in hospitals or the criminal-justice system.

Laurence Miller, M.D., medical director of the Arkansas Division of Behavioral Health and chair of the APA Assembly Committee on Public and Community Psychiatry, understands the current economic problems of many of the states and the corresponding pressure this puts on the legislatures, but believes that lawmakers need to think carefully about how to cut budgets to have the least impact. "Cuts have to be made in a reasonable way, not just the biggest ticket item [because] that can lead to unintended consequences."

The cuts detailed in the NAMI report are likely to be far from the last. Many states are looking at further reductions to close significant budget gaps, and mental health care often appears in the crosshairs. Miller noted as well that states funded many budget items through federal stimulus funds, which will be drying up this summer when the stimulus program ends. State money to replace most of these funds simply isn't there.

The report did not focus on Medicaid funds, which states use to pay for many of their mental health programs and may be targeted by federal budget-cutting efforts.

The report is posted at <www.nami.org/Content/NavigationMenu/State_Advocacy/State_Budget_Cuts_Report/NAMIStateBudgetCrisis2011.pdf>.