So-called austerity measures, a strategy in many Republican-dominated state legislatures to control spending, are getting increased attention nationally, spurred by the international news story that is Wisconsin’s budget battle. Within the scope of healthcare-related legislation, budget-specific priorities can come in many flavors. While modifying entitlements (like Medicaid) probably constitutes the best known example for balancing state budgets with respect to health policy, slashing funding for state-employed healthcare organizations and care delivery is increasingly being seen as an easy target for many state governments, many with the potential for significantly negative consequences. In Texas, funding for institutional and community based mental healthcare programs has never been seen as adequate by many mental health proponents there. Those same activists are more concerned than ever that recent cuts in mental healthcare delivery will increase the role of law enforcement in the lives of patients affected by diminished care access. For police officers, sheriff deputies, and other law enforcement personnel, a crash course in mental health crisis intervention is becoming the rule in the Lone Star State. In Washington, cuts to institutional care also add to the burden that will ultimately be placed on taxpayers there to foot the bill for involuntarily committed patients who quite literally have nowhere to go for treatment.
[A] patient who had been civilly committed and previously had threatened his community corrections officer, walked off the grounds at Western State on March 4, fueling concerns among some mental-health and public-safety advocates. They warn that closures and staffing cuts could result in the deterioration of care, potentially endangering patients and the public.
In the realm of ambulatory mental health services, those not qualifying for entitlements under disability rules, for example, can easily “fall through the cracks”, placing further strains on the usual frontline mode of care — the emergency department — propogating the issue of problematic, fractured follow up and further cost of care increases as a result. Whether it be law enforcement, emergency physicians, primary care physicians, or other non-traditional taxpayer subsidized healthcare providers — myriad other disciplines are taking on the new roles of mental healthcare providers, for better or worse, in the age of cuts to essential services in many states. It remains to be seen if reform measures to be implemented in the next two years will increase care access to the relapsed mentally ill or if the priority will be finding a way to simply pay for only the most basic cares for the inevitable backlog in patients some are now beginning to see in states such as Washington and Texas.
