Modest increases in some states' mental health budgets have done little to erase massive cuts nationwide in the past three years and a reduction in Medicaid funds, according to a report to be released Thursday by the nation's largest mental health advocacy group.
All told, the Washington-based National Alliance on Mental Illness found 28 states and the District of Columbia have cut nearly $1.7 billion from their mental health budgets since the 2009 fiscal year.
Among the other 22 states, mental health budgets increased about $487 million, though NAMI said that spending was offset by legislatures' funding cuts to Medicaid, the largest public payer of mental health care.
Medicaid spending was not included in the report nor was spending that might come from other areas of a state budget, such as mental health housing assistance or programs under child and family service budgets.
NAMI said the level of cuts would have been even higher.
"The system is staggered," said Mike Fitzpatrick, executive director of NAMI. "Many of the services that existed either no longer exist or exist in such small amounts you have decreased services, waiting lists backing up, crowded emergency rooms."
Three large states — California, New York and Illinois — collectively accounted for a staggering $1.2 billion in mental health budget cuts since the 2009 fiscal year, according to the report.
But cuts have been pervasive across the country, exacerbated by the expiration in June of $87 billion in federal stimulus money to state Medicaid programs. Some legislatures made up for the shortfall by shifting more dollars to their Medicaid programs, but NAMI said that sometimes came at the expense of mental health services paid for outside the Medicaid system, which only assists the poorest.
The cuts come as mental health care providers report record demand in the sagging economy. Fitzpatrick said patients have grown used to a pattern in which programs are slowly reduced until they disappear.
"Services exist one year, the next year they're chipped away at, the third year they're eliminated," he said.
Although most of the states that cut their mental health budgets trimmed by single-percentage-point rates, a number of states slashed funding even more sizably, as much as 39 percent in South Carolina since the 2009 fiscal year.
In Greer, S.C., Kelly Troyer has felt the impact as she struggles to care for her 18-year-old son, Alex McAbee, who suffers from bipolar disorder, autism and mental retardation and is covered under the state Medicaid system.
He no longer has a case manager to find him services; that job has fallen to his mother. The waiting list for mental health housing numbers is in the thousands, so his mother is paying out of pocket. It can take months to get an appointment with a mental health professional.
"If my child had diabetes, if my child had cancer, we could have all the services in the world," Troyer said. "In our country, we treat our animals better than we treat people who have mental illness."
Among the states with the largest cuts were Illinois, which cut funding by 31.7 percent since the 2009 fiscal year; Nevada, which cut by 28.1 percent; and California, which cut by 21.2 percent.
Those cuts continued even as some states' revenue forecast improved, the report said.
California cut $177.4 million from its mental health budget between the 2011 and 2012 fiscal years, New York cut $95.2 million, Illinois cut $62.2 million and North Carolina cut $48.2 million.