12/28/2011 11:00 am ET Updated Feb 27, 2012

As the Economy Lags, Mental Health Must Be a Priority

New York state faces yet another tough budget year. With lagging tax returns and an unpredictable financial market, projections are that New York will have a budget deficit of $3.5 billion.

The recent agreement between Governor Cuomo, the New York State Assembly Speaker, and the New York State Senate Majority Leader to raise taxes on the wealthiest and cut taxes on the middle class is a step in the right direction that will mean less budget pressure on the social safety net for those most in need.

Despite this achievement, we have much to do to address the effect of the continuing fiscal crisis on New Yorkers' mental health. We need to be concerned about the impact of the continued economic decline on people with long-term psychiatric disabilities. We also need to be worried about the sustained emotional toll of the bad financial climate on average New Yorkers.

People with long-term psychiatric disabilities rely on an array of local mental health services to live productively in the community. State funding for mental health, which was not a priority even in a good economy, has sustained cuts and continues to remain in jeopardy. According to the National Alliance on Mental Illness (NAMI)'s report on state cuts to mental health care, New York State cut mental health services by a staggering $95.2 million between 2011 and 2012. Such cuts begin to unfairly chip away at the safety net, which has taken years to build, and that so many in great need depend on.

One area of great cost concern is Medicaid -- the largest source of funding for the mental health system. In order to control skyrocketing Medicaid costs, New York state has decided to transition all Medicaid recipients, including those with long-term psychiatric disabilities, into managed care over the next few years. As part of this transition, New York state is taking advantage of opportunities under the federal health care reform act to improve mental health care while decreasing costs.

One of these opportunities is health homes, which gives New York state a chance at improving the care of high need, Medicaid beneficiaries with chronic conditions, including those with long-term psychiatric disabilities, through enhanced care coordination at a lower cost to the state. Health homes offer a federal Medicaid match rate of 90 percent for the first two years. The model holds great promise for better integrating health and mental health care for this population and improving their overall quality of life, but effective outreach and engagement and adequate funding will be key to the model's success.

We must remain fully engaged in the transition to Medicaid managed care. We need more services, not less. Thus, we must ensure that the new system builds on the promise and expectation of a robust, coordinated, community-based mental health system that is accessible to people with mental illness and is responsive to their needs -- including the need for choices when making decisions about care.

This economic crisis is not only of concern to people with long-term psychiatric disabilities, but also to the many New Yorkers who have lost jobs, pensions, savings, in many cases, their houses, which results in tremendous emotional stress. Some people are even experiencing mental and/or substance use disorders as a reaction to their situations. Ellen Friedman, project director for the New York state OASAS Hopeline says:

The tremendous stress, rejection, fear and frequent bouts of depression that often result from being unemployed are high risk factors for the development of a substance abuse problem. Drugs and alcohol are used to cope with stress and uncomfortable feelings such as pain, guilt, anxiety, and depression and to overcome feelings of inadequacy.

The emotional toll of the fiscal crisis has led to more people seeking mental health and substance abuse services at a time when budgets for these resources are decreasing. Essential mental health assistance such as emotional support, education on how to manage stress, peer and community support, treatment for those who need it, and suicide prevention, are all the more critical in a bad economy to help individuals, families, and communities manage through tough times.

Given the state's unstable fiscal situation, advocates will once again need to be out in full force come January when the governor releases his budget proposal for 2012-13. Despite the fiscal tightening, we must not let the state abandon its responsibility to those among us who are most vulnerable. The need will only increase, until the economy improves. Continued advocacy is needed to protect the vital safety net -- including both Medicaid and non-Medicaid support -- that we have fought so hard to build so people with mental illness could lead better lives.