States Need More, Not Fewer, Mental-Health Services

By Jacob Lambert
Add Comment Add Comment | Comments: 2 | Posted Apr. 20, 2010

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In September of 2008, my older brother walked free from a New Jersey mental hospital and made his way to my home in Philadelphia. It was not a welcome visit, with David’s release the result of an apparent administrative error. After his eventual arrest here, he was admitted to a West Philadelphia facility, plunging my family and I into a thick bureaucratic fog: As an out-of state resident, he was ineligible for long-term care. After a token stay in West Philly, he was shown the door and pointed to a homeless shelter. Back on the streets, it would only be a matter of time until David was again arrested and committed; it seemed that the cycle was set to repeat itself.

In January of 2009, I wrote about the experience in PW, and the story ended on an upbeat note: Upon his discharge, I managed to get David into my car and up to our parents’ house in New Jersey. Much to our surprise, he flourished there. He began to watch his diet, do the cooking and take care of the house. When we spoke on the phone, he was funny and measured. Gone were the grandiosity and long, tangled sentences. He was 42 at the time, and as the weeks became months, we allowed ourselves to believe that after 18 years, he had finally outrun his acute bipolar disorder.

We were wrong. Last October, David called to share his thoughts on Obama and Facebook and “electronic democracy.” Out of 24 minutes of conversation, I spoke for maybe 30 seconds. At home, he was becoming unpredictable, clashing with our parents. Soon enough, he was back in the hospital. His progress erased.

In recent years, New Jersey has moved toward a “community-based” approach to mental-health care, instead of languishing in an institution as before, David was moved into “supportive housing.” There, social workers administered medication, settled disputes and offered much-needed guidance. But now that he could freely come and go, he soon dropped out of sight, roaming Manhattan and sleeping on the street. He resurfaced at Bellevue Hospital Center, went back to supportive housing, and began to create real trouble: He threatened our mother’s former boss, filed petty lawsuits and broke into our parents’ house. He’s currently in yet another state hospital, awaiting yet another transfer.

The move to reintegrate patients into society is truly progressive, and largely commendable. But for people like my brother, the shift has been destabilizing. Too erratic to live on his own, too self-aware for eternal hospitalization, David seems doomed to a life of institutional ping-pong. Most troubling is that the organizations that represent the future of mental-health care in New Jersey—those that, properly funded, might actually be able to help people like David move on—are getting slaughtered, year after year, by budget cuts.

Of course, Pennsylvania has faced much of the same carnage.

Last May, Gov. Rendell proposed cuts that the National Alliance on Mental Illness’ Pennsylvania chapter warned would “devastate services for individuals and families.” In the 2010-2011 budget, mental healthcare is slated for an $18.4 million hit, with the outlook even dimmer after federal stimulus funds expire in 2012. According to Debbie Plotkin, of the Mental Health Association of Southeastern Pennsylvania, prospects for mental healthcare providers are “really bad now and [are] going to get a whole lot worse.” This, she adds, at a time when “demand for mental-health care services are way up” due to the recession’s social toll.

In a letter to the Inquirer last June, NAMI PA Executive Director Jim Jordan put it succinctly:

“While we understand today’s very difficult economic environment, it makes no sense to pull the rug out from under the feet of our most vulnerable citizens … Cutting behavioral-health services does not mean people who need mental-health services will go away. In fact, when they are denied these services, they use more costly services, such as emergency rooms, homeless shelters and corrections facilities.”

When it comes to finding new revenue—funds that could mitigate or offset cuts to social services—Pennsylvania has a number of reasonable options. Ours is the only state that does not impose a tax on smokeless tobacco. The looming Marcellus Shale bonanza will not include an estimated $160 million in extraction levies. According to the Southeastern Pennsylvania Budget Coalition, “more than 70 percent of corporations in Pennsylvania do not pay any income tax.” The group calculates that by lowering the corporate tax rate and closing such loopholes, $67 million could be raised. Local Reaganomicists would counter, as they always do, that new taxes would harm the state’s economy and cause businesses to flee. Yet here’s our alternative: Keep on cutting at the expense of the worst-off—with the mentally ill a favored target of the budgetary hacksaw.

It seems unlikely that the trend of paring from Pennsylvania’s mental-health care services will ever go out of fashion; the act is as politically ingrained as obfuscation and grandstanding. I recently came across a Reading Eagle piece headlined “Mental Health Budget Cut Assailed.” Among the assailers was State Representative and president of Wernersville State Hospital Board Robert Gerhart Jr., who said that his 1,800-patient facility “has only three psychiatrists.” Also protesting was State Representative Gus Yatron, who “felt legislators were ‘both morally and socially bound’ to provide funds for mental health programs.” The article ran on Oct. 9, 1957.

Sadly, in the five decades since, that moral obligation—in Pennsylvania, New Jersey and countless other states—remains thoroughly unrecognized.

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1. Janice said... on Nov 3, 2010 at 05:37PM

“I found your article while researching the state of PA's mental healthcare. I am considering moving to PA to be with family, and escape the unconscionable state of NC's mental healthcare funding. My son was doing relatively well for 10 years, with only an initial hospitalization to determine that he has Schizophrenia. A little over a year ago, the community supports he received were pulled. With his services, he was flourishing; he stayed on his meds, his social skills were good, he had a daily schedule as well as competitive employment. Then, NC pulled the plug. My son was alone during the day. When I realized that his behavior was slipping I quit my job to be home with him--too late. Now he is in a revolving door of arrests, and hospitalizations that "stabilize" him on meds and let him go, and back around again. NC pulled funding to save money. It is costing more in arrests, hospitalizations, and former taxpayers who are staying home to care for their abandoned loved ones.”

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2. JonahClint said... on Jan 21, 2011 at 11:57AM

“Wendell Potter, former CIGNA Chief of Corporate Communications, will discuss what it means to turn our health system over to the health insurance industry.”

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