Current and potential future cuts of state funding for Medicaid come at a hard time for mental healthcare in Arkansas. That is because demand is up, both from soldiers returning from the wars in Afghanistan and Iraq, and because more people who need assistance are unemployed because of the recession.

 

The exact amount of future cuts that could impact mental health programs funded by Medicaid isn’t yet known because decisions haven’t been finalized. But there have already been layoffs and other impacts of funding cuts for the present fiscal year.

 

Community Mental Health funding from state general revenue funds has been cut twice this year totaling $1,443,754. One cut was in October 2009 and another was in December 2009. These reductions coupled with the recent changes in the Medicaid program have created reduced access and availability in a period of increased need. 

 

“There have been some layoffs,” said Pam Christie, executive director, the Mental Health Council of Arkansas, which represents Community Mental Health Centers throughout the state. “The Community Mental Health Centers at this point are doing what you would expect. They are stretching their resources while facing reductions in staff and closing programs in order to reduce expenses while maintaining the same level and quality of care.”

 

There are, of course, worries about how this affects the clients seen by the centers.

 

“Our primary concern is the patients we serve and what the reductions are doing to the programs that serve them,” Christie said. “Some current factors are making mental health more of a mainstream discussion such as the downturn in the economy, loss of jobs and the influx of returning veterans, bringing mental health to the forefront. Many Arkansans are dealing with family issues and depression.”

 

These increased demands and lower revenues combined have exacerbated the situation. But while the state and nation work on economic recovery, people can’t wait to receive critical mental health services.

 

“A lot of people we see have long-term illnesses, as well as short-term intervention issues,” Christie said. “It isn’t like presenting with a sprained ankle, where a bandage is applied and the patient goes home. Mental illness requires a long-term approach to care for people who stay in the system a long time. The   reductions don’t only jeopardize people coming in for family counseling or just personal counseling one on one.”

 

Community Mental Health Centers provide care in all 75 counties in Arkansas. Particularly in rural areas, people have limited access and many times there is nowhere else to get help. If they can’t get help, it doesn’t affect just them and their families, but the community at large.

 

 “Also, we work with a lot of the other state agencies and look at the whole statewide system of care,” Christie said. “It isn’t just providing counseling in the office. It is also wraparound services involving jobs and housing. When funding is reduced, it affects all those services, too.

 

“Community Mental Health Centers do an amazing job. These Centers and mental health programs and the people who serve those with mental health issues are some of the unsung heroes. Community Mental Health Centers respond 24-7 to the seriously mentally ill in the state. Mental health professionals respond to law enforcement situations and cases in the emergency room, and then also show up for normal business hours. Unless you or a family member are directly impacted, you don’t understand it takes a special group of people to provide that kind of care.”

 

After Eugene Gessow was appointed as the new director of Arkansas Medicaid in January, he started soliciting feedback from healthcare providers on how to reduce Medicaid costs. Providers have provided input on how savings might be realized, and those recommendations are currently under advisement.

 

Strategies include reducing the number of people covered, limiting the scope of services, reducing utilization of services, reducing provider reimbursement and reducing fraud and abuse.

 

“These are all just options on the table at this point,” Christie said. “What is going to be chosen, we don’t know. A lot of steps have to be taken before we can respond. Whatever Mr. Gessow recommends as priorities, they will then go to the governor’s office, for the governor to evaluate the needs of the state. The decisions will be made there.”

 

The National Alliance on Mental Illness (NAMI) in Arkansas has concerns that more cuts in Medicaid funding for mental health services could result in more mentally ill people losing their jobs, and ending up homeless, in a hospital or in prison.

 

“The thing I would ask that we would do, if we can, is preserve mental health funding because any cuts can be devastating to children, adults our families and communities,” said Kim Arnold, executive director of NAMI in Arkansas. “We are going to have overcrowded jails and prisons. These individuals need treatment, not punishments. If they aren’t treated and end up in hospitals, that is a higher expense than we need. Emergency rooms are very expensive.”

 

She said mentally ill people who aren’t getting the help they need face school failure or possible job loss or lost work productivity, and increased police encounters.

 

Arnold said that she favors greater accountability so unnecessary services or practices are eliminated. But she doesn’t think further budget cuts are a good idea.

 

“We need to be very, very wise about how we treat people so we know we are getting the results we need,” Arnold said. “But any more cuts I’m greatly concerned about.”

 

NAMI has warned that budget cuts threaten progress made on mental health in Arkansas in recent years. NAMI downgraded Arkansas from a D to an F in its national report card in 2009.

 

“There’s not much to say about dropping from a D to an F,” Arnold said. “We are at rock bottom. We need to be investing in change and moving forward instead. Clearly, our state has few of the moving parts for a proven, cost-effective mental healthcare system. Political leadership, investment, improved planning, and, lastly, action will be needed in order to improve.”

 

Arkansas is one of six states receiving an F, and one of 12 states that saw their grades decline this year. The national average is D, remaining stagnant from three years ago.

 

Arnold there is a strong desire for improvement in the mental health community.

 

“But, for that improvement to occur, we need desire and commitment from all,” she said.