State Mental Health Cuts: A National Crisis
This report reflects corrections to a version that was distributed on March 9, 2011; this report is current as of March 15, 2011.
The recent tragic shooting of Congresswoman Gabrielle Giffords and the killing of six innocent
citizens in Arizona focused national attention on the state of the public mental health system in
Arizona and other states. Many asked how a tragedy like this could happen again, with chilling
references to Virginia Tech. How did Jared Loughner fall through the cracks when the signs of a
serious psychiatric crisis seemed so clear?
For NAMI, the National Alliance on Mental Illness, what happened in Tucson is all too familiar.
Even during the best of economic times, youth and adults living with mental illness struggle to
access essential mental health services and supports. Services are often unavailable or inaccessible
for those who need them the most.
One in 17 people in America lives with a serious mental illnesses such as schizophrenia, major
depression, or bipolar disorder. About one in 10 children live with a serious mental disorder.
In recent years, the worst recession in the U.S. since the Great Depression has dramatically
impacted an already inadequate public mental health system. From 2009 to 2011, massive cuts to
non-Medicaid state mental health spending totaled nearly $1.6 billion dollars. And, deeper cuts
are projected in 2011 and 2012. States have cuts vital services for tens of thousands of youth and
adults living with the most serious mental illness. These services include community and hospital
based psychiatric care, housing and access to medications.
To make matters worse, Medicaid funding of mental health services is also potentially on the
chopping block in 2011. The temporary increase in federal funding of Medicaid through the
stimulus package will end on June 30, 2011. Medicaid is the most important source of funding of
public mental health services for youth and adults, leaving people with mental illness facing the
real threat of being cut off from life-saving services.
Communities pay a high price for cuts of this magnitude. Rather than saving states and communities
money, these cuts to services simply shift financial responsibility to emergency rooms, community
hospitals, law enforcement agencies, correctional facilities and homeless shelters.
Massive cuts to mental health services also potentially impact public safety. As a whole, people
living with serious mental illness are no more violent than the rest of the population. In fact, it is
well documented that these individuals are far more frequently the victims of violence than the
perpetrators of violent acts.
However, the risks of violence among a small subset of individuals may increase when appropriate
treatment and supports are not available. The use of alcohol or drugs as a form of self medication
can also increase these risks.
Unfortunately, the public often focuses on mental illness only when high visibility tragedies of the
magnitude of Tucson or Virginia Tech occur. However, less visible tragedies take place everyday
in our communities—suicides, homelessness, arrests, incarceration, school drop-out and more.
These personal tragedies also occur because of our failure to provide access to effective mental
health services and supports.
This report documents the state-by-state funding changes for public mental health services since 2009
for youth and adults living with serious mental illness. These cuts are likely to worsen in 2011 and 2012.
The report also describes how states have chosen to implement these funding cuts. The report
concludes with policy recommendations, focused on the steps that should be taken to ensure that
valuable public resources are spent wisely and effectively. Crisis should be used as a vehicle for
change, not as an excuse for abandoning some of our nation’s most vulnerable citizens.
Funding Changes by State
Fiscal information for this report was derived from state budgets and fiscal documents from
FY2008 through FY 2011 and consisted primarily of state general fund expenditures excluding
state Medicaid allocations. Wherever possible, reporting is limited to dollars spent on inpatient and
community mental health services for children and adults and does not included expenditures for
developmental disability or substance abuse services. However, due to variations in state budget
reporting, some expenditures for substance abuse or developmental disabilities may be included
in a few states.
Sources for service utilization data include the SAMHSA Uniform Reporting System (URS) www.
samhsa.gov/dataoutcomes/urs/ and publications from the National Association of State Mental
Health Program Directors National Research Institute (NRI). Examples of the impact of state budget cuts on service
systems and individuals were drawn from media coverage and from individuals who courageously
shared their personal stories with NAMI.