At least 46 states have now cut budgets that help vulnerable low income people, especially those of us with mental illness. In times of struggle, it’s easy to hunker down and try to keep doing the same things we have always been doing, just with less money. I personally think we need to do more than just stick out our hands out and say, “Please don’t cut us… Please.” However, another way out of our difficulty is to find radically new ways of doing things that cost significantly less money while providing even higher quality results. Here are a couple of key suggestions for how we can keep high quality community health care even during budget cuts.
* Recognize the community mental health centers as sources of innovation and progress. In Kansas and Missouri, the states in which I work, they are the only providers of medicaid billable peer support, assertive community outreach, case management, and employment services. Although many people think that private health care is preferable, in the mental health system it might not be. The public care is the only place possible to get these evidence based treatments that help move people towards recovery. Innovation should be our primary response to economic difficulties, not stagnation.
* Recognize that the alternative to community based care is often hospitalization or jail, at up to 40 times the cost. It would be a significant cost savings to keep people treated in the community rather than re-institutionalizing us.
* For every dollar spent on rehabilitating a disabled person to be able to go back to work, $10 is returned to the economy. U.S. Census Bureau, 1986
* Increasing the amount of peer support would reduce overall mental health costs by increasing people’s recovery, helping people to get more involved in their community, and decreasing reliance on the mental health system. Peer support is an evidence based practice and often peer supporters can work at lower expense than professional with a higher educational requirement.
* Respite care centers cost 1/5 as much as psychiatric hospitalization and shift funding from large institutions to small community based mental health center or local consumer run organizations. Providing people in crisis with peer run centers would save large amounts of public funding. This would also increase people’s ability to stay closer to their local communities and keep their family and native supports involved. Respite care does less to delay peoples’ recovery than does institutionalization. There are quite a few existing models in the U.S.
* Trauma-informed care involves dealing with people’s primary experiences of loss of choice, voice, and control. Increasing the use of trauma informed care in the community mental health centers will greatly decrease costs by helping people to end the revolving cycle of becoming so strongly influenced by emotions brought on by past overwhelming experiences.
* Treat sex offenders in the criminal justice system instead of leaving them indefinitely in more expensive hospital situations that take away beds from people in crisis.
* Consumer run organizations promote well-being and recovery and are very cost-effective. One study found that the more people used these programs, the greater their increase in well-being.
* Some psychiatric medications may be less effective that previously reported and may in fact worsen long term outcomes. Keeping non-medication options like peer support, employment services, and respite care available is crucial to helping people who don’t respond to meds. For depression, this may be the majority of people according to a re-review of the data from the STAR-D trial, the biggest ever government funded clinical trial of antidepressants. This data shows that only 7.7% of participants did not relapse or drop out the end of the one year trial. If we were simply to admit the existence of a large percentage of people that aren’t helped by meds, then we could as a society make other treatments the primary option for up to 40% who have negative medication effects and not the positive benefits. This would drastically reduce medication expenditures and then we wouldn’t have to resort to using preferred drug lists that limit medication choice for the people that ARE being helped by their medications. This would free up vast amounts of funding for more recovery oriented approaches to mental health treatment.
In conclusion, although budgets are very lean in almost every state, now would be the time to radically rethink our approach to funding. We could fund approaches like the ones above that have been consistently shown to be effective while have significant cost savings. Many of in the consumer movement have appreciated the move towards recovery approaches, because we know recovery is possible. We are the evidence. We would love to help bring innovation into our states to help relieve the budget shortfall.
Follow Corrina on twitter or on the web at http://corinnawest.com/
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