Ohio mental health agencies scramble to find funding amid budget cuts

From the Marietta Times:

Several years ago, Shirley Holland (pictured), crippled with severe depression, struggled to leave the house or even speak.

Today, that's not the case.

"Now they can't shut me up," Holland says with a quick laugh, her eyes alight and her sturdy cane by her side in the computer room of the House of Hope, a drop-in center for adults with chronic mental illness, and where Holland spends most of her week, working on newsletters, playing in the garden and socializing with others. "That's how much I've changed."

Holland, 74, who lives on Harmar Hill in Marietta, credits that change to the House of Hope and the local mental health services available through the Washington County Mental Health and Addiction Recovery Board.

Seventeen years ago she was diagnosed with severe depression, but she "was sick long before that and didn't know it yet." Seven years ago, when the center opened, she became a regular. And today, she's the self-proclaimed jack-of-all-trades at the House of Hope.

Holland often gets the coffee ready most mornings for up to 30 others, sorts through the worksheet and organizes chores for the day and helps newcomers adjust to life at the center. Some days she works on crafts or learns new computer skills.

"Every day I learn something new here," she says.

The House of Hope could be a cave of despair soon though.

That's because the center, which is funded solely through the mental health and addiction recovery board, is facing severe funding cuts.

Washington County's local mental health treatment agency learned earlier this week that it stands to lose up to $700,000 under the current Ohio budget.

Ohio legislators were originally told up to $65 million, which would still have been a cut for local mental health services, were allocated in the budget. When that budget was finalized last week, only $15 million was allocated.

Mental health advocates and legislators are now scrambling to find that missing money.

In fiscal year 2008, the local board paid for mental health services for 2,063 people and alcohol and drug treatment for 506.

Overall, it distributed $4.11 million for outpatient mental health services and paid $240,500 for inpatient care at the state hospital. Additionally, the board distributed $646,564 for outpatient alcohol and drug treatment and distributed more than $3.5 million to local agencies for Medicaid services.

So while $700,000 might not sound like much compared to those figures, Ron Rees, executive director of the Washington County Mental Health and Addiction Recovery Board, said it's significant for a board that's constantly getting funding cut amid increasing pressures to pay for state Medicaid mandates.

"We're already at pretty low (funding) levels," Rees said. "There are mandates that we must provide a match for (federal) Medicaid (funds). So when you have that cut, coupled with no limit of how much Medicaid match we have to provide, it looks scary."

Every year, the agency sees a 12 to 14 percent increase in that Medicaid match, which means more and more resources that went to services for those without Medicaid are being cut.

It's too early to say specifically what services would be cut, Rees said, because the budget cuts aren't finalized yet and the board and mental health advocates across the state are still pursuing ways to restore the funding.

But at a glance, Rees said the local agency would likely cease some services, such as crisis services, for those without Medicaid since it would no longer have funding for those people.

In fiscal year 2009, the board handled 829 episodes of crisis intervention, which can occur when a person shows up a hospital emergency room, is found by law enforcement or comes to the board's attention in some other way, and is suicidal, delusional, emotionally upset or depressed. Sometimes it's the result of a mental illness or a traumatic event.

Of those 829 episodes, Rees said 295 were provided to people with Medicaid at a cost of $45,164 and 534 were provided to people without Medicaid at a cost of $82,108.

This can get particularly troublesome, he said, in tough economic times like these.

"Drug addiction will go up, suicide will go up," Rees said. "For mental health, those issues will manifest in other kinds of ways. People will show up in the emergency room for crisis with no way to be treated. There will be problems at work places. There will be problems at any place people congregate because if people aren't able to get treatment those symptoms escalate and spill over into the community in a variety of ways."

A study released this month by Oxford University and the London School of Hygiene and Tropical Medicine concludes that in people 65 and younger a 1 percent increase in unemployment brings about a 0.8 percent rise in murder-suicides. When the unemployment rate grew more than 3 percent there was an increase in suicides of 4.5 percent.

As a tragic, extreme example of what can go wrong when someone doesn't get help for crisis services, Rees alluded to the recent murder and suicide in Noble County where a man killed himself, his wife and his 11-year-old son after he became despondent over a disability that left him unable to work.

"Untreated mental illness doesn't just go away, it manifests in worse ways," he said.

Ideally, the board wouldn't need to offer crisis services as much either, he said, because more prevention methods would be available.

"It is better for everyone to have access to treatment before things become a crisis," he said later in an e-mail. "But we are currently unable to offer services on a sliding fee scale to people who don't have Medicaid, Medicare, insurance or some ability to pay the whole cost."

Standard outpatient services include psychiatric appointments, therapy, case management, medication, nursing services and medication education.

"The other problem is, what happens after the crisis," Rees said. "We want to provide follow-up services and that's all on the mental health side."

On the drug and alcohol side, the local agency used to provide detoxification services. Now it's limited to outpatient services. Additionally, Rees said the area suffers from no longer having a drug court, and the Marietta Memorial Hospital psychiatric and chemical dependency unit is no longer in service. When it was, nearly six people at a time used it.

When these services aren't available, it's not just the mentally ill that feel it, either, he said.

"The cost of hospitalization vs. treatment is another effect," he said. "Some people will show up at the hospital when they can't get community treatment. Someone will pay and it will be the taxpayers one way or the other. They will end up spending 30 times as much."

That means it would cost the state up $600 a month for someone with a serious chronic illness to receive help.

"There's no way that cost won't float to taxpayers. It's inevitable the cost will escalate and the budget problems Ohio has will deeply worsen if that happens," Rees said.

Throughout this week, legislators and mental health advocates have been meeting to find that missing money. Some state reports suggest it was simply a line item error, others say it was an oversight.

For Rees, the primary focus is on getting that funding restored, whether through a corrections bill or some other avenue.

Other larger counties are considering a lawsuit against the Ohio Department of Health and the state of Ohio for their inability to fund mental health services, which they are obliged to do thanks to a 1988 law.

"What history has shown is sometimes the courts have to be involved to make sure vulnerable people's rights are protected," Rees said.

The local agency, however, won't pursue such a cause. For one, Rees said, the cost is prohibitive.

A local levy also doesn't appear to be an option, as efforts in the past have been soundly defeated. Even though when it was set up in 1988 for local communities to provide mental health services it was anticipated counties would pass levies to pay for that support.

"Our greatest vulnerability comes from not having those local resources," he said. "We are an area with significant poverty and that's undoubtedly a factor in why we don't have a levy because the other counties without a levy are in this area of the state."

The problem is then exacerbated because those who often most need the services are those less likely to have insurance to pay for the services.

Beyond a levy or state funding, though, Rees doesn't see many alternatives at this point. That's not to say he won't stop looking, though.

"We can't know fully what our next step will be till we know what our response to (the state budget) is. But the most important thing to people living with mental illness in the community is to know we will not give up," he said. "We will do whatever it takes."