OPINION: A continuum for mental health

Sept. 14--John Kasich speaks passionately about our duty to those afflicted with mental illness. The governor did so in his most recent State of the State address. He recalled Creigh Deeds, a Virginia state senator "who took his son to a hospital in crisis. No room. A day later, he attacked his father. It's terrible."

Deeds suffered multiple stab wounds. His son, who struggled with a bipolar disorder, committed suicide. Kasich explained that such episodes are why "we've taken a new approach to mental health so that families and communities have more resources." He pointed with pride to "making a difference ... because it's so easy in politics to run over them. ... "

In this election season, the question deserves attention: What has the governor accomplished for those with mental illness?

The subject resonates more deeply in view of talk about a presidential run, his current pursuit of a mandate, his wish for Ohioans "to send a message to the country," as the Columbus Dispatch reported last week. The governor and his team have been crafting the narrative of a different kind of Republican, one devoted to tax cuts yet also committed to ensuring assistance and opportunity for those in need.

Think back to Jack Kemp, or the "compassionate conservative" theme of George W. Bush.

In taking the measure of the governor, it is best to start in July 2010. Susan Ackerman, then a fellow at the Center for Community Solutions and now the executive director of the Joint Medicaid Oversight Committee at the Statehouse, produced an analysis of the mental health system across the state. She found it "on the brink of failure and collapse." State leaders had slashed funding to help balance the state budget, revenue having declined steeply in the Great Recession.

This neglect of people with mental illness resulted in increased hospitalizations, greater use of nursing homes and time in jail. No surprise that these options are "significantly more expensive" than the alternatives that had been reduced.

State funding for mental health systems in communities fell from $123.8 million a year in 2008 to $29.6 million in 2010. What has happened the past four years? Spending has climbed steadily, to $77.6 million appropriated for this fiscal year.

Arguably, much of the increase would have happened, anyway, akin to the governor taking credit for job growth in the private sector.

That said, the governor has made mental health a priority. His words have helped to ease the stigma. No step has been more telling than his expansion of Medicaid, defying many in his own party. Roughly 75,000 Ohioans with mental illness now have access to health coverage and thus a path to productive lives. More, the state has taken up the task of matching federal Medicaid money, freeing local dollars to address mental illness.

Listen to the governor talk about "a new approach," about "doctors and clinics ... available in more places," about communities offering "more care to those in need, including many who are not poor," and the question arises: Will Ohio close its funding gap? In November 2011, the National Alliance on Mental Illness (NAMI) reported that at $74.26 per capita, the state spent less on mental health services than 38 states. The study put the national average at $122.90.

Of late, Ohio has done better. What more to do?

Return to 1988. State lawmakers approved legislation to move many with severe mental illness from state hospitals into the community. The accompanying promise involved the necessary support system -- a continuum of services that would reflect, as Terry Russell of NAMI Ohio puts it, "what a person needs to function on a daily basis."

The task is complex. The mental health system is balkanized, like so many things in Ohio. Summit County performs well by comparison because of a local levy, providing 80 percent of funding. Other counties rely exclusively on state and federal money. Priorities clash. The recent mid-biennium review included shifting dollars from mental health to fighting opiate addiction. Now local mental health boards are squeezing budgets, some dialing back initiatives already launched.

Building a continuum calls for guaranteeing any Ohio resident with severe mental illness access to the necessary medication and counseling. It hardly stops there. It keeps in mind families under immense strain. Other states take fuller advantage of services eligible for Medicaid reimbursement, such as therapy through day programs, leveraging additional federal dollars.

Then, there is what Medicaid doesn't cover, such items as early prevention, housing, employment support and transportation. These and other pieces are essential to restoring lives, the return far outpacing the costs. Many around the governor know as much. They have been noodling how to move toward a continuum. That is the test and the opening, for this governor who portrays himself as bold, truly to make a big difference.

Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514 or emailed at mdouglas@thebeaconjournal.com.

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