WASHINGTON -- The push for expanded mental health services after the mass murders of schoolchildren in Newtown, Conn., has moved from Congress to the nation's statehouses, where health-care advocates hope growing tax revenues and renewed outrage over gun violence will lead lawmakers to boost funding for counseling.
While experts say a connection between mental illness and gun violence is tenuous, a string of deadly shootings by mentally troubled gunmen has fueled calls to beef up affordable treatment options for people who might be dangerous to themselves and others.
States, reeling from faltering tax revenues and the end of enhanced Medicaid funding from the economic stimulus bill, cut a collective $4.4 billion from their mental health budgets from 2009 to 2012, according to the National Association of State Mental Health Program Directors.
The cuts came just as the need for services was growing, with more people facing the emotional stress and financial uncertainty of job losses stemming from the Great Recession.
"It came down to sort of a tough choice," said Ted Lutterman, the director of research analysis at the national association's research institute in Alexandria, Va. "Do you close community-based crisis services, things that can help [mentally ill] people live in the community? Or do you close state hospital beds? A number of states did a mixture of both."
South Carolina led the nation, cutting its mental health budget by 39 percent from 2009 to 2012, according to the National Alliance on Mental Illness. The state mental health agency continued to provide services for 70,000 adults and 30,000 youths, "but they're just not seeing them as often," said Bill Lindsey, the executive director of the alliance's South Carolina affiliate.
"A patient may be seeing a psychiatrist every four to six weeks, but now it's 12 to 16 weeks between visits," Lindsey said. "And in terms of new patients coming in, they're only able to see the sickest of the sick."
Other states made similar cuts. Alaska pared nearly $41 million, about one-third of its mental health services budget, from 2009 to 2012. Illinois cut $187 million, about 32 percent of its budget. Kansas trimmed more than 12 percent, or $12.4 million of its budget, according to alliance figures.
The effects were devastating. An estimated 4,500 state psychiatric hospital beds were eliminated over that time, Lutterman said, and state mental health agencies across the country reduced staff, cut funding for community providers and served fewer people.
But the budget pressures that caused the cuts are easing. After increasing for the last 11 quarters, state tax revenue continues to rebound, according to the Rockefeller Institute of Government at the State University of New York at Albany. While tax receipts haven't reached pre-recession levels, many states now have more budget flexibility than at any time since the recession officially ended in June 2009.
In the aftershock of Newtown, where 20 children and six adults were killed in December when a mentally ill gunman stormed the Sandy Hook Elementary School, Congress and the White House have emphasized better mental services, among other approaches, as one way to combat gun violence. As a result, mental health advocates are finding state lawmakers more open to boosting spending, even in states where budget-cutting Republicans have chafed at increasing state services.
"We are seeing some good things," said Debbie Plotnick, the senior director of state policy at the advocacy group Mental Health America. "But we're also seeing some bad things."
Kansas Gov. Sam Brownback wants to put another $10 million into mental health services for at-risk patients who can't get services through Medicaid. In Pennsylvania, where the current state budget cuts 10 percent from community mental health services, the Republican chair of the House of Representatives Human Services Committee, state Rep. Gene DiGirolamo, will offer legislation to restore the funding.
"Properly funded treatment for mental illness and addiction is not a luxury," DiGirolamo said recently.
In South Carolina, where the state mental health budget has shrunk by $74 million since 2009, Republican Gov. Nikki Haley is calling for an $11 million increase for the state's beleaguered mental health agency.
After a recent legislative hearing on the proposal, Lindsey liked what he'd heard from lawmakers: "It looks like they're at least going to do that much, but we won't know for sure until June," when the budget is finalized. "But so far, so good."
In Mississippi, however, Republican Gov. Phil Bryant wants to cut $1.7 million from the mental health agency budget, while the Republican-led legislature wants to cut nearly $6 million from the department, which already has absorbed $27 million in cuts since 2009.
"From our perspective, there's already a shortage of treatment in the state as it is, and if we keep cutting, then it just makes it harder and harder," said Kay Daneault, the executive director of the Mental Health Association of South Mississippi.
Patient advocates in California, where the state mental health budget has shrunk by nearly $765 million since 2009, were troubled when Democratic Gov. Jerry Brown didn't mention the Newtown shootings or call for more mental health spending in recent speeches.
"He didn't say a word about it in his State of the State speech," said Rusty Selix, the executive director of Mental Health America of California. "He didn't say a word about it in his speech introducing the budget. Not a word. That's pretty revealing."
Luis Vizcaino, a spokesman for the state Health and Human Services Agency, said Brown's budget proposal called for no further cuts in mental health services. He defended the governor, saying Brown's State of the State speech discussed implementing the Affordable Care Act, which includes mental health services.
After several years of decline, increases are expected this year in tax revenue from Proposition 63, a 1 percent tax on wealthy Californians that helps fund state mental health services. A recent survey by the Public Policy Institute of California found that 55 percent of Californians supported the governor's focus on paying down the state's debt, while 38 percent preferred more spending on social services.
In Idaho, Gov. C.L. "Butch" Otter is backing plans to have the Department of Correction build a $70 million hospital to house nearly 600 mentally ill prisoners, along with non-offenders who've been involuntarily committed by the courts.
But Dr. Jeff Wright, the president of the Mental Health Providers Association of Idaho, said the state had enough hospital beds and should try to rebuild the network of residential, partial care and day treatment services for the mentally ill, which was decimated by budget cuts. Idaho has cut 18 percent of its mental health budget since 2009.
"If we had proper community-based services, [patients] wouldn't need to go to a facility," Wright said. "They could go to a day treatment center and then go home at night. Instead we're going to put them in a facility where it costs astronomically more to care for them."