Mental illness and services for people with mental illness and their families have been the focus of considerable debate for decades. Despite the overwhelming evidence that mental illness and substance abuse are the leading causes of illness and disability in the U.S. they are rarely mentioned within the context of healthcare reform and frequently mentioned when cutting is proposed. This paper looks at the current budget proposal in the state of Maine and its effect on metal health services.
Budget Cuts in Maine
The Effect of Budget Cuts in Maine on Mental Health Care
Maine Governor Paul LePage's supplemental budget proposal will have dire effects on individuals with mental afflictions according to the Bangor Daily News. The governor's budget will cut about 14,000 people from MaineCare health coverage. Currently the state is facing a 438 million dollar budget shortfall. The proposed cuts will slice about 60 million from health care services for the mentally ill, poor, and unemployed (Hamilton, Prybylo, & Schmidt).
Those people who are without health insurance will be forced to get services at higher cost service centers including emergency rooms and hospital beds. Critics of the proposal say community health centers, community health organizations, homeless shelters, law enforcement, municipalities, and prisons will all end up absorbing individuals who are left without services.
Discussion
Jennifer Rooks of the Maine Public Broadcasting Network reports that the a 2009 Muskie School report reveals that one in five residents of Maine will experience a diagnosable mental illness in any given year and one half of all residents of the state will be diagnosed with a mental illness during their life time.
The current budget proposal affects a wide range of services including mental health advocacy groups, mental health training and education sessions, peer and family support groups, help lines, even the allowable number of visits to a therapist and the allowable number of laboratory charges. These cuts follow years of previous cuts resulting in creating an ever greater mental health care crisis in the state. According to experts the question is not if, but how these services will be paid.
Mental health advocates say proposed cuts could destroy an already tenuous safety net and that slashing funds for the mentally ill will create much bigger problems for the state down the road. Valerie Gamache of the National Alliance of Mental Illness (NAMI) Maine points out that the population that is going to be hit the hardest with the proposed budget cuts is the population that also has the very least ability to advocate for themselves and has the least public understanding or empathy associated with it (Rooks).
For every dollar the state spends on Medicaid and other grants and programs it receives three dollars in matching funds from the federal government. Betsy Sweet of the Moose Ridge Association estimates that the state is potentially losing 400 to 500 million dollars from Maine's economy because of the proposed budget cuts (Rooks).
In 2010 a federal judge terminated a long-standing consent decree that was established to address the needs of residents of Maine with mental and developmental disabilities. The Pineland consent decree originated in1975 when a lawsuit challenged conditions at the Pineland Center in New Gloucester, a residential facility run by the state. The lawsuit alleged that residents did not get medical care and other services. In 1994 a new consent decree focused more on the need for community services (Cover).
Gerald Petruccelli, attorney for the plaintiffs argued in court filings that the state has failed to live up to its commitments in the past, which justified keeping the decree in place, however U.S. District Judge George Z. Singal ruled that despite the threat of budget cuts, he's was comfortable that the state will follow current laws. Singal wrote, "The fear that history may repeat itself will always be present and will require that the class members and those that advocate on their behalf be forever vigilant. While it may not be enough to quell Plaintiffs' fears, the record documents the numerous statues and regulations as well as advocacy and oversight organizations, which, together, should serve to prevent backsliding and keep the current system operating at a level of substantial compliance." Unfortunately, the current budget proposal once again raises the possibility that the state may be unable to meet its obligations thus raising the possibility of further litigation (Cover).
Conclusion
Mental illness and services for people with mental illness and their families have been the focus of considerable debate for decades. Despite the overwhelming evidence that mental illness and substance abuse are the leading causes of illness and disability in the United States they are rarely mentioned within the context of healthcare reform and frequently mentioned when cutting is proposed.
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