WASHINGTON, Sept. 29 (UPI) -- Access to mental health services in the United States has declined since the terrorist attacks two years ago, with Americans finding it difficult to find assistance in their communities as states cut back or shut down vital programs directed at acute and chronically ill patients, mental health advocates say.
The attacks on Sept. 11, 2001, left many in the nation afraid and suffering from anxiety and post-traumatic stress disorder, and cash-strapped states are slashing public health services despite the increased need for psychological care, according to the National Mental Health Association.
"At its core terrorism is an assault on the mental health of all Americans," said Michael Faenza, president of NMHA. "Since the 9/11 attacks, the need for mental health services has risen dramatically with increased anxiety, post-traumatic stress disorder and other mental health problems."
The states faced with the worst budget shortfalls since World War II have instituted hiring freezes, cut down on the number of people they are serving, reduced staff and administrative expenses and furloughed employees. State have had to close a collective $200 billion shortfall over the past three years, according to the National Conference of State Legislatures.
In Texas, some 57,000 children who receive mental health coverage through the state's Children's Health Insurance Program, SCHIP, may loose coverage. Lawmakers there are considering severely curtailing mental health benefits under the program.
The state has asked U.S. Department of Health and Human Services Secretary Tommy Thompson to approve its plan to limit coverage under SCHIP to a single diagnostic visit, six medication checks and one consultation with a psychiatrist after a child has been stabilized from an emergency condition, according to NMHA.
South Carolina has closed 300 psychiatric beds in response to its budget problems. The National Association of State Mental Health Program Directors Research Institute found in a survey of state mental health agencies in fiscal year 2003 that 19 had 3-percent to 5-percent budget reductions, three had reductions between 5 percent to 10 percent and two had cuts of 10 percent or more.
"It really does depend on the state. There are states that are trying to take corrective action by downsizing hospitals, but frankly that has happened in almost every place to a pretty large degree. And there are many states where in fact there isn't enough inpatient capacity for their needs," said Bill Emmet, a project director for the National Association of State Mental Health Program Directors.
"They wind up having to take cuts out of community services and that causes a ripple effect because if people can't get services in the community then their symptoms get worse and they might wind up in the criminal justice system or hospital emergency rooms, or on the street, homeless," Emmet said.
Some areas have had problems on the horizon for several years. In an effort to streamline its operations in the early 1990s, Montgomery County, Md., dismantled its community mental health services almost entirely. In 1996, the county privatized its community mental health program, placing patient care in the hands of a contractor who went bankrupt a short two years later.
Maryland cut $10 million from its 2004 budget for the state's Department of Health and Mental Hygiene, forcing community health centers to turn away patients and reduce services.
A presidential commission report released in July found 29 states have already cut mental health funding and 35 anticipate cuts in 2004. The Bush administration is seeking $3.3 billion for substance abuse and mental health services from Congress for next year, up from $3.1 billion in 2003. But like many domestic programs, approval may hinge the growing federal budget deficits and an $87 billion supplemental request by the White House to pay for the Iraq war.
"The competing priorities that the federal government has historically have been a real problem for mental health. Mental health doesn't do well when it's matched against national security, for example," Emmet said.
The U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration has a proposed $3.4-billion budget in 2004, up $206 million over fiscal year 2003. The budget includes $834 million for mental health services, an increase of $12 million over 2003 funding levels.
The budget proposes $107 million for children's mental health services, a 10-percent increase over 2003, and $433 million for community mental health services block grant that would provide services for 222,500 adults with serious mental illnesses and children with serious emotional problems.
The president's commission reported the nation's $23-billion public mental health system only manages symptoms and accepts long-term disability rather than trying to improve the lives people suffering from mental illness.
The commission declared the public mental health delivery system "fragmented and in disarray" with gaps in care for children and adults with serious mental illnesses. It also found a high rate of unemployment for people diagnosed with mental illness and a lack of care for seniors with mental problems. The country a lack of national priority for mental health and suicide prevention, the group said.
"In any given year, about 5 percent to 7 percent of adults have a serious mental illness, according to several nationally representative studies. A similar percentage of children -- about 5 percent to 9 percent -- have a serious emotional disturbance. These figures mean that millions of adults and children are disabled by mental illnesses every year," the report said.
The issue has drawn the attention of Democratic presidential candidates former Vermont Gov. Howard Dean and Massachusetts Sen. John Kerry, and both have released their plans for revamping mental healthcare in the United States.
Emmet said both proposals parallel the work Bush's commission put forth in its report. He said they recognize the system's problems -- including access and officials not doing as good a job as they should be in implementing best practices.
"They seem to be on the same page as the ... commission," Emmet said.
Dean's plan would ban insurance companies from providing less coverage for mental health services than for physical illnesses, integrate mental healthcare other social service support systems such as housing and employment and improving access to community care. His plan also calls for school-based screening and treatment for children.
Kerry's version also supports the issue of mental health parity, expanded community-based programs and a reform of Medicaid and Medicare. But Kerry said mental health has to be a critical component of the nation's response to terrorism.
"This week as we remember those who died on September 11th, we must also think about the millions of victims who were impacted by the terrorist attacks. There has been an increase in cases of people with anxiety, post-traumatic stress disorder and other mental health problems. We need to make sure that when we consider our homeland security priorities mental health support is included," Kerry said as he rolled out his proposal in early September.