spending cuts tagged posts

David Baron, MSED, DO

Professor and Vice Chair, and Chief of Psychiatry, University Hospital, Keck School of Medicine, University of Southern California

Care For Your Mind: As the provisions of the Affordable Care Act are implemented, what are the big changes you see for mental health care?

David Baron: Mostly, they are positive changes. More people will receive services whether under expanded Medicaid or purchasing insurance: this will enable them to seek care that they might not have had previously. The key will be making sure there are enough professionals to provide the care that people need and, of course, helping people to understand what kind of care they are entitled to.

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Care for Your Mind Update

Two months ago, we shifted from discussing the importance of access and barriers to access to examining how a specific governmental policy, sequestration, was impacting the delivery of mental health services across the country. Even then, we could already point to examples of sequestration’s impact: the closing of a residential treatment center in Alaska, the reduced availability of civilian mental health professionals to military personnel, and the increased wait to receive residential treatment in Utah—not to mention the potentially devastating long-term impact of spending cuts on research, both in terms of treating people during clinical studies and finding effective treatments to mental health conditions.

It is unsettling, though perhaps not surprising, that the most-reported impacts of sequestration have been airport travel delays and the cancellation of air shows at Military bases for the July 4 celebrations. Because these cause discomfort for the general population, they are easy topics for media coverage. However, this does not appropriately reflect the level of real suffering happening as a result of sequestration across the country. This under representation of suffering is probably due to the fact that the populations arguably suffering the most severe consequences from sequestration are in fact underrepresented in general—the poor, people in the military, and minorities (an ironic realization as we reach the end of National Minority Mental Health Awareness Month, which draws attention to the need for mental health awareness, better utilization of services, and the development of culturally competent care for the nation’s racial and ethnic minorities).

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Jessica Eagle, M.A.Ed., N.C.C.
Legislative Representative, American Counseling Association

Since the Newtown tragedy, a spotlight has been placed on the mental health of our country’s youth, creating an expectation among many Americans that we would come together as a nation and respond to the need for improved school safety and mental health access. Indeed, dozens of bills were introduced in the Congress, and numerous Congressional hearings on mental health were held. In the Senate, 95 Senators voted in favor of the Mental Health Awareness and Improvement Act, which would have reduced youth suicide and mental health barriers to academic and social success.

Unfortunately, the effort to pass comprehensive mental health reform legislation has lost its momentum, leaving our schools and communities in a dire situation due to a one-two punch of funding cuts by state and local governments, and a polarized Congress’ inability to agree on a budget to fund essential community-based programs that support our country’s most vulnerable populations.

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How are you affected?

Estimating Impact
Mental Health America projected more than 1.13 million Americans could lose access to any kind of public mental health support.

The White House warned that “up to 373,000 seriously mentally ill adults and seriously emotionally disturbed children could go untreated. This would likely lead to increased hospitalizations, involvement in the criminal justice system, and homelessness for these individuals.”

One article termed the sequester to be a “mental health crisis,” noting that some sequestration-related spending cuts had potential to be more devastating than others, both for individuals and society. For example, “a furlough for a Reston, Virginia, Defense Department worker doesn’t have the same consequences as it does for a young man with severe bipolar disorder waiting an extra month to see a psychiatrist.”

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Care for Your Mind

Due to Congress’ stalemate in reducing the federal deficit, automatic, across-the-board spending cuts, known as sequestration, are taking effect on federal government programs. Medicaid and Social Security are practically the only programs unaffected, and the Congress has begun scrambling to address the high-profile, high-impact cuts as they arise, such as providing relief for air traffic control. With spending being cut on a broad scale, what will sequestration mean in practical terms for people dealing with mental health conditions? Will the cuts affect you?

(For background information, read What is Sequestration? at USA.gov.)

The overriding concern about sequestration is that it has absolutely no precision: sequestration was designed to cut wide swaths through government, sparing no agency or program. This means that spending in every federal agency—from the National Institutes of Health and Centers for Disease Control and Prevention to the FBI—and on every federal program—like the national parks, disaster relief, food safety inspection, and airport security—will be cut by 5 percent this year, and even more each year for the next nine years. And because of the delay in implementing sequestration, the cuts are more severe as reductions that would have been spread over 12 months are now crammed into 7 months instead.

(This interactive chart from the Washington Post provides estimates of the state-by-state impact of sequestration by category, based on White House estimates. Click on “Public Health” for the most relevant information.)

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