(Photo: Jessica Brown)

The Deepest Cuts

As funding declines for mental health facilities, patients fear for their futures

Both federal and state funding for mental health has declined since the 1980s.  And with the recent financial and budget troubles in Illinois, mental health funding is at an all new low, according to a public record statistical compilation.

Illinois ranks 38 out of 50 states in terms of investment in mental health services.  The biggest cut to the Illinois budget happened between 2009 and 2011, according to Heather O’Donnell, vice president of public policy and advocacy at the Chicago-based community outreach program Thresholds.

These programs offer many services to individuals suffering from chronic and “significant mental illnesses,” including treatment, counseling and supportive housing, O’Donnell said. As she described, “significant mental illnesses” can mean anything from bipolar disorder to illnesses with possible psychotic episodes.

As funding for services decreased, many people with mental health issues who were under treatment lost their options.  O’Donnell likened the loss to telling a cancer patient that his or her chemotherapy was no longer available partway through the process.

Illinois Hospital Association data shows that as funding was cut, more people were hospitalized due to significant mental illnesses. Hospitalization costs then rose by 19 percent between 2009 and 2011.

The state tried to save $113 million with those funding cuts, but instead they actually cost taxpayers $131 million over the span of those three years.  Mental health treatment costs roughly $28 per day. Hospitalization costs $1,000 per day.

 “Yet the chief opposition to mental health funding reform is still the money,” O’Donnell said. “We literally have thousands and thousands of lives that are just destroyed because of this.

 “But there’s an enormous cost to the state. If these people go without the right treatment, then they spiral into disability for life.”

In the Illinois Legislature’s past session, a bill on the funding of “first episode psychosis treatment” was introduced in an attempt to prevent the spiral O’Donnell described.  “Psychosis is an early symptom of a lot of disorders,” O’Donnell said.  And with every episode, the brain is damaged.  These episodes “typically manifest before the age of 24,” she explained.

The Illinois bill, if passed, would provide secondary coverage of preventative treatment by seeking federal approval for privately covered families to receive Medicaid coverage.  “The whole goal is to keep them on their employer-provided insurance,” O’Donnell said.

Because the private sector doesn’t fund a lot of treatment options, the public sector shoulders most of the burden.  Groups like Thresholds rely primarily on whether individuals who come to them have Medicaid, “and Medicaid does not come close to paying for treatment options,” O’Donnell said.  To pay for community outreach services, payment options are Medicaid or out-of-pocket payment.

Although the organization does take non-Medicaid clients, she said it has limited services available. And not everyone is eligible for Medicaid.

Mark Heyrman, chair of public policy for the advocacy group Mental Health America in Illinois, said part of the problem is that “our mental health funding is very much dependent on continued federal support for Medi-caid.”

The University of Chicago professor said the state is also behind in strategies to keep people with mental illnesses out of the criminal justice system and out of nursing homes. Cook County sheriff Tom Dart refers to the county jail as “the largest mental health facility in the state of Illinois.”  Public records show that over 75 percent of inmates have some type of mental health issue.

Custody relinquishment is another problem.  It happens after a psychiatric lockout.  Teenagers with early signs of a mental health condition, who have tried to either commit suicide multiple times or become violent toward a family member, become hospitalized as a result of their condition, O’Donnell said.

 “The family might be afraid to take the child home or the hospital won’t allow them to take the child home,” she said.  “And when there is a lockout, the hospital has to call the Department of Children and Family Services.”

From there, the situation is investigated as if it were a case of abuse or neglect, despite being a problem of lacking treatment.  “It took a couple years, but it’s mildly better,” O’Donnell said.  “But we shouldn’t even need to be having a conversation about custody relinquishment.”

There have been some improvements, said the advocates.

Both O’Donnell and Heyrman attributed positive movement on the funding front to the Affordable Care Act (ACA) and Medicare expansion.  “That really allowed thousands of people across the nation to have access to treatment for the first time in their life,” O’Donnell said.  Both advocates fear, however, that the proposed repeal of the ACA or the implementation of Medicaid spending caps could stunt efforts to increase the availability of cost-effective treatment options.

At the state level, Gov. Bruce Rauner’s administration has recently applied for an 1115 waiver.  That means the state of Illinois is asking the federal government for an $11 billion increase in federal Medicaid money for substance use and mental health treatment.

“That effort is laudable, but I don’t want anybody to think that that’s a magic bullet,” O’Donnell said.  “It doesn’t address the commercial insurance issue.”

Illinois Rep. Patti Bellock, R-DuPage, has worked for 19 years to strengthen “parity laws.” Parity in funding is supposed to mean that commercial insurance companies are given a baseline for types of mental illnesses they must cover.  These laws typically specify a minimum dollar amount for treatment coverage.  Some drafts of parity bills prevent insurance companies from switching people from one medication to another just because the new medication is cheaper than the old one.

 “Insurers were all opposed to it because they felt that they would be bankrupt,” Bellock said of her first venture into parity legislation.  “But what we said was true, if people got therapy, we would keep them out of hospitals, give people a better quality of life and save a lot of money.”

House Bill 68, a new parity bill, is in the pipeline.  It aims to increase transparency between the public and private insurance sectors.  It would also allow the state’s Department of Insurance to better monitor private insurers’ implementation of parity requirements.

Two decades of United States Surgeon General’s Office statistics show that 1 out of every 6 people has a serious mental health condition. 

“It’s come out of the darkness some now,” Bellock said, “But there’s always been a stigma, and the stigma still exists.”


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