This month's coverage of the “state-of-the-state budgets” (p. 16) has been highly revealing in many ways. It will be a surprise to no one in today's economy that all state budgets for behavioral services are under intense pressure, with no end in sight. Program cutbacks, staff reductions and lengthening waiting lists are hitting several states and, to that extent, writer Brian Albright's “States of Despair” title is apt. A close look at the status quo, though, discloses a mixed picture-some of it arguably good news. Let's take a closer look at the mix:
The good: Our contacts in several states indicated that elected officials are trying to hold the line on behavioral program funding and avoid cutbacks that they now realize will lead to costlier impacts on state budgets, particularly more institutional care. Moreover, some states are showing greater respect for behavioral services and have allowed them to grow, albeit slowly, from their virtually minimal status of 10 or 15 years ago. In short, the hard work and unceasing devotion of behavioral health advocate groups over the years seems to have paid off, which is especially good news in today's hard times.
The bad: Mental health and substance abuse programs of all descriptions are being cut by states throughout the nation. In our reporting, you will see examples, and note that some states in particular-such as California, Illinois, and Ohio-can rightfully be called behavioral care “basket cases.” Federal stimulus money, via the American Recovery and Reinvestment Act, may have helped prop up Medicaid to some extent and thereby relieved some pressure on state-funded programs. But in states like these, behavioral care budgeting is trending negatively, and will quite possibly turn nightmarish next year if economic recovery dawdles and stimulus funding ceases.
The ugly: In a revealing comment on the imminent demise of a pioneering New Jersey program for substance-dependent mothers called MatriArk (see online exclusive at http://www.behavioral.net, September 17, 2009), Seabrook House president Edward Diehl noted that, when testifying in the state legislature for sustained funding, he found himself jostling with representatives of the developmentally disabled, the seriously mentally ill and other clinically vulnerable people. It's the kind of “competition” no one wants to see. It hearkened back to an incident that occurred when I was covering an annual conference of for-profit nursing homes. Disabled people in power wheelchairs physically stormed the San Francisco convention center, alarming exhibitors and seriously injuring a police officer. This grew out of a competition between the disabled and nursing home providers for the same Medicaid dollar-a pathetic display that led me to conclude that our country had a long way to go in civilized support for its neediest citizens.
Richard L. Peck, Editor-in-Chief Behavioral Healthcare 2009 October;29(9):8