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The proposed cuts in the community mental health General Fund will have their first and most obvious effects on service providers such as SCCMHA and the treatment organizations that comprise their network. Community Mental Health Service Programs will be forced to turn people away from the care they need and for those sick enough to get service, programs will still need to reduce staff, limit hours and cut services.
“Legislators understand this,” says Sandra M. Lindsey, SCCMHA CEO. “They’re forcing us, and our consumers, to make impossible choices about who will be served, who will live, and who, without services, may die."
“What they might not understand is how this will ripple outward – and possibly end up costing more in the long run.”
People will have more acute, serious needs, Lindsey says, that will be more expensive to manage. “It’s a lot like cutting your healthcare budget by cutting out your annual checkup, discontinuing your medication and all your preventive care,” she says, “and only dealing with things when they’re emergencies or require surgery.”
Here’s where those ripples will be felt:
Many people with mental illness and developmental disabilities have other medical conditions, from heart disease and diabetes to periodontal and nutritional disorders. Part of the service SCCMHA provides is ensuring the consumer gets proper care for other conditions – often coordinating care because consumers cannot do this themselves.
Without that coordination and “watchful eye,” many consumers’ conditions will worsen and be forced into the health care system when they become acutely ill. Many of the mental health consumers who will be affected by these cuts can be, without proper care, self-destructive. Still others have very fragile health and complex medical needs. Ultimately, that service will cost already struggling hospitals more in uncompensated care. Uncompensated care is a large factor in the increase of healthcare costs for private insurance.
Many of these self-destructive injuries will be suicide attempts. In Michigan more than 1,000 residents take their lives each year – about 20 of them in Saginaw County and completed suicides in Saginaw County and across mid Michigan are on the rise. Suicide is one of the top five causes of years of life lost under age 75, and for every suicide there are between 12 and 25 attempts.
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Saginaw County Community Mental Health already has had to restrict non-emergency service access to the most severely disabled of our citizens due to inadequate funding for years now. Saginaw already has some of the most stringent eligibility criteria in the state. By further reducing access to specialty mental health care as the result of these proposed funding reductions, there is no doubt that there will be an increased number of completed suicides and suicide attempts. This will also increase the demand for healthcare services with no corresponding increase in reimbursement for local hospitals that will be forced to treat these same citizens for self-inflicted injuries.
The same self-destructive behaviors that will bring mental health consumers into the healthcare system will also impact law enforcement. Crisis intervention services for people who are suicidal or violently self-destructive or aggressive and pose a risk to others requires some degree of police assistance. Only police officers can take mentally ill and severely behaviorally challenged persons with disabilities into protective custody.
Suicides must be investigated by police.
The greatest fear for the future however will be how vulnerable large numbers of untreated citizens will be, who cannot access psychiatric medications and care. Confused and impaired thinking caused by the symptoms of mental illness will see more of these persons victims of crimes like assault, rape and robbery.
Police must respond to “vagrancy” complaints, frequently involving people who are homeless and mentally ill. Many persons with mental illness have co-occurring chemical dependency concerns and are really dually diagnosed. When they cannot get appropriate psychiatric care and related medication, many will attempt to self medicate with street drugs and alcohol, which will further complicate their illness. There will be in turn increased demand for police involvement.
This increased demand for law enforcement assistance comes at a time when most police departments are feeling the pinch of state budget cuts of their own. We need our ever-shrinking law enforcement officers on the street, protecting the public, not tied up with mental health runs and protective custody responsibilities, working on increased involuntary probate orders and waiting for these same persons to be admitted to psychiatric inpatient units.
The Michigan Probate Court system has jurisdiction over legal proceedings involving people with mental illness or developmental disabilities. These proceedings range from guardianship issues to orders for involuntary hospitalization.
The proposed cuts will lead to an increased caseload for the Probate Court system. And those cases will be more complex.
Providing food and shelter for people who are homeless. Feeding, clothing and counseling victims of abuse. Employment training, assistance to people exiting prisons and jails and a host of resources and supports for people living in poverty, including those with disabilities. Most of these services are provided, almost exclusively, by local nonprofit organizations. And many of the people who need their services have mental illness or developmental disabilities.
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Community mental health providers such as SCCMHA work closely with these agencies, and provide an important outreach and consultation role – helping these organizations meet the needs of their disabled customers so that their services meet the needs of these individuals too.
Proposed cuts will severely limit the SCCMHA network providers’ ability to provide that outreach consultation and coordination, and that role will fall upon the nonprofit agencies themselves. Some of them are not fully equipped to serve in that capacity, and nearly all are already financially pressed.
Our nation’s veterans have a disproportionately high rate of mental and emotional illness. From the VA to local support groups, veterans’ groups depend on local CMH providers for crisis care and service coordination that is funded exclusively through GF dollars. Cuts will lessen SCCMHA’s ability to offer those services.
Children with serious emotional disturbance and/or developmental disabilities, who are uninsured or underinsured and not Medicaid or MI Child eligible and need the unique services only available through the public mental health system will simply no longer be able to be served or will see their services reduced. Children of adults with mental illness will face greater emotional turmoil as they cope with parents who cannot receive the care they need. This will leave teachers, school administrators and support staff to cope with symptoms and behavior challenges untreated at home and spilling into the classroom.
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