How mental health care cuts in NC will cost more than they save

Last week, North Carolina’s legislators announced a $110 million budget reduction across the state’s eight regional mental health agencies. Reducing the mental health budget and requesting that agencies spend down their reserves represent a strategy for short-term savings. However, it’s likely to result in significant, long-term costs and will move North Carolina away from its goal of being “one of the healthiest states in the nation.”

Budgeting more money, not less, on government-funded mental health services is an investment that would benefit all North Carolinians – and, ultimately, help the state’s bottom line.

As researchers in psychology and mental health services, we focus on the effects and costs of government-funded mental health treatment for adults with mental illnesses and substance-use problems. We have studied outcomes of mental health care, and the factors that contribute to those outcomes, in almost 15,000 people. Our research shows that routine treatments, including medication and community-based services, can improve mental health and well-being in adults with mental illnesses.

Our findings also show that using these routine outpatient services can reduce the need for more expensive inpatient, crisis-driven services, while also reducing rates of violence, victimization and arrest.

For example, in a study of more than 4,000 people who had experienced a psychiatric inpatient hospitalization, we found that those who received government-funded services following release from the hospital were significantly less likely to be arrested in the future. When we looked at the relative health care and criminal justice costs, we found savings, not losses, associated with using government-funded behavioral health services.

Beyond routine community-based services, we have found that more intensive government-funded services, such as assertive community treatment and intensive case management, also improve outcomes while still providing cost savings.

Finally, we have found that receiving mental health care can increase participation in treatment for other problems, including substance use, which can improve outcomes even further. Taken together, findings from our research suggest that government-funded mental health services actually save money in the long run.

This $110 million budget reduction will disproportionately affect our most vulnerable citizens: those who rely on government-funded programs. This population is already straining our overburdened health care and correctional systems. The budget does propose to add 150 hospital beds across the state for short-term mental health treatment, beds that are desperately needed.

On the surface, adding these beds seems like a reasonable effort to offset dramatic cuts in the number of people served in the state’s psychiatric hospitals since the early 2000s. During this time, the number of jail inmates with mental health problems has increased commensurately. In Wake County, for example, more than half of those being booked into jail are identified as needing further mental health evaluation.

So, while these 150 beds will increase our state’s ability to provide short-term inpatient treatment, they don’t compensate for the fact that the state’s eight regional mental health agencies have fewer and fewer resources for innovative, adaptive and evidence-based community-based programming. Without a robust network of government-funded outpatient programs, people with mental illnesses will have less access to the community-based treatment that research has shown to be most effective in preventing future hospitalizations and criminal justice involvement.

In other words, the state is cutting funds from services that can help prevent mental health crises and, instead, is putting limited funds into efforts to address these crises.

With another $152 million reduction planned for next year, North Carolina’s legislators seem prepared to continue to deplete the resources of our regional mental health agencies, while at the same time disregarding empirical evidence demonstrating the role of government-funded, community-based services in increasing public safety and improving the quality of life of adults with mental illnesses.

Simply put, government-funded mental health services are a good investment that will yield both social and fiscal benefits. We hope that, next year, our state legislators will reinvest in mental health services and focus on the long-term, rather than short-term, economic strategy.

This story was originally published September 26, 2015 at 2:00 PM with the headline "How mental health care cuts in NC will cost more than they save."