Insight Matters
Summer, 2001

We must raise our voices!

It is time to shout for all to hear…. The public mental health system in Ohio faces a serious funding crisis. The safety net which we are supposed to provide as a system is fraying. Unless swift action is taken, many people will fall right through the giant holes in the net. While the recent Report of Ohio's Mental Health Commission (Changing Lives: Ohio's Action Agenda for Mental Health) points out the crisis, it is fundamentally an optimistic report. Reality may not warrant optimism. The Ohio Department of Mental Health recently published an Executive Summary of a Safety Net Survey of the 50 ADAMH/CMH boards (available at www.mh.state.oh.us/offices/oper/safetynet.html). NAMI Ohio published an annotated summary of the same report, Falling Through the Safety Net, which adds to its frightening message with comments from families and consumers who are facing the reality of our failing systems every day. Call NAMI Ohio and request a copy (800-686-2646). It is an eye opening report.

Here are selected findings from the study, based on responses from 47 of the 50 boards.

• Data returned from the 47 boards paints a picture of a system of care that is facing a rapidly eroding safety net for persons with serious and persistent mental illness.
• The most pervasive and far-reaching gap in public mental health services involves time with psychiatric physicians, nursing assessments, and access to psychotropic medication.
• Despite this limited capacity, many boards reported increased demand for care of adults involved with Child Protective Services, Jobs & Family Services, and local jails and court systems.
• Although hospitalization may be the "next step" in the safety net for some boards, gaps in inpatient access, capacity, and quality were reported by more than half.
• There is a significant lack of available mental health professionals with specialized training, credentials and experience necessary to provide appropriate quality of care to SED youth and their families.
• Slightly over half the state's ADAMH/CMH boards report they have depleted operating reserves to provide care.

Essentially the public mental health system is being asked throughout the state to do more with less. As the Commission Report demonstrates, over the past decade funding for public mental health has not kept up with inflation. Over that decade the focus of care substantially shifted from hospital to community, so community services grew as funds shifted out of hospital to the community. But that growth, which was never a dollar for dollar transfer, has now leveled off, while the demand for services in our communities has continued to grow. So overall mental health funding has been losing ground. As state funds get tighter with the current budget crisis, local funds are equally hard to come by. Property tax levies are increasingly difficult to pass, especially if Boards ask for increases. In fact no new mental health levies have passed in Ohio since 1994. And we haven't even discussed the shifting burden from the private to public sector and the complicated problem of Medicaid match.

In order to address this crisis it is worth repeating the concluding remarks from the NAMI Ohio document: "NAMI Ohio calls upon everybody who cares about the safety net that protects our most vulnerable citizens to actively work to mend our deteriorating mental health system. Our track record in the past has not been stellar in terms of working together. Only through a concerted, cooperative effort can we hope to make the necessary changes. Without a full force effort, we cannot hope to succeed - and we cannot afford to fail."

With much help from our Executive Director, Phil Workman, OPA has been an active and vocal participant in the Coalition for Healthy Communities. The Coalition has been advocating for increased funding, estimating the system needs $96 million of additional funds just to maintain the current inadequate system. We need to continue shouting, both at the state and local levels, as an organization and more importantly in collaboration with the patients we serve and their families. And our voices must be loud, as we are shouting over a loud background din related to school funding, the needs of our growing prison system and an ever-growing Medicaid program. Only working together are we likely to be heard over all this noise.

Mark Munetz, M.D., Chair
Public Mental Health Committee