Budget Cuts For State Mental Health Programs Lead To Crowded Emergency Rooms

Our guest blogger is Katrina Womble, a Health Policy intern at the Center for American Progress.

In an attempt to address state budget shortages, Pennsylvania Governor Tom Corbett‘s (R) FY 2013 budget, released February 7th, proposes reducing funding for mental health services by $168 million (20 percent), with additional cuts to other critical mental health services. State officials, mental health advocates, and patients are concerned about Corbett’s proposed state budget. But the notion that this funding cut will save the state money is an illusion, as reduced access to mental health services have led to increased — and expensive — use of hospital emergency room services. Some of the mental health related cuts in Corbett’s budget include:

$110 million reduction to Community Mental Health Services. The remaining Mental Health funds are to be put into county Human Services Development Fund Block Grant. Behavioral health funding accounts for 73 percent of the proposed block grant total, but there is no mechanism in place to guarantee that counties will spend that 73 percent on persons with mental illness.

Cuts Intellectual Disability Community Services by $28.995 million

— An additional $12.6 million reduction to the Behavioral Health Services Initiative and the Act 152 Drug and Alcohol Program. These programs provide assessment, treatment, and case management services for individuals for individuals with mental illness and people in need of treatment for drug and/or alcohol abuse.

Unfortunately, Corbett’s proposed cuts are not unique. States across the U.S. have slashed state mental health agency budgets since FY 2009 as a result of the recession. The National Association of State Mental Health Program Directors (NASMHPD) estimated that states have cut $3.4 billion in mental health funding since FY 2009, while the demand for services has increased during this time period (since FY 2009, demand for community-based services has increased by 56 percent, and the demand for emergency room, state hospital, and emergency psychiatric care has climbed 18 percent).


Due to the recession and the resulting state budget cuts to mental health services, hospital emergency rooms have increasingly become costly and ineffective treatment centers for individuals with mental illness. Increased demand has required hospital doctors and social workers to spend hours and even days arranging care for patients in need of mental health services. For example, a 40-year-old man named Erik was taken to Memorial Hospital of Rhode Island by the police after he called to report a theft from his apartment. Doctors in the ER determined that Erik, who has been diagnosed with schizoaffective disorder and PTSD, was in need of psychiatric care for his anxiety and psychosis. Since Memorial Hospital does not have a psychiatric unit, Erik was bound to a gurney and watched by a security guard for nearly 2 days before he could be transferred.

According to a 2010 survey by the Schumacher group, more than 70 percent of emergency department administrators said that they have kept patients waiting in the ER for 24 hours and 10 percent said that they “boarded” some patients for a week or more. Boarding patients — keeping them in the ER after they have been admitted to the hospital because no inpatient beds are available — places a large economic burden on communities. For example, in Texas the average per day cost of community‐based services is $12 for adults and $13 for children, as compared to $401 for a State Hospital bed and $986 for an emergency room visit.

The consequences of reducing funds for mental health services are clear: Patients in need of mental health services often do not get the care they need; hospital emergency rooms must treat patients that they are not equipped to handle (most hospitals do not even have psychiatric services); and the public has fewer ER beds available.