Mentally ill at bottom of the pile once again

Few things are certain for the mentally ill, but this is; they will get the short end of the stick every time there is stick being swung. It therefore came as no surprise to the mentally ill, or those who care for them, that Gov. King’s proposed state budget cuts whack funding for mental health services to an extent that we in the medical field would describe as “big time.”

The budget cuts proposed for the state’s Department of Behavioral and Developmental Services amount to more than $20 million in state and federal matching funds for mental health care, spread over multiple programs administered by the department. Among others, there are cuts proposed in children’s services, respite care services for families of the mentally ill, and probably for the state chapter of the National Alliance for the Mentally Ill, the advocacy and support group. (Perhaps the thinking is that if funds for advocacy are cut there will be fewer advocates around to oppose the cuts.)

The proposed cuts could not come at a worse time. Mental health services have always been poorly funded, and the cuts will therefore gouge the already strained resources of community mental health providers and other programs. A lame economy hits hard at the lower level of the job market, where many of the mentally ill are employed in jobs that are often the first to go. The ability of charity agencies to fill in the void also suffers in a slow economy. The ratcheting back of inpatient psychiatric hospital care by all insurance payers in the last several years has made community-based mental health care, the target of many of the cuts, more important than ever to the well-being of the mentally ill.

There are more reasons than those, however, for mental health services to be absolutely the last place the governor and the Maine Legislature’s Appropriations Committee should look for money to close the state budget gap.

First and foremost, the proposed cuts are just patently unfair. State and federal funding for mental health services has always been so poor that those services have effectively already had their budgets cut. The result: There is no fat to cut because mental health services have never been anything but skin and bones.

Second and related, commercial health insurance companies have always shortchanged benefits for mental illness. That means any services lost because of reductions in state funding will fall on a class of patients whose affordable services from other sources are already often inadequate. This is especially true for those with chronic, serious mental illness, who will bear the burden of these cuts most heavily.

Third, the lives and independent function of many mental health patients hang by delicate threads of family, community and mental health service support. Those lives are exquisitely sensitive to losses of any kind of support, and the consequences of such losses can be catastrophic and expensive. A mentally ill patient whose illness acutely worsens will then use expensive emergency and inpatient hospital services, or worse, the services of law enforcement and the criminal justice system. The repercussions of the proposed cuts will be seen on Maine’s streets, and in its courts, emergency departments and chronically underfunded psychiatric hospitals. That will cost the state some of the dollars it is proposing to cut.

Fourth, the proposed cuts to services for mentally ill children will help further shred a system of care so tattered already that, if it was a net, could not catch a baked halibut. In particular, the state is so short of pediatric psychiatric hospital beds mentally ill children who need to be in a psychiatric hospital have become one of the state’s chief exports, sent to other states for hospitalization (how is that for a Maine-made product for export?). Cutting funding for services to children with mental illness when they have nowhere else to go amounts to the cruelest cut of all.

To the governor’s defense, he has a $248 million state budget deficit to close and he had to cut somewhere. To the governor’s credit, his proposed budget includes $10.6 million in supplemental appropriations for the two state psychiatric hospitals, which should help them make up for years of inadequate funding.

To the governor’s budget wizards, look somewhere else.

These are ugly times in Augusta, where hard-working people in state government are surrounded by ugly choices in the battle to balance the state budget. They are inundated with desperate pleas on behalf of other important programs facing budget cuts in the next two years. Among those, the voices of the mentally ill, the ones we so often ignore, must be heard this time. The funding cuts to mental health services proposed by Gov. King should be taken off the table and the savings found somewhere else. He should stand up for the mentally ill of Maine and declare that for once they will not get the short end of the stick. We should too.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.