In the wake of the Sandy Hook Elementary School massacre, the national discussion has focused largely on gun control and access to firearms.
The other side of the issue, though, is mental health. Much of the conversation surrounding mental health issues at the state level begins with a 1975 Supreme Court decision — O’Connor v. Donaldson — that resulted in the massive deinstitutionalization of mental health patients nationwide.
As a response to this, Congress passed the Mental Health Systems Act of 1980. The aim of this legislation was not only to eliminate the warehousing of mental health patients, but also to fund services, research and training professionals. Stated simply, the act worked to eliminate reliance on expensive nursing homes, jails and prisons.
In 1981, changes to funding mechanisms were made as the federal government announced it would curtail the budget of the National Institute of Mental Health and phase out training of clinicians and eliminate services, among other cutbacks. Then the Omnibus Budget Reconciliation Act of 1982 merged money for mental health programs into block grants. States were given the discretion to use the funds however they saw fit.
In the years since, those funding mechanisms have met with consternation from mental health advocates.
Organizations like the National Alliance on Mental Illness urge states to better fund mental health initiatives and periodically issue reports on how states rank against each other. While it would seem that looking at their data or simply how much money is spent by the Tennessee Department of Mental Health and Substance Abuse Services would answer the question, it isn’t that simple. While that department does tackle mental health issues, TennCare pays for mental health services as well and thus does not show up in some budget comparisons of other states.
In Tennessee, the Department of Mental Health operates four mental health hospitals in the state: Nashville, Memphis, Chattanooga and Bolivar. A fifth facility
in Knoxville closed down earlier this year, but department spokesman Michael Rabkin said most of the money that had been used to operate that facility is now being used to fund mental health programs in the Knoxville community.
Rabkin detailed the department’s funding: “In Fiscal Year 2012, the Department of Mental Health received $291,929,600 in total funding. Of that, about $186 million was from the state, about $63 million was federal, and about $42 million was from other sources. In Fiscal Year 2011, we received $275,943,700 in funding (the FY 2012 number was higher because of new federal grants that we received). That broke down as about $182 million from the state, about $49 million from federal and about $44 million from other sources. In FY 2010, we received $295,178,600 in funding — about $177 million from the state, about $64 million from federal and about $53 million from other sources.”
Rabkin also noted that the department licenses more than 2,000 facilities in
the state that deal with mental health and substance abuse issues.
As for how the money is spent, he laid out the state’s system.
“The department is divided into two functional areas: Administrative Services and Mental Health and Substance Abuse Services,” he said. “The MHSAS division provides community services for individuals suffering mental illness or a substance-related disorder through a comprehensive network of service providers, including the state’s four regional mental health institutes.
“A key area in which we work is with the Behavioral Health Safety Net of Tennessee,” he added. Via that program, the department “helps Tennesseans with serious mental illness who are poor and uninsured by working with community mental health agencies across the state to provide key mental health services.”
The safety net was installed for those individuals who need of mental health services but are denied TennCare coverage, a byproduct of the changes former Gov. Phil Bredesen made to the TennCare program during his administration.
As for what TennCare spends on mental health, department spokeswoman Sarah Tanksley said, “TennCare spent approximately $365 million in FY 2012 on inpatient and outpatient mental health services. This does not include pharmacy services.”
“Psychiatric inpatient hospitalization, 24-hour psychiatric residential treatment, outpatient mental health services, partial hospitalization, day treatment, crisis services (available 24 hours), crisis stabilization unit (adult only), mental health case management, applied behavioral analysts, psychiatric rehabilitation services (adult only), medication management, ECT, and psych testing. On substance abuse we have provided for inpatient hospitalization for rehab and detox, residential treatment for rehab and detox, outpatient treatment and detox.”
She added, “All services are available to children under 18 and adults 18 and older unless indicated differently. These services are covered as part of the TennCare managed care program and covered as medically necessary. In addition, TennCare provides funding to the Crisis Services program which is part of the Department of Mental Health and Substance Abuse Services.”
So, what steps might Tennessee take after Sandy Hook?
Earlier this week, Gov. Bill Haslam was asked whether the school massacre would make him reconsider how much money he gives to the Department of Mental Health. He said he’s still considering whether “there are real things we can do. Everybody’s
always going to have their hand up saying, ‘If you fund us more, we’re doing this.’ Because there’s such a surplus of demand over available funds, we have to think, ‘Where do we know we can make a difference?’ ”