Budget cuts in mental health care cost more over time

PORTLAND – Over the past year, we’ve seen and heard more and more media reports about police interactions with people who are mentally ill. Portland’s new police chief has publicly stated that his department’s No. 1 problem is not ethnic gangs or Old Port bar fights, but crisis calls dealing with the mentally ill.

Law enforcement officers around the state echo his concerns, noting that they’re seeing a marked increase in the frequency and the intensity of these kinds of encounters, frustrating police and tying up police resources.

We hear related cries of help from our state’s top correctional officers, who note that our county jails have become de facto mental health hospitals, with more people than ever before incarcerated with – and sometimes because of – mental health problems. They continuously remind us they are neither trained nor funded for these responsibilities.

These stories suggest that cuts in state funding have a real social and economic impact. Research supports this conclusion. As co-director of the Center for Research and Evaluation in the School of Social Work at the University of New England, I have been collecting data from 102 local police and county sheriff’s offices across the state on the number and frequency of mental health-related service calls.

The data demonstrate that since 2008 – the beginning of the state’s budget crisis and increasingly large cuts to mental health and other social services – there has been a 26 percent increase in mental health-related calls for service.

Almost all respondents also reported a significant increase in the intensity and duration of these calls.

The connection between these calls for service and state funding cuts seems clear. The number of people in community mental health programs has not increased, and crime in nearly all areas of the state has decreased.

The only relevant change in the system has been the funding cuts that affect how these services are provided.

While the social implications are tragic, there is also a significant cost to these shifts. Intense police calls require departments to call in other officers, pay overtime or reallocate other services. In most cases, all local and county police costs (including overtime) are paid for by property taxes.

In addition, law enforcement and most emergency services are not set up to provide this level of service on a prolonged basis; such services are quickly overwhelmed and become very expensive to sustain.

These services are also significantly more costly and less effective than providing community-based treatment.

Another piece of research I participated in also supports this cost-benefit analysis.

For the past four years, I have been working with Shalom House and Preble Street on a project to assess the costs associated with housing, social services and homelessness.

We collected data on 262 individuals with mental illness across the state.

These data provide a clear picture of the costs associated with managing people who are homeless (the majority of whom are mentally ill) through emergency service systems as compared to MaineCare.

The results between the two approaches are striking.

When people in the study had MaineCare, their overall mental health care costs were reduced by 57 percent, about a $325,000 savings over the six-month study period. The reason for this is that people were shifted from the more expensive psychiatric in-patient care to less-expensive community-based outpatient services.

Psychiatric hospitalizations decreased 58 percent, resulting in a $360,000 savings. Emergency room cost savings were 14 percent, or nearly $25,000.

Data analysis also demonstrated cost savings in jail nights, shelter stays and ambulance usage. All told, there was a $1,348 average cost savings per person.

The obvious conclusion is that if more mentally ill people received MaineCare over a longer period of time, much greater cost savings would be realized.

But the reality, unfortunately, is quite different. The governor and the Legislature, with the best of intentions but incomplete information, make budget proposals and decisions that run counter to what we have observed in this study and others that have been replicated across the county.

The outcome of such decisions is quite clear: Further budget cuts will most certainly result in higher emergency, hospital, law enforcement and corrections costs over time.

And these costs are shifted from state (and federally matched) funds to community property taxes.

This strongly suggests that deep budget cuts that generate greater long-term costs are fiscally short-sighted and irresponsible. With better information, I believe our lawmakers can make better decisions.