ideastream Focus on Mental Health: Budget Cuts and Mental Health

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Lynn Olman, a state representative for Ohio's 46th House district, is all too aware of the state's money problem.

Lynn Olman: The size of the budgetary hole that we have for 2004 and 2005 is not a static number because so much depends on how well the economy rebounds, but at the outset it has been estimated that we have a two to four billion dollars hole that has to be filled.

Like many of his fellow republicans, Representative Olman's is not happy at the growth in state spending, at a time when revenues have shriveled away. However, this self-described conservative did something unusual last week. Sitting down before a key House committee, he asked his colleagues not to cut spending on mental health. Olman says the mental health system has become a vortex that is pulling consumers back to state hospitals again and again. He points out that many people with severe disturbances get comprehensive psychiatric help through Medicaid, the federal and state program that cares for the poor. The problem, he says, comes when these consumers try to leave entitlement programs.

Lynn Olman: We heard testimony upon testimony about people who went back to work, only to find that the insurance that they would have through their new employer had inadequate benefits, and therefore they could not receive the proper treatment, the psychotropic drugs they need to remain normal - and they would go back and become a ward of the state.

State leaders have been somewhat receptive to the idea that moderate investments in mental health services can helpavoid more spending over the long run. The Governor's proposed spending plan for the Ohio Department of Mental Health for the next biennium actually calls for slight increases. But that's not what advocates are worried about. There are dozens of revenue streams for support services--from housing to vocational training--that are threatened in other departments. Also, the state's considering major changes in Medicaid enrollment. If the plan goes through, tens of thousands of Ohioans would lose their access to counseling and medication, putting additional stress on the local funding system. Some acute examples of the budget dilemma can be found in Cuyahoga County, which has the highest caseload in the state.

Denise Lofgren: Alright so we're going to run out to Lakewood to see this woman. She's 37, I believe...

When a person with mental illness is having a psychiatric emergency, someone has to go out, assess the situation, and decide what to do. In this county, that someone works for the Mobile Crisis Unit.

Denise Lofgren: What we're going to do is try to engage this woman as much as we can. Not that she would want to hurt herself or someone else, but her illness might lead her in that direction, through her paranoia or her outbursts.

This is the front line of the behavioral health system, but the county's funding situation is so anemic that Mobile crisis has had to slash its hours of operation by one third. Anyone with an emergency between midnight and 8:00 A.M. will be dealt with by the police.

Counselor Denise Lofgren is driving down a wealthy west side avenue, lined by palatial houses and expensive high-rise apartments. Safe as this neighborhood looks, she never knows what she's walking into. Mobile Crisis received a call from an apartment manager about a tenant who's being evicted, has refused to leave, and is exhibiting signs of psychosis.

Denise Lofgren (speaking to building manager): Hi, you wouldn't happen to be the maintenance man, would you? We're going to try to go up and talk to this young lady...

The woman has been yelling at the walls, fighting with neighbors, and leaving the water running. Once she's arrived on the correct floor, Lofgren knocks repeatedly, but after getting no answer, she decides to go in.

Denise Lofgren: Hello! Are you here?

Walking into this uncertain situation may seem like a big decision, the work's actually just beginning. The woman is home, and is willing to talk. She's not violent, but isn't very coherent either. Lofgren spends the better part of an hour talking with her, getting some basic information, and trying to convince her to accept help. Ultimately, the consumer makes it clear she will not. Lofgren and her supervisor decide to go to probate court, seeking the right to intervene in her situation.

The cuts made in Cuyahoga County have had serious consequences for people in immediate need of services. Most other counties are in slightly better shape. But as they look at what's happening in Greater Cleveland, they're worried they may be seeing their own future. William Harper is the executive director of the Lorain County Community Mental Health Board.

William Harper: When the state budget gets cut, either you have to cut services locally, or you have to respond with local tax initiatives, going back to the voters time and time again. What gets laid on top of that is we're not seeing fewer people seeking our services. We're seeing two times as many adults with severe mental illness than we did just ten years ago, and three times as many kids.

And while Lorain County's voters have been supportive of community mental health care, Harper's situation is the exception, NOT the rule. In 2002, seventeen Mental Health levies put before Ohio voters. They were on the ballot in regions as diverse as northeast Ohio's Geauga County to the Cincinnati area's Butler County, to the Marietta area in the southeast. Of those 17 levies, only five passed. In Cleveland, I'm April Baer, 90.3.

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