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Kristen Wyatt the Associated Press
Published: 14 March 2011

DENVER (AP) — State budget writers looking for cash to balance the books have stripped a cumulative $1.8 billion from mental health services over the last 2½ years, putting the public at risk as the mentally ill crowd emergency rooms and prisons, according to the nation's largest mental health advocacy group.

The Washington-based National Alliance on Mental Illness tallied state budget cuts to mental health services between 2008 and today and found that 32 states and Washington, D.C., cut funding just as economic stressors such as layoffs and home foreclosures boosted demand for services.

California slashed funding by more than $587 million, or 16 percent. Kentucky gutted its mental health budget by an astounding 47 percent over the last two years.

In many states, the picture is likely to get uglier for those relying on state mental services. Starting this summer, some $87 billion in federal stimulus money for Medicaid assistance to the states starts drying up. Because virtually all Medicaid-funded mental health services are optional, states projecting another couple years of budget deficits are likely to chop mental health services further.

"These are really dangerous times," warned Michael Fitzpatrick, NAMI's executive director. The group reviewed state mental health budget cuts in the wake of the January shooting in Arizona, in which six people died and 13 were injured, including U.S. Rep. Gabrielle Giffords. The man charged with shooting them, Jared Loughner, showed signs of mental illness but was never referred for treatment.

"People really need to learn their lessons from Arizona and think about what we're doing to address mental illness," Fitzpatrick said.

Arizona cut mental health services more than $57 million between 2009 and 2010, reducing or cutting services for about 14,000 people. Less well known have been dramatic cuts in dozens more states, which have removed hospital beds and shuttered outpatient services. States have cut staff, reduced clinic hours and trimmed add-on services such as transportation and housing assistance credited for keeping the mentally ill in treatment and off the streets.

Eleven states simply treat fewer people. States with a net reduction in both inpatients and community settings between 2007 and 2009 were Alabama, Alaska, California, Idaho, Illinois, Nebraska, New Jersey, New Mexico, North Carolina, Virginia and Wyoming. Those numbers come from a federal accounting and are the most recent available; NAMI's report notes that those reductions were made "before the worst of the state budget cuts."

Indeed, the picture looks only grimmer in many states where legislatures still at work on next year's budgets are considering making things worse.

Texas is debating an additional 20 percent cut next year, which would leave some 2,800 youth and adults in eight central Texas counties without services. Tennessee may close community health programs and drug abuse treatment facilities to save $15 million. Massachusetts may eliminate a quarter of the beds in state psychiatric hospitals. And in Kansas, nine of 27 Community Mental Health Centers may have to close their doors.

The state cuts have advocates worried that untreated mental illnesses will grow worse.

In Kentucky, where the cuts have been deepest, Martin Cortez Wesley, a social work professor at Lindsey Wilson College, said advancements in mental health treatment over the past 50 years are at risk.

"Today we are abandoning them, kicking them out of their homes, leaving them to go back to the overcrowded prisons and back to the streets," said Wesley, who did not work on the NAMI report.

Mental health advocates insist that cuts don't save money in the long run.

"Any time you make cuts this massive in mental health cuts, the needs in prisons and hospitals and emergency rooms and homeless shelters start to pile up," Fitzpatrick said.

Cuts can strike even harder in rural areas, where mental health services were spotty to begin with.

Christopher R. Larrison, a social work professor at the University of Illinois at Urbana-Champaign, tracks public funding for mental health and said outpatient treatment options in rural areas often vanish for good when they're cut and don't return when state finances improve.

"Many people in rural areas, they don't leave their communities. They just don't get served," Larrison said. "This causes huge problems for police departments and emergency rooms, which have been taking cuts, too, and aren't prepared to take over services for others."

Mental health advocates hope that the federal health care overhaul taking effect after 2014 will help add services for the mentally ill — but their hopes are dim that things will get better before then.

"It's a bleak time across the board," said Sarah Steverman, director of state policy for Mental Health America, an advocacy group that did not work on the NAMI study.

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