A mental-health safety net, frayed and torn

Janet Lowrie tries to stay busy. She fills her days with chores around the house, walks in the park, writes in her journal - anything to keep from swallowing a fistful of pills, as she did last April.

Ms. Lowrie is one of thousands of mentally ill people in Texas who are having to fend for themselves now that the state has implemented its most severe cuts ever in mental-health services. She used to meet regularly with a counselor, a man who encouraged her and taught her how to stay positive. Now Medicaid no longer covers those sessions, and Lowrie can't afford to pay for them on her own.

"I feel pretty isolated and alone," says Lowrie, who has been diagnosed with bipolar disorder. "And that really scares me."

So far, this former nurse has cared for herself successfully, but many others haven't. Since the latest cuts took effect Sept. 1, emergency rooms, homeless shelters, and jails are bursting with the mentally ill in crisis.

It's a common scene across the country. States, facing their worst fiscal crises since World War II, have been making drastic cuts - and are considering more. And since healthcare programs such as Medicaid constitute roughly 20 percent of state budgets, they are often targets.

In the last legislative session, 29 states cut their mental-healthcare systems, according to the National Alliance for the Mentally Ill. But experts say lawmakers will regret their choices. The mentally ill need treatment one way or another - and prevention is far less costly than crisis care. A 24-hour hospital stay for a mentally ill patient in crisis can cost a state the same as six months of outpatient care. Jailing the same person for a misdemeanor, such as trespassing or panhandling, can cost as much as a year of outpatient care.

"State governments don't recognize that cuts in one place are going to show up somewhere else," says Michael Fitzpatrick, director of the Policy Research Institute at the National Alliance for the Mentally Ill. "With such a diminished safety net, more people end up in jail, in homeless shelters, in emergency rooms. We already had a fragmented system of care; now it's in dire straits."

Already the impact is clear in emergency rooms and prisons nationwide:

• In Massachusetts, Boston Medical Center's emergency room saw a 20 percent jump in psychiatric patients after recent cutbacks to MassHealth, the state's indigent-insurance program.

• In Oregon, which is in the process of reducing its budget for mental-health services by $200 million over the next two years, the state Health & Science University reported a 25 to 30 percent jump in psychiatric patients since cuts began.

• And across the country, 1 in 6 inmates is mentally ill, according to a recent report by Human Rights Watch - making prisons America's primary mental-health facilities. California and New York have more mentally ill people in prison than in psychiatric hospitals.

Historically, the mentally ill were cared for in asylums or state hospitals. But with advances in medications to treat such illnesses in the 1960s, states began closing those hospitals in favor of community-based treatment. Thousands escaped often-grim institutions, but experts say the new systems have never been adequately funded. Now, with this round of cuts, the system is even more strained.

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