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Sequestration is a big blow to an already ailing mental-health system

addiction treatment patient
REUTERS/Brian Snyder
Sequestration means 169,000 fewer individuals will be admitted to substance-abuse treatment programs.

Despite recent alarms to give mental health a more serious approach and to mobilize more funding to address a broken mental-health system across the country and in Minnesota, sequestration is here. According to the White House, if sequestration is fully implemented 373,000 mentally-ill adults and children across our nation will have to go untreated. Mental Health America reports that over the past three years, states across the country have had to cut approximately $4 billion in mental-health budgets — yet there are more cuts on the way with sequestration.

The Minnesota Department of Health reports that Minnesota ranks 24th among the states in the number of psychiatrists per 100,000 in the population. There is also a huge shortage of beds in mental-health wards  across Minnesota — and partial-day programs have long waiting periods.

Because there are so few beds available, individuals with severe psychiatric disorders who need to be hospitalized are often unable to get admitted. Those who are admitted are often discharged prematurely and without a treatment plan.   

The situation is even worse in rural Minnesota, where the Health Resources and Services Administration (HRSA) reports a shortage equal to 52 full-time equivalent practitioners in Minnesota. HRSA estimates that 1,456,036 Minnesotans do not receive an appropriate amount of mental-health services. These patients cannot receive the medication, treatment or support that would help them as they have to drive long distances to access mental health treatment. If they do not have insurance or cannot afford treatment and travel, they are forced to forgo mental-health treatment. In Anoka County, where the state’s largest mental-health hospital is located, an estimated $344, 000 in budget cuts is definitely bound to affect mental health services for vulnerable adults, adult mental health, chemical dependency and children’s mental health.

Homeless will lose social services, programs

According the Treatment Advocacy Center, budget cuts to mental health means that nearly 9,000 homeless people with mental illness across the nation will lose social services and outreach programs that put them on a path to transition to permanent homes. These issues are very troubling given the fact that a federal survey conducted in 2005 estimated that approximately 500,000 people are homeless in the United States at any given time, and one-third of those individuals have a serious mental illness. The same study concluded that, out of the percentage of mentally ill patients that do not receive mental-health treatment, 5 to 10 percent are bound to commit violent acts.

The outcomes of sequestration in mental health at this time are troubling as we could end up having increases in suicides, jailing or untreated mental-health patients turning violent. Even in the wake of some of the  most troubling tragedies in our nation’s history that have been linked to a lack of proper mental-health treatment, like the Newtown tragedy, we have to endure more budget cuts. Given that one in every four Americans lives with a mental-health or substance-use condition, and more than 67 percent of adults and 80 percent of children who need services do not receive treatment, maintaining discretionary federal funding for mental-health and substance-use services is pivotal to ensure citizens have access to behavioral health care.

Substance-abuse and violence prevention

America and Minnesota cannot afford to have 1.13 million children and adults at risk of losing access to any type of public mental-health support and more than 320,000 children miss out on coordinated mental-health services, early intervention and prevention programming, and other suicide prevention services. It would be a shame to have 230,000 individuals with mental illness lose access to treatment and prevention services. It would also be devastating to have 169,000 fewer individuals admitted to substance-abuse treatment programs or to decrease the number of effective teen dating violence-prevention programs that could result in increased psychological and sexual abuse for our teens.

It is, therefore, time for our lawmakers to bury their political stands and work for the good of the country. There comes a time when the nation and its people are bigger than one’s political ideology or stand.  It is time for a bipartisan unison to come up with solutions that would prevent ongoing sequestration cuts.

This is a crucial moment for Congress to find a different approach to reducing the financial deficit through a balanced approach. Mental-health and public-health programs are so important to the health and well-being of our society. Less funding for mental health will only create more problems for our nation. Cutting funding for mental health will be way too costly for mental health patients, their families and the community at large.

Caroline Kuria is a graduate student at the University of North Dakota.

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Comments (2)

A continuing deterioration

When the concept of "mainstreaming" was introduced quite some time back, it was spun up as a more humane way of engaging the mentally ill. In reality it was only a cost saving measure that resulted in a prison cell for many of the mentally ill. "Inhumane" treatment, such as that offered by a state mental health system in places like Cambridge Hospital, were apparently less satisfactory than having a patient in a prison cell. Makes sense, apparently, to someone. Now, after decades of systematic reductions we are set to implement even further reductions. And with politicians taking care of themselves and their sponsors rather than the citizens, we should look for more of the mentally ill to be sent to prison, where "treatment" is really just a word. This nation is not the nation the sloganeering describes. It is become a capitalist state, with all the cold comfort that that can provide a needful population. It's become frontier days in America. We are forging a social contract based on the old class lines that Great Britain so loved.

It gets worse

Almost simultaneous to sequestration another blow to the mental health system occurred within the state system but was caused by national forces. Each year rates are set for the publically funded privately provided mental health system. These rates include payment for everything from out-patient counseling to day treatment, in-home mental health and a variety of other services. The provider community was shocked as were state officials to find that the rates for 2013 will decrease. For example outpatient counseling saw a 3.6% decrease while family therapy saw a 14% increase. This at a time when society seems united on only one issue: the need to provide more mental health. Governor Dayton has proposed a 5% increase in rates which would have helped but both the DFL controlled Senate and House have actually targeted Health and Human Services for cuts which will mean further rate reductions.

Aside from our own DFL politicians, the culprit? Look to the AMA. The doctors group 'owns' the rate setting mechanism from which they receive $70 million per year in royalties. The meetings are secret and minutes are unpublished but speculation is that the AMA is trying to raise primary physician rates-a laudable goal. But apparently the specialists who make up the rate setting group which has no representation from any other field of mental health and just one lone psychiatrist decided to take away from the lower paid fields such as mental health in order to preserve lucrative rates for specialists such as dermatologists etc. The government by law (thanks to lobbying by the AMA) must use the AMA rates. If you want to see how corrupt our health system is read Time's recent extensive and much remarked on story AND google the rate setting system to which I refer-RBRVS. Unbelievable!