“Are these the shadows of the things that Will be, or are they shadows of things that May be, only?”
–Ebenezer Scrooge upon viewing Tiny Tim’s grave with the ghost of Christmas yet to be (Charles Dickens)
The governor’s proposed budget, with $25.5 million cuts to the safety net for people with severe mental illness and substance use problems will have a two-fold effect. No money will be saved, and dollars will shift from evidence-based treatment provided to people in their communities, to a variety of expensive and inappropriate alternatives, such as increased inpatient hospitalizations, emergency room visits, incarceration, and nursing home placements.
For those wondering if the above is hyperbole, I’d point them to the closure of Fairfield Hills Hospital in Newtown, and the transformation of the adjacent Garner Correctional Institute into an all-behavioral health prison. Well done us. Let’s take schizophrenia, bipolar disorder, and severe autism spectrum disorders and make them felonies.
As a psychiatrist who has spent his career working in both the public and the private sectors, the above is not speculative, but is based on decades of watching the cause and effect of budget cuts and Medicaid reimbursement that covers far less than half the cost of the care delivered.
Combine that with reduction and elimination of grants from social service agencies (Department of Mental Health and Addiction Services, Department of Children and Families, Department of Developmental Services) and it’s impossible for non-profit behavioral health agencies and hospital-based clinics to keep their doors open.
What we’ve seen are radically reduced services, clinic closures, and some regions of the state with little or no access to providers willing and able to work with people who have more serious problems.
A typical client for such services might be a woman with schizophrenia –a neuropsychiatric disorder, which impacts about one-percent of the population worldwide. In times past, such individuals would have spent much of their lives locked away in state hospitals, deprived of nearly all civil liberties.
The last 30 years have shown that with adequate wrap-around services, even those with severe mental illness, often compounded by drugs and/or alcohol, can improve and build full and meaningful lives in the community.
Studies looking at such treatment models, which involve teams of case managers, medical staff, and recovery specialists, who are themselves in recovery from mental illness, show:
• Decreased rates of homelessness
• Decreased arrests
• Better health outcomes
• Fewer inpatient hospitalizations
• Fewer emergency room visits
• Higher rates of employment
• Overall improved quality of life
• Lower cost
So yes, treatment works. However, effective treatment has to be tailored to the individual, his or her needs, and personal goals. It is much more than simply taking medication, and it does cost money, albeit less than more-restrictive alternatives such as hospitals and prisons.
Sadly, if the proposed budget goes forward unchanged, it will diminish, and in some cases, eliminate treatment for some of our most vulnerable.
Faced with this looming reality, we need to be clear on the following: there will be no savings, as budget cuts will not magically make those in need go away. We will see them on our streets, in prison, and in emergency rooms and hospital beds. But just as Ebenezer wondered if he could alter the course of his life, we are all tasked with reaching out to our legislators, and letting them know of our own family members, neighbors, or even ourselves who need these services.
Your voice, your letter, your email to your representatives at the capitol is needed, and it will make a difference.
Charles Atkins, M.D., is the chief medical officer for Community Mental Health Affiliates in New Britain, Waterbury, and Torrington, a nonprofit, multi-service, community-oriented behavioral health organization. He is also a member of the volunteer faculty at the Yale School of Medicine.