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here to listen to discussion on "The Crisis in Funding."
State
of Mind: America 2003:
Discussion One: The Crisis in Public Funding
Dramatic
cutbacks in public mental health care in states throughout the country
are dumping people with serious mental illness into jails, homeless
shelters and on the street at a rate eerily reminiscent of the deinstitutionalization
of the 1960s and 70s.
To address this looming crisis, host Dr.
Fred Goodwin welcomes Dr.
Thomas Bornemann, director
of The Carter Center's Mental Health Program and Dr.
David Pollack, mental
health medical director for the State of Oregon.
Dr. Pollack, who is also a board member of the American Association
of Community Psychiatrists, begins by observing that that most states
in the nation are currently cutting back on mental health programs.
The result, he says: "Suicides, people turning up in the streets,
people turning up in jails and emergency rooms
Dr. Bornemann says that while expenses are indeed being cut in all
areas of state and local budgets, we must remember that mental health
programs have been under-funded all along. Jails and prisons all
over the country are already serving as de facto mental health centers
because the needs of mentally ill people are not being met in a
more appropriate setting. We will see the costs of treating mental
illness continue to shift into other sectors as program funding
continues to decline.
Agreeing, Pollack uses as an example the 3,000 people cut off from
methadone recently in his home state of Oregon, where officials
predicted an 80 percent relapse rate. It cost the state $5 million
a year to treat the patients, the cost of heroin for them was estimated
at between $250 million and $350 million a year, and since January,
Portland alone has seen a 40 percent increase in the rate of property
crime.
Dr. Goodwin observes that funding for mental health care, as opposed
to care for other medical illnesses, has historically come from
the government. When that funding stream is cut off, he says, people
with serious mental illnesses are unlikely to have other sources
for treatment. The vast majority of people with serious mental illness
receive their funding from Medicaid, Bornemann says, which, across
the country, is targeted for cuts.
Bornemann and Pollack both say the current situation is similar
to the deinstitutionalization of the 1960s and 1970s, when people
were discharged from closed psychiatric hospitals with no plans
for their future, and that similar results can be expected. Pollack
says that in both instances, a failure in leadership can be blamed
for the inability of state and local governments to figure out a
way to provide care.
In Oregon, Pollack, says, the state had created a progressive health
plan that has recently been undermined by the state's loss of revenue
and unwillingness to raise taxes. Those factors, combined with the
economic downturn, the war, and the September 11th attacks, created
what he called the "perfect economic storm." Although
Oregon has fallen harder and faster perhaps that many other states,
it's clear that the rest of the nation is headed in the same direction,
he says.
Next, Dr. Goodwin takes a couple questions from the audience at
The Carter Center. Annie Stewart wants to know how to find help
for people on the street who clearly aren't getting the services
they need. Pollack says experience and research have demonstrated
the importance of taking services to people wherever they are, even
if that means getting their medication to them on the street. Audience
member Eileen Franco asks what might be done to find additional
funding for mental health services and Bornemann recommends educating
the electorate to the importance of these services and the fact
that budget cuts in this area are short-sighted.
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The Infinite Mind is
supported in part by major underwriting from the John D. and Catherine
T. MacArthur Foundation, the National Institute of Mental Health,
and the Nonprofit Finance Fund. Additional underwriting in the form
of unrestricted educational grants from Eli Lilly and Company and
Bristol-Myers Squibb. Major underwriting for State of Mind: America
2003 was provided in the form of an unrestricted educational grant
from Solvay Pharmaceuticals. Additional support was provided by
Tom and Edwina Johnson, The J. B. Fuqua Foundation and the Turner
Foundation.
The
Infinite Mind is non-profit production of Lichtenstein Creative
Media, in association with the New York Foundation for the Arts
and WNYC/FM.
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