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Advocate Now for Mental Health Funding for Next Year

An Opinion by Michael B. Friedman, CSW
First Published in Mental Health News, Fall 2003

Now is the time to begin to advocate for a decent budget for mental health in 2004-5. That may seem strange since the current year's budget passed just a couple of months ago. But state departments are currently working on budget proposals for next year that potentially will have a vast impact on people with mental illnesses. They will submit their proposals to the Governor and the Division of the Budget in early Fall, and the Governor will submit his budget request to the NYS Legislature in mid-January.

What are the key issues for next year?

No Cuts for Community Mental Health Services

Since New York State still faces substantial economic challenges, the Governor will probably take the position that state spending cannot grow, indeed that there will have to be some cuts. We need to fight against cuts to community mental health services, and in doing so we should insist on two general principles.

First, we need to be clear that lack of funding to enable community mental health services to keep pace with inflation is a cut. If the cost of living goes up-and it will-and funding for mental health services does not increase accordingly, mental health services will have to be cut. For health care, the state administration presents failure to keep pace with inflation as a cut. It does not use the same analytic approach for mental health services. We should provide the correct analysis, and we should advocate for enough mental health funding to maintain current services.
Second, not all funding for community mental health services is in the budget of The Office of Mental Health. For example, last year cuts to psychiatric services provided by general hospitals were contained in the budget of the Department of Health, and some cuts to services for children with serious emotional disturbance were in the Department of Education budget. Community mental health advocates should fight for adequate funding for the entire community mental health system including:
- Community mental health agencies
- Outpatient and community support services provided by general and state hospitals
- Inpatient services provided by general hospitals
- Other mental health programs supported by various state agencies

Reinvestment, Reduced Census and Hospital Closures

With the exception of the infusion of funding that the Governor provided when Kendra's Law was passed, over the past decade growth of mental health services and some funding increases for current programs have depended on reinvestment of savings from reductions of state hospital beds or state hospital closures.

It is important to continue to fight for the principle of reinvestment. But we also need to be cautious about the impact of reductions in the state hospital system. Last year the Legislature rejected the Governor's proposal to close more state hospitals largely because his proposal did not include a clear plan about how alternative services would be provided, what the fate of state workers would be, and how local communities would be helped to deal with the economic impact of the closures.

We should support full funding of Reinvestment in the coming year, but we should also insist that the administration engage in a meaningful public planning process prior to closing more state psychiatric centers.

Housing

Residential programs are at the core of New York State's system of helping people with serious mental illnesses and children with serious emotional disturbances to live in the community. Unfortunately, funding for existing programs has fallen well behind inflation over the past decade. This has resulted in rapid staff turnover, high staff vacancy rates, and potentially hazardous conditions. It is critical to provide increased funding to stabilize existing programs.

In addition there are substantial unmet housing needs:

Homelessness is at its highest level in history in New York City
Last year's revelations about the scandalous conditions in some adult homes has made it clear that at least 6000 units of community-based housing should be substituted for inappropriate living arrangements in adult homes
People leaving state and local hospitals need adequate housing in the community
The children's mental health system has an inadequate supply of residential alternatives to institutional care

Both capital and operating funds are needed to expand residential opportunities in New York State.

Children's Mental Health

The need for expansion and reorganization of mental health services for seriously emotionally disturbed children and adolescents has been documented repeatedly over the past twenty-five years. There has been limited growth of community-based mental health services for this population, but not at the pace planned by the state ten years ago. The coming year's budget should provide for further growth of mental health services for children and adolescents and at a more rapid pace.

Adult Homes

Adult home reform in New York State is imperative. In addition to the housing development noted above, there need to be substantial improvements regarding:

Mental health and medical services
Medication management
Oversight and enforcement
Assistance moving to the mainstream community
Funds to meet personal needs

The coming year's budget should address these issues.

Substituting Medicaid for State Aid

In recent years, the State has held funding for mental health services constant by substituting Medicaid funding for state aid to localities. This approach has been beneficial, but this year two key issues need to be confronted.

First, the Office of Mental Health has proposed a new form of licensure called "Personal Recovery Oriented Services" (PROS). It has aroused controversy regarding impact on service delivery. Will there be enough money? Will good programs be forced to drop effective, non-medical models? Answers are not yet available; therefore the state should be cautious about predicating a budget on PROS.
Second, the federal government is pushing for a major change in Medicaid, which would limit future federal financial support. Is it wise to continue to expand reliance on Medicaid at this time?

It may seem foolish to call for increases in spending on mental health services and to question the expanded use of Medicaid as a device to preserve services at a time when New York State is experiencing vast financial problems. How can advocates ask for more when overall cutting appears likely?

There are two responses:

The next budget will be an election year budget, and election years are generally more generous the non-election years.
More importantly, given the instability of the current mental health system and vast continuing unmet needs, how can we ask for less?

(Michael B. Friedman is the Public Policy Consultant for the Mental Health Associations of New York City and Westchester County. The opinions expressed in this column are his own and not necessarily the positions of the Mental Health Associations.)

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