Monday, December 31, 2012

We're in Freefall

Everyone has been up in arms over the fiscal cliff. As expected, it looks like Congress may be pulling its collective head out of its ass to catch the New Years fireworks and maybe, hopefully, agree to a deal that averts the biggest problems set to hit us on January 1st. Keep in mind, though, that last year Congress was congratulating itself on creating the fiscal cliff in the first place...

Anyway, it seems everyone is glued to this story about fiscal policy in Washington. But they're missing some of the more depressing and distressing news going on. Specifically, everything happening in state legislatures around this country when it comes to funding some of those pesky human services programs that have been unfortunately labeled "entitlements."

Well, let me clear that up. These are not entitlements in the commonly used sense of the word. They're not food stamp programs, medical voucher programs, housing/fuel assistance programs. True, all of those have seen their budgets slashed, and they can no longer meet the needs of the people. But we're not talking about those. We're talking about mental health.

It's an interesting fact that most state governments have now lumped mental health into the same agency or department that deals with things like housing, food assistance, etc. In fact, mental health has come almost exclusively under the umbrella of government control. Why? Because private mental health practicioners who are appropriately licensed and accredited get most of their money from the system anyway, they may as well be.

In my job, I deal with mental health professionals on a regular basis. The biggest mental health agencies run almost entirely on state and federal contract. They are for-profit, and charge groups that they contract with (including schools - think of that, a government-sponsored agency charging a government-sponsored agency enough money to turn a profit) some pretty hefty fees for their services. So, what happens when state money dries up, and the federal government can't figure out which way is up long enough to fill in the gaps?

What happens is, we get fewer beds available for non-crisis individuals. We have to deny services to all but the most extreme cases. We have to do more with less, because the prevalence of mental illness increases when the economy is bad.

We've seen what happens when there is inadequate mental health services. Those who need treatment end up hurting themselves or others. They are unable to function, and the system has to find a place for them. In the worst of scenarios, they become violent, and can even become deadly.

We can gripe and complain all we want about the fiscal cliff, and how Congress is a do-nothing institution, etc. and on. But we should take the time to look at what is happening in our own back yard, because that is where the truly concerning things are happening. Even now, states are looking for ways to slash budgets. We know the usual suspects: education, infrastructure, contracting, and those pesky entitlement programs. But if we really delve into those numbers, we see that cutting those programs is hurting our future, and those in our current society that need the most help are finding themselves lost in the shuffle.

So, we're already in a kind of free-fall. States have been employing austerity for months now, even years, and we're starting to see the effects in our mental health system, as well as in education and social programs. Whether you believe austerity is helping, or whether you believe that it's hurting, the fact remains that this is the dark secret of spending cuts: spiraling crises that will end in catastrophe, and no way of preventing them. I hope that this next year brings more serious contemplation of these issues, and I hope we come to an agreement where we say that some things are just too important to cut.

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