A Long Road Back To Sanity - States Finally Reversing Cuts to Mental Health

All over the country, governors are finally beginning to propose new mental health services funding in the aftermath of last year’s mass shootings in Aurora and Sandy Hook.

Notes: OH funding is from existing OHT appropriation.
CT funding is bond money, some of which may
be used by non-MHSA providers.

There will be a long road back to policy sanity.  We have to dig ourselves out of the mess caused by $4.6 billion in state mental health cuts over the last few years.  But these governors give us hope that the funding-cut nightmare over which many of them have presided may be finally coming to an end. 

In recent weeks, both Republicans and Democrats have announced new community behavioral health funding initiatives, typically ranging between $5 million and $20 million.  

But support for community mental health services is not universal.  In states with the worst track records in funding mental health services, their governors continue to be sadly out of step with their colleagues across the nation.

In Idaho, which has recently dropped to the bottom of mental health services spending, Governor Butch Otter’s major mental health initiative in the aftermath of the Sandy Hook shooting is for $70 million to construct a 579-bed “secure mental health facility” on the grounds of the state’s prison south of Boise.  That would be considered progressive by late 19^th century standards.

At least Otter’s proposing to do something.

Florida has been at or near the bottom of mental health spending for years.  But Governor Rick Scott – whose administration just cut millions more away from community mental health services in October – seems to think that if he just ignores the problem it will go away.  He requested no new dollars for mental health services in his 2014 budget.

But in the rest of the country, the emerging news is much better.  In the last month or so:

According to the Lansing State Journal, MichiganGovernor Rick Snyder said he will seek $5 million in new funding for mental health services to identify young people with mental health needs.  Michigan has cut $124 million from community mental health programs since 2004.

In Missouri, where eighteen months ago Anna Brown’s death in a St. Louis jail after she was refused care in a hospital emergency room drew national attention, Governor Jay Nixon is proposing $10 million in new mental health funding, primarily for a hospital emergency room diversion program.

In Colorado, Governor John Hickenlooper, whose state suffered through the Aurora mass shooting last summer, has proposed spending $18.5 million in new funding, including over $10 million for five urgent care centers for people with mental illness and a statewide 24-hour hotline.

In Connecticut, the site of the Sandy Hook massacre, Governor Dan Malloy proposed $20 million in new bond funding to assist community behavioral health providers with infrastructure projects that providers say have either been set aside because of budget cuts or have been draining money needed for direct services.

Kansas Governor Sam Brownback, saying that he was committed to strengthening the state’s community mental health system, announced his support for an additional $10 million to increase funding to 27 community mental health centers and to establish a regional system of peer support, intensive case management, crisis intervention, and other evidence-based services.

Oklahoma Governor Mary Fallin announced that she will seek $16 million in new mental health services funding - $8 million for existing programs and $8 million for new programs, including early intervention programs for children and a new state-supported mental health crisis center.

And in Ohio, Governor John Kasich reported that he was authorizing the expenditure of $5 million from an Office of Health Transformation discretionary fund to support children’s crisis intervention services.

These represent just a handful of states taking action, but a cross-section as well. 

The reasons the governors made these proposals may vary.  Some governors may be avoiding gun control debates.  Others may still erroneously equate mental illness with violence. 

The mental health funding initiatives the governors are proposing, however, are needed. 

The governors are working to improve community mental health systems.  They are calling for early identification and treatment of mental illnesses in children, adding new crisis intervention services, and addressing other neglected priorities in their own states. 

And while the numbers may pale in comparison to the cuts made in recent years and won’t undo the damage overnight, they are steps in the right direction. 

These steps should be embraced by legislators in their states, and in states with less understanding governors.  

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/

The Shock of Sudden Violence

The shock of sudden violence is so severe it takes your breath away.

When it happens in a time and place where it is unexpected, it does more than just remind us that no one is immune to it.  It also reminds us how pervasive it is, how much it affects us all, and how important it is that we do something about it. 

In the summer of 1989, I imagined that sudden, random violence was something far removed from my hometown.  But I was about to learn differently.

An article in The Atlantichas just detailed the event, dredging up some quarter century old memories of a day that changed my community’s life.

I was running for Mayor of Middletown, Connecticut, at the time, and had reserved a booth at the city’s annual Sidewalk Sale in late July.  I was handing out yardsticks, asking for a vote “for government that measures up to your expectations.”

Suddenly, there was a commotion about a block north of where I was standing.  I noticed people running in two directions, both toward and away from the Woolworth’s store in the center of downtown. 

A young girl, randomly chosen, had been grabbed outside the store and then repeatedly stabbed by a 38 year old man.  She died on the spot.  Hundreds of people witnessed the event.

Over the next weeks and months, Middletown was in shock, just as other communities – Newtown, Aurora, Tucson, Blacksburg VA, Littleton CO, and others – have been shocked since.

The trauma in Middletown almost killed our downtown.  Its suddenness and randomness made everyone feel unsafe.  It killed much of our sense of community and personal safety.

The healing didn’t happen very quickly.

It took at least a decade or two of steady changes to the Main Street area for that to happen.  These changes were so significant that – with the exception of a few businesses, nonprofits, and restaurants that remain from that time – one would barely recognize the Middletown of twenty-five years ago in its vibrant downtown today.

The trauma to which Sandy Hook and other communities have been exposed is even greater. 

To appreciate fully the scale of the Sandy Hook tragedy, we must realize that because of it Newtown’s 27611 residents – who experienced zero murders in 2011 – may well have experienced the highest homicide rate in the nation in 2012.

The healing time will be long.  And, at some level, my limited personal experience in Middletown suggests that a community exposed to that level of violence may never fully recover.

And this suggests something even more frightening about the shock of violence in communities across the nation.

There were 14,612 murders in the United States in 2011.  That’s 4.7 homicides for every 100,000 people.

In Middletown, Newtown, and Blacksburg, the homicide rate was zero.  In Aurora, it was 3.  In Littleton, it was 5.  Even in Tucson, which lived through the shopping center massacre that year, it was under 10.

Murders are uncommon in these communities, contributing to their newsworthiness.

But elsewhere, the everyday shock and trauma of violence is so much more powerful.  And because it is so prevalent, media headlines cannot capture fully its true effect. 

The murder rate per thousand in Miami in 2011 was 17, in Philadelphia 21, in Jackson 30, in St. Louis 35, in Detroit 48, and New Orleans 58.

Here is another way to look at this.  The Aurora massacre this past summer will double Aurora’s homicide rate in 2012, by a factor of 3.6 per hundred thousand residents. 

The people of St. Louis collectively live through the trauma of an Aurora-level massacre an average of once every six weeks, the people of Detroit live through it every month, and the people of New Orleans live through it every three weeks.  No one gets used to this.

If this is hard to absorb, imagine what these war zones must be like for the children and families living in them.  Every year, 3.5% of adults have diagnosable PTSD, and almost 8% will have it at some point in their lives.  Half will have PTSD before they reach the age of 18.

What are we doing about the traumatic effect of all of this violence in all of our neighborhoods – including those where it is commonplace?  And, more importantly, what are we doing to prevent such violence in the first place?

Email Paul Gionfriddo at gionfriddopaul@gmail.com.  Follow Paul Gionfriddo on Twitter: @pgionfriddo.