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Federal health care reform law holds hope for mental health services

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School of Social Work

Three successive years of funding decrements for mental health agencies are having a devastating effect on services and staffing, and may make it difficult for the uninsured to find care, according to a report by Christopher Larrison, a professor in the School of Social Work.

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12/15/2011 | Sharita Forrest, News Editor | 217-244-1072; slforres@illinois.edu

CHAMPAIGN, Ill. — Uninsured adults with serious mental illnesses may have a harder time finding care because state budgetary cutbacks are dramatically affecting services and staffing levels at community mental health agencies in Illinois and other states. But full implementation of the federal health care reform law could help alleviate that, according to scholars in the School of Social Work at the University of Illinois.

Since fiscal year 2008, CMHAs have lost a substantial portion of the state general revenue funds used to provide services for uninsured and underinsured adults with serious mental illness.  With further cuts expected during 2012, people in need of mental health care – especially those who don’t have insurance or who live in rural areas – may have a difficult time getting it.

“There’s already a shortage of resources, especially in rural areas, that’s occurring without there being a crisis,” said Christopher R. Larrison, a professor of social work who has professional and research experience with CMHAs. “The CMHAs are poor agencies that are stretched to their limits and have been for a long time.”

CMHAs receive nearly all their funding from the state or the federal government – about 70 percent of it from Medicaid, Larrison said.

In Illinois, Gov. Pat Quinn initially proposed cutting general revenue funding for behavioral health by $90 million, or 39 percent, in 2011. Although $54 million earmarked for supportive housing services was restored, the remaining cutbacks were achieved by reducing services for the uninsured.

Illinois’ behavioral health services budget for FY12 was down $114.2 million – about 20 percent – from the FY11 budget of $143.6 million. However, there are reports that the decrease was a mistake and that the funding may be restored, Larrison said.

In a recent telephone poll conducted by the School of Social Work, the executive directors of CMHAs that serve 24 of the 33 counties in Region 5 – the southern-most quarter  of Illinois – said that a third consecutive year of state funding reductions is forcing them to restrict services for uninsured clients to crisis intervention and two hours of assessment. In particular, services such as group and individual therapy, medication administration, and employment and housing assistance services have been limited because of budgetary constraints.

“You’ll be able to get a diagnosis and they’ll work with you whenever you have a crisis, but that’s about it,” Larrison said. “My fear is that these multiyear cuts are reducing core services that keep people productive members of the community.”

All of the CMHA executive directors polled said that their agencies were no longer accepting new patients and 55 percent were reducing services to current patients. Nearly all – 91 percent – had plans for further service reductions, 87 percent had implemented hiring freezes, and 46 percent had undergone staff layoffs.

Region 5 has a population of 1.2 million – about 15 percent of the state’s population outside of Cook County. The agency directors who were polled estimated that between 10 and 35 percent of their clients were affected by the service restrictions.

The majority of states – especially those struggling with multibillion budgetary deficits such as Illinois and California – have slashed funding for mental health services by millions of dollars over the past three years. Nationwide, the aggregate decrease in funding is expected to reach $2.2 billion in 2012.

Despite the decline in state support, 56 percent of mental health agencies in the U.S. reported an increased demand for community-based services, Larrison said, citing a report by the National Association of State Mental Health Program Directors Research Institute.

However, CMHAs’ dependence on state general revenue funds for providing services for uninsured patients could be mitigated by full implementation of the federal Patient Protection and Affordable Care Act, in particular the planned expansion of Medicaid in 2014 to include adults without children and people with incomes up to 133 percent of the federal poverty level. To help fund the expansion, the federal government will match 100 percent of states’ funding for medical services provided to newly eligible Medicaid recipients, with the match decreasing gradually to a permanent level of 90 percent in 2020.

The Medicaid expansion, if not ruled unconstitutional by the U.S. Supreme Court, is likely to have a very positive effect on CMHAs’ abilities to provide services, Larrison said.

While the health care act also includes provisions aimed at increasing the number of mental health professionals, which could help offset some of the workforce erosion at CMHAs created by reductions in state funding, it’s likely that demand for care will exceed the number of providers in the years to come, particularly in rural areas.

Co-authors of the report included, at Illinois, social work professors Barry J. Ackerson and Wynne S. Korr, who also is the dean of the School of Social Work; doctoral candidate Samantha Hack-Ritzo; and alumnus Benjamin D. Koerner; as well as Susan S. Schoppelrey, of the Waldron College of Health and Human Services at Radford University in Virginia.

Editor's note: To contact Christopher R. Larrison, call 217-419-3145; email larrison@illinois.edu.

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