Grim Reaper Visits Mental Health Budget

grim-reaper face2

Mental health beds have been eviscerated by budget cuts and the problem is going to get worse, according to a new report by the National Alliance on Mental Illness (NAMI).  In their devastating report,  State Mental Health Cuts: a National Crisis ,  NAMI describes the deep cuts in mental health programs throughout the country and details state-by-state reductions to mental health funding.  According to their analysis, the problem is going to get worse.

In Colorado, for example, mental health funding has been reduced by over $10 million through fiscal years 2009-2011.  Now, with a proposal from the Department of Human Services,  the state agency that oversees mental health services, Colorado may add another $2 million to their loss.  The Department of Human Services, not the legislature, proposed cutting a twenty bed program serving individuals with mental health and substance issues, a program aimed primarily at keeping individuals out of jail.

This, despite the fact that for mental health beds, Colorado has been classified as a state with a “severe bed shortage” in a study by E. Fuller Torrey, MD, et. al., entitled The Shortage of Mental Hospital Beds for Mentally Ill Persons.  The study shows that  the minimum number of hospital beds in a state should be 50 beds per population of 100,000. Colorado, though, has only 16.9 beds per 100,000.

The Torrey report also shows a statistical relationship between radical bed shortages and a number of consequences.  One consequence is an increase in the mentally ill who are homeless.  A 2005 Federal study, they note, estimated that 5,000 single men and women are homeless at any given time, and points out that several other studies show that one-third of them are mentally ill.  The effects socially of homeless men and women on sidewalks, parks, and libraries is well known.

Another consequence of bed shortages has been the massive increase of mentally ill in jails and prisons.  Although conservative estimates conclude between 7% to 10% of inmates, Torrey says, some studies have placed the figure at 20% or higher.  Comes now the Colorado Department of Human Services,  playing bureaucratic grim reaper, proposing to close a program that was designed specifically to keep people out of jail.

The  2011 Joint Budget Committee Figure-Setting Document , the document detailing for the Colorado legislature each department’s budget and their requests, says this about the Department of Human Services’ proposed cuts:

“The Department itself even recognizes that the closure of the 20 bed unit could result in increased commitments to the Department of Corrections (DOC) and increased bed days in county jails.”

So why is the Department willing to move these people off to jail?  It’s laid out in the document:

“ Despite the evidence that the Circle Program achievers measurable success, staff recommends  closing the Circle Program, effective July 1, 2011.  As the Department indicates in its request, the Circle Program does not meet the core mission of the State-run institutes of providing inpatient, psychiatric services to indigent and Medicaid-eligible individuals.  As staff indicated during the 2011 legislative session figure setting process, the CMHIP facility suffers from  inadequate staff-to-patient ratios in its core treatment divisions that provide inpatient, psychiatric treatment services to indigent and Medicaid-eligible individuals (geriatrics, adults, and adolescents).”

What that means is the Department chooses to cannibalize it’s own programs to increase staffing on it’s admittedly understaffed units, rather than request an adequate number of staff to begin with.  It’s a strategy that less than courageous bureaucrats have found to be a comfortable way to please the budget cutters.

This whole story begs the question of why the Department did not request the number of staff that they were told by expert consultants they needed.  They did make a request, but for roughly half the staff.  For the rest, they will further reduce Colorado’s bed capacity for the mentally ill, and wave goodbye as the mentally ill march off to jails and prisons, to join their brethren.

About ghostofvangogh

Advocate for mental health care and services, and for ethical treatment of other human beings.
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