Wednesday, April 13, 2011

Now is the time to write your representatives in Congress and in your state, about mental health budget cuts

We are in dire times, Americans. At the last NAMI Education meeting in my county, it was stated by a CEO of a community mental health agency that Florida is cutting its budget for mental health and substance abuse services by some $230 million, leaving nothing left, if this goes through, but some funding for a few crisis unit beds.

While this situation in Florida is horrible, it is not any different than what is happening in many other states.

Simultaneously, the GOP wants to slash funding for Social Security and Medicare: the very programs that many of us need to survive.

Left without the supports of community mental health centers, disability benefits to live on, and healthcare to get treatment, people are going to die. People are going to suffer. Even more than they are already suffering. There are going to be increases in suicides, homelessness, and arrests for petty misdemeanors by people forced to live on the streets because they have nowhere else to go.

 We need more help, not less!! I have written about this subject on this blog many times. I don't know how many of you write letters to your members of Congress, but I did get an email from one of you recently and she asked me, "who can I write to?" At the time, I didn't have an answer. She was talking about my post about how I'm not going to have case management or therapy for much longer. Well, the people really responsible for that, really the ones who could change that are legislators. And that is who you can write to. Write to Florida's legislators if you want to; that is where I will be affected. But write for yourself to your state's legislators too. Write to Congress about the federal budget. Write now. Write on behalf of your family and friends who live with mental illnesses. Write on behalf of those who have died. Write now. Call. Fax. Visit. Email. Write.

Contact Information:

Here are some tips on contacting your members of Congress. Letters are preferred and receive more attention than emails, but of course email is easier. There is a letter I wrote which I sent to my reps and Senator a while ago here.
What I wrote was not concise, so try to write something shorter than my email.

Whatever you do, please at least try to do something. If we act like bystanders in a democracy, we really can't blame everyone else when things like budget cut travesties occur. We have to voice our concerns, tell our stories, and change the way people think about mental health and treatment. We must make them understand treatment is necessary and deserved, and no country with a conscience should deny its citizens the right to mental health care. So send an email, fax a letter, or make a phone call, and please do it right away.

Tell them the services you use, and how your life would be affected if those services no longer existed. If you don't use services, tell them about someone you know who does. For example, I go to a community mental health center where I get  injections ever other week, see a psychiatric ARNP  who prescribes many medications, see a therapist, who helps me manage my life, and have a case manager who helps me keep getting the treatment I need, and advocates on my behalf when necessary. Because of the low budget that already exists I don't qualify for case management anymore, because I haven't been in a hospital in a few years. One of the reasons I haven't been in a hospital in years is that I had that case manager helping me. Because Medicare has strict rules and will no longer fund my therapy, I will no longer have my therapist in a couple of months. And this is also what has kept me going - therapy. And this is with the current budget. When that budget is totally slashed, which it is likely going to be, then these services won't be available for many, many people who need them. I used to be homeless, psychotic, suicidal, and alone. I have not been that way in years, because I have had help. Now the state and the federal governments want to take that help away from people like me. Please help me take a stand so this won't happen. So if you don't have a story of your own to tell, then please go ahead and tell my story.

Please read the below important information, and use it when you contact your representatives:
DENVER (AP) - State budget writers looking for cash to balance the books have stripped a cumulative $1.8 billion from mental health services over the last 2½ years, putting the public at risk as the mentally ill crowd emergency rooms and prisons, according to the nation's largest mental health advocacy group.

The Washington-based National Alliance on Mental Illness tallied state budget cuts to mental health services between 2008 and today and found that 32 states and Washington, D.C., cut funding just as economic stressors such as layoffs and home foreclosures boosted demand for services.

California slashed funding by more than $587 million, or 16 percent. Kentucky gutted its mental health budget by an astounding 47 percent over the last two years.
In many states, the picture is likely to get uglier for those relying on state mental services. Starting this summer, some $87 billion in federal stimulus money for Medicaid assistance to the states starts drying up. Because virtually all Medicaid-funded mental health services are optional, states projecting another couple years of budget deficits are likely to chop mental health services further.
"These are really dangerous times," warned Michael Fitzpatrick, NAMI's executive director. The group reviewed state mental health budget cuts in the wake of the January shooting in Arizona, in which six people died and 13 were injured, including U.S. Rep. Gabrielle Giffords. The man charged with shooting them, Jared Loughner, showed signs of mental illness but was never referred for treatment.
"People really need to learn their lessons from Arizona and think about what we're doing to address mental illness," Fitzpatrick said.
Silverman, of Delray Beach, has struggled for decades with a complex mix of mental illnesses that was finally diagnosed as bipolar disease, depression and mood disorder. The problem renders her unable to work, at 55.

She takes numerous medications that she and her doctor settled upon after much experimentation. The pills keep her stable, avoiding crises that have sent her to emergency rooms at times.

The proposed cuts could alter state coverage for drugs and end virtually all outpatient mental health services for uninsured adults. Gone would be doctors, counseling and group homes. Under the Senate's $137 million of cuts, the state would cover only crisis treatment.

"I don't want to go back to the way I was. Please don't make that happen to me," Silverman said. "Is this honestly the way to try to cut costs? By driving people crazy, by making their lives miserable?"

-Copyright 2011 South Florida Sun-Sentinel
Seventy percent of emergency department administrators report that they hold mentally ill patients for 24 hours or longer, according to a 2010 survey by the Schumacher Group, a Louisiana firm that manages emergency departments across the country. Ten percent said they had boarded some patients for a week or more. Most administrators said delays compromise patient care in the ER, increasing waiting times for all patients and overcrowding.
States Cut Mental Health Budgets
The problem has worsened during the economic downturn. Since 2009, 32 states have cut their mental health budgets, largely from outpatient services that keep people healthy and out of the ER, according to a study by the National Alliance on Mental Illness, a patient advocacy group. And since 2010, states have closed or are planning to close nearly 4,000 state psychiatric beds, about 8 percent of capacity, according to the National Association of State Mental Health Program Directors Research Institute.
"We're not cutting fat anymore," says Charles Ingoglia, vice president of public policy at the National Council for Community Behavioral Healthcare, a membership organization for mental health organizations that treat the uninsured and underinsured. "We're at the bone. All of the easy cuts have already been made over the years."

At the same time, many Americans have lost their jobs and health insurance and are leaning on the state programs being cut. The need for such services has also grown as depression and anxiety have increased: a 2009 survey by the U.S. Substance Abuse and Mental Health Services Administration found that mental illness is more prevalent among unemployed adults. Many wait until their illness reaches a breaking point and then seek care at the ER.
-Copyright KHN
  • From fact sheet, "Best Return on Investment (ROI): Mental Health and Substance Abuse Treatment":

 Tough economic times require legislators to maximize the use of taxpayer dollars. Funding behavioral health services is one of the most effective

investments of public dollars. Here’s why:

Treatment saves taxpayers money.

Treatment/ No Treatment

  • Average crisis stabilization bed cost per day: $292
Average Florida emergency room cost per visit: $2,887
  •  Average detox cost per day: $205

Average hospital cost per day: $2,000
  • Average annual substance abuse treatment cost for an adult: $2,400
 Average prison cost for a drug offender: $55,000
  • Average annual mental health treatment cost for an adult: $1,551
Average state hospital cost: $112,000

Treatment works.

 It is estimated that the economic benefits of expanded diagnosis and treatment of depression has a ROI of $7 for every $1 invested.

 $1 invested in treatment for alcohol and other drug-related problems saves taxpayers $7.14 in future costs.

 93% of offenders who complete community drug treatment do not re-offend. One percent change equals $8 million over three years.

 Prevention and treatment result in safer communities. Orange County’s mental health diversion program has saved law enforcement $2.2 million over seven years by reducing or eliminating time spent at emergency rooms.

Treatment supports jobs and local economies.

 Community mental health and substance abuse agencies provide over 50,000 private sector jobs.

 Treatment gets people back to work – 69% of adults are employed post treatment.

 Over 1,490 vendors supply community treatment companies.

 The economic impact in Florida of alcohol and drug abuse is $43.7 billion each year. (The Price Florida Pays for Drug and Alcohol Abuse, 2009)

 Untreated and mistreated mental illness costs the United States $105 billion in lost productivity and $8 billion in crime and welfare expenditures each year. A 5.5% increase in spending by businesses and government on mental health treatment could cut these costs by half. (National Mental Health Association, 2001)

 Treatment success rates for such disorders as schizophrenia (60%), depression (80% percent) and substance abuse disorders (60%) surpass those of other medical conditions such as heart disease (45-50%) and other chronic illnesses. (National Institute of Mental Health, 2004)

 Individuals with mental illnesses are four times more likely to die from treatable illnesses than other individuals and 58 times more likely to die before the age of 50 (Disability Rights Commission, 2005)

 For every $1 invested in mental health treatment, $3.68 is saved in reduced criminal activity and hospitalizations. (The “SCOPE” Mental Health Study Group Report)

 One study in Texas found that providing substance abuse treatment would give the state a ROI of $2.26. The most interesting statistic was a projection about cuts made in the last decade. “If the state had stuck to its 2000 budget for mental health and substance abuse treatment, Texas would be earning a 170% ROI on the money or netting $32.76 today for every dollar spent. (Peter Earley, 2010)

 Sixteen percent of people in jails and prisons suffer from a serious mental illness. (NIMH, 2008)

 Between 50% and 75% of youth in juvenile justice facilities suffer from a diagnosable mental health disorder and frequently do not receive counseling, treatment or support. (NIMH, 2008)

 It is estimated that at least 25% of homeless people suffer from serious mental illness. (NIMH, 2008)

 Twenty-three percent (23%) of parents and caregivers of children with mental illness were forced by state regulations to consider relinquishing custody of their child in order to access mental health services and 20% actually did so. (NIMH, 2008)

 Of adults using homeless services, 31% report having a mental illness and/or a substance abuse condition. (Burt, 2001)


  1. This is shocking and scary, Jen. Thank you for providing information on what we can do - the situation here in Australia is currently better, but possibly will head down the same path. How much worse off we would all be without the help we receive...

  2. NPR had a little segment about mental health patients in emergency rooms in Rhode Island, my neck of the woods. How they can stay in the ER for days until a bed opens up.

    It's not a Rep/Dem thing because up here is bad and there aren't a lot of Reps about.

    We need to open up more beds. I have never been in an ER for my issues but it horrifies and scares. Just sitting with my Dad for 10 hours for medical stuff is enough of a problem.

    If you get a chance to listen, I would.

  3. Preach it sister! We need to know these facts. I for one will be writing a letter today.

  4. I am also in Australia and in the public hospitals here there's basically an in and out policy where as soon as you show any improvement, out the door you go. I finally found out that my private health insurance covers me in a private hospital and here I get to see my own doctor that I see outside of hospital and things are pretty good. However, I still feel awful for other people that aren't as fortunate as me and can't afford private cover. From what I have heard from my American friend Jan, in the States you pay so much more for insurance. She said what we pay in a year, you pay in a month. It's an awful situation.

  5. Lil, I'm glad things are at least a little better in Australia. You're right, we would all be worse off without the help we need.

    Jen, I actually posted an article about that story from NPR in this post, towards the end, so it's funny that you mentioned it. I didn't hear the story on the radio ,but I read it online.

    Afton/Pink, thanks for writing a letter on behalf of us all! That's great.

    Sarah, I don't know how much it costs for insurance in Australia, but that's too bad the public health system isn't so great. Here if you can get into a hospital, even with private insurance, they generally only keep people three days. I guess because it costs insurance companies money to hospitalize anyone. One of the things that would make sense is for the government to spend more on outpatient care so people can avoid ending up in such a bad state that they need the hospital in the first place. If they had better outpatient care for the average person, we wouldn't need as many hospital beds. I don't know why legislators don't realize that, but I don't think legislators should really be making healthcare decisions for people. Oh well, things will change eventually. At least we might have some progress with Obama, though nothing like what I hoped for.

  6. Consider it done. I'm going to write to everyone. As (believe it or not) a registered voter in your county, I'm starting with those guys.

  7. Backward E,

    You're a registered voter in my county? Who knew??!! That is really bizarre. I don't even recall mentioning the county I live in on here but I must have done so, probably numerous times and forgot. If you're ever interested in NAMI meetings, let me know and I'll give you all the info on them.

  8. Couldn't agree more!!! I have been active in this area, too. I've been writing my Representative and two Senators. As well as, President Obama. I even wrote an editorial on saving Medicare, which was printed in the local paper. I agree that we have to speak up or not complain.

    I think a good thing to mention in letters is how mental health treatment can prevent incidents like the Congresswoman Gifford's incident. You touched on that in this post and I think that's an important point to make.

    I think I might write up my own post about this on my Asylum blog. If you mind me borrowing some of what you wrote, let me know because you did a good job with the argument. I promise I will link to this post and attribute your work back to you!! :)


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