OP-ED: DEFUNDING COMMUNITY MENTAL HEALTH CENTERS WILL LEAD TO A PROVISION CRISIS AND WORSENED MENTAL HEALTH OUTCOMES
Mental illness is prevalent in society, both at the national and community level. It affects relationship dynamics both at work and at the family level. Now more than ever, affected people require adequate access to mental health care, both with respect to providers and access to medication. This access which is made possible by health insurance requires adequate and substantial funding. Budget cuts to funding, particularly to Medicaid will lead to worsened health outcomes due to lack of access to adequate medicine and psychiatric care.
Mental illnesses affect people according to type and severity, along cognitive, behavioral and emotional modalities. Something common among mental illnesses is their effect on people both socially and functionally, whether professionally or academically. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 46.6 million people lived with a mental illness in 2017, which translates to 1 in every five U.S. adults. However, access to mental health care, which is often facilitated by having health insurance, falls short. According to the Mental Health America organization, in spite of health care reform leading up to 2017, 19 percent of the mentally ill remained uninsured in states that didn’t expand Medicaid, while the number was 13 percent in states that expanded it.
Funding for mental health treatment by health insurance is supplied at the federal and state level. According to the Mental Health America organization, the Federal government funds mental health services that fall under Medicare and the Department of Veteran Affairs. It also matches state Medicaid and Children’s Health Insurance Program (CHIP) from between 50 and 70 percent, varying by state. Medicaid is the largest source of funding for mental health treatment. Funding is also provided under Mental Health Block Grants that support states in establishing and maintaining community mental health services. States employ their own mandates in designing and funding their mental health services, which includes state hospitals as well as community mental health centers at the local level.
Community Mental Health Centers were established by the Community Mental Health Act, signed into law by President Kennedy on October 31, 1963. This helped lead to a deemphasizing of treatment in the then cramped mental hospitals and an establishment of more community-centric treatment centers, which would help improve treatment outcomes both functionally and cost-effectively. Since then, as per the National Council for Behavioral Health, treatment has been delivered through government and county-based organizations as well as private non-profit and for-profit organizations.
The funding for mental health has vacillated over the years. Even when there have been slight gains in provisions and allocations, some members of the demographic have still been left out. According to SAMSHA, among the 11.2 million adults with serious mental illness in 2017, only 7.5 million received treatment in the past year, which amounts to 66.7 percent. That left 33.3 percent likely uninsured and without mental health treatment or intervention. That is a sizeable statistic that simply cannot be ignored. One of the essential functions of Community Mental Health Centers is to provide mental health interventions to both insured and uninsured individuals. If Community Mental Health Centers are likely understaffed due to insufficient funding, it stands to reason that they will prioritize seeing insured individuals. Furthermore, uninsured individuals will likely not have access to prescriptions, which is quite a price to cover out-of-pocket. Only in a rare number of instances might they receive samples from their providers, that is if they are fortunate to be seeing one.
In December 2019, Congress passed a budget for the Fiscal Year of 2020. In it, the Community Mental Health Services Block Grant allocated was 722.6 million dollars, which was at par with the previous year. This failed to take into account the possible unemployment numbers, which stand at 20.6 percent as of April 2020, as per Fortune. Furthermore, President Trump outlined a budget request for 2020, in which he calls for the elimination of the Medicaid expansion contained in the Affordable Care Act, as well as an imposition of per-capita caps into Medicaid. The President also proposed denyingMedicaid coverage to people with mental health conditions who don’t work a set number of hours each month, necessitating some form of employment for affected people who may find it difficult to secure it in the first place. The National Council for Behavioral Health is of the conviction that this move will be of serious detriment to individuals with mental illness and addiction who rely on Medicaid. This would directly impact them at the Community Mental Health Center level.
There are certainly other confounding factors that may lead to poor mental health outcomes in populations sub served by Community Mental Health Centers. Issues like non-compliance, both to therapy and to taking medication may be witnessed. In a study in 2002, Glyndal et al. found that 32% of 137 patients did not show up to their first scheduled appointment in a community psychiatry unit. The number dropped to 16% after subsequent contact. However, while a minority of mental health patients may not utilize Community Mental Health Centers, the majority appear to utilize such interventions. Defunding these centers will leave them with little alternative for mental health access.
People with mental illness are in need of regular care, with both psychiatric or behavioral and medicinal interventions. The smallest interruption in this care can seriously derail the outlook of their improvement and maintenance of health. For those who do not have private insurance, have to rely on Medicaid or have none to speak of, Community Mental Health Centers are a bedrock of their therapy; these need to stay open and adequately funded. Since funding decisions appear to take place almost entirely at the legislative level, we need leaders – congressional members and those in the Executive to champion this cause. And in the absence of initiative, we need meaningful advocacy from non-profit organizations and charities. Mental illness is like any other, it needs tending to, whatever the cost.
