PI Original Ellyn Fortino Saturday May 30th, 2015, 1:05am

'Bare-Bones' Illinois Mental Health System Can't Afford Further Cuts, Advocates Say

In a new report, the National Alliance on Mental Illness of Chicago urges against cuts to public mental health services in Illinois, which are already stretched thin and could be dealt a significant blow if Gov. Bruce Rauner gets his way on the budget. 

The proposed cuts outlined in Republican Gov. Bruce Rauner's 2016 budget proposal could result in more than 16,500 Illinois adults with mental illness losing access to mental health services and housing supports.

That's according to the National Alliance on Mental Illness (NAMI) of Chicago, which released a report this week on the status of the state's mental health care system and ways to improve it. The group further examined the potential impacts of Rauner's proposal to cut Medicaid by $1.5 billion and slashing mental health services funded through the Department of Human Services by more than $87 million.

The report comes just days before the scheduled end of the legislative session and as Democrats and Republicans continue to tussle over the state budget for the fiscal year beginning July 1. Illinois faces a more than $6 billion deficit in the 2016 fiscal year, due mostly to the rollback of the 2011 income tax hike. Rauner has proposed a $31.5 billion spending plan that calls for no new revenue and includes deep cuts to a range of budgetary items.

Democrats have rejected Rauner's budget proposal and are pushing their own spending plan that is $3 billion short. The governor on Friday said he won't sign off on an unbalanced budget.

Among the mental health care items on the chopping block under Rauner's budget plan is the $27 million "psychiatric leadership capacity grant" program, which helps community mental health agencies hire psychiatrists. The governor has also proposed cutting $18.5 million from coordinate care services, $14.1 million from supportive housing services, $5.5 million from state psychiatric hospital services and $1 million from the homeless prevention program.

NAMI Chicago estimates that Rauner's proposed budget cuts could directly impact 16,533 Illinois adults living with mental illness who receive Medicaid. But more people in Illinois with mental illness would likely feel the effects of such budget cuts, as the 16,533 estimate does not factor in non-adults and people who are uninsured or have private insurance, explained NAMI Chicago's Executive Director Alexa James.

Some 2 million Illinois adults were living with mental illness in 2013, including over 434,400 with a serious mental illness, according to the report.

NAMI Chicago argues that Rauner's proposed budget cuts would put too much pressure on an already "bare-bones" public mental health system.

The state has already slashed more than $113 million in general revenue funding for mental health services between fiscal years 2009 to 2012, the report notes. Over the same time period, the state saw a 19 percent increase in emergency room visits among people experiencing psychiatric crises.

In addition, two state-run inpatient facilities have closed along with six public mental health clinics in Chicago since fiscal year 2009.

Cook County Jail is currently considered to be the state's largest provider of mental health services, housing more than 1,800 inmates with some form of mental illness, according to Cook County corrections department figures provided earlier this month.

Cutting mental health care and social services will only cost Illinois more in the long run in terms of emergency room, incarceration and other costs, James said.

"It's a very basic formula," she said. "Invest in the front end. Invest in prevention. Invest in health. You're going to see decrease in costs in other places."

"If somebody's not getting access to care, and if they're not getting treatment, we're not going to save money, but also what's worse? We could lose somebody," James stressed. "People are attempting suicide. People are using drugs and alcohol. People are committing crimes of survival. People are putting themselves in really dangerous positions because they're not getting treatment."

The Rauner administration has argued that Medicaid expansion via the Affordable Care Act, plus the health reform law's mental health coverage requirements for private plans, has allowed room for some cutbacks in the area of mental health services.

But mental health advocates disagree.

For one, Medicaid does not cover a number of services Rauner is looking to cut, including supportive housing. Also, since the state's public mental health system is already stretched thin, it is concentrated on serving people living with chronic and disabling mental illness more than those in need of less intensive services, the report says. People who have become newly eligible for Medicaid under the ACA expansion are more likely to need "less-intensive, recovery promoting services" and "today's providers just don't have infrastructure to serve them," the report reads.

Also at issue is the state's Medicaid reimbursement system, which mental health advocates say needs to be addressed as rates for psychiatry and other mental health services have been stagnant for several years. Increasing Medicaid reimbursement rates is one of several recommendations cited in the report to improve the state's mental health system. 

"These amazing social service agencies that are supporting the mental health of so many that are receiving Medicaid, they can't afford it," James said. "They really have to subsidize in order to pay for the treatment through other means. It's not OK. It's not how they're going to be able to expand. They want to expand, but we don't have the infrastructure."

NAMI Chicago also recommends that there be a greater focus in the state on promoting and funding programs aimed at fighting the stigma surrounding mental health. Despite more uninsured people getting health care coverage through the ACA, for example, many individuals "are still not going out and seeking treatment because of the stigma," James said. 

"So they may have accessibility to mental health coverage, but they're not getting the help that they would need," she said.

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