Community mental health saves lives and tax dollars

Tuesday, June 08, 2010
SPECIAL TO THE TIMES

State budget planners have a daunting task. How do they save tax dollars without throwing to the wolves society's most vulnerable?

One strategy is to invest in more programs like community mental health, which not only pays for itself and returns to the taxpayer $1 billion each year in savings, but also each year improves the quality of life for 500,000 New Jersey residents.

Thirty years ago, the state began investing in community mental health's statewide network of community prevention and treatment programs. These programs replaced high-cost inpatient care as the treatment of choice for those with disabling mental health conditions.

By investing in community mental health programs, the state has reduced the number of public psychiatric beds from 15,000 in 1970 to roughly 2,000 in 2010. Thanks to this 87 percent reduction, the taxpayer avoided a $2 billion price tag in FY 2010 for public psychiatric beds. Instead, investing in community mental health has allowed the state to finance the entire community treatment system and remaining public psychiatric beds at a combined cost of $1 billion.

In FY 2010 alone, this provided the taxpayer a net savings of $1 billion. Now, multiply that by 20 or 30 years and we get a sense of how much has been saved over the past few decades. So, what will be the impact of the proposed cutbacks in the FY 2011 budget?

Whenever there are community mental health cutbacks, there is always the risk of increased high-cost emergency care, hospitalizations, community incidents, incarcerations, etc. Any cutback to these services is always a high-cost gamble for short-term budget savings.

Instead of cutbacks, the state should focus on applying community mental health's cost-saving strategy to other problems. For example, we should focus on reducing the high cost of homelessness by implementing community mental health's Housing First model throughout New Jersey, as numerous other cities and states have done.

Housing First is a triumph of common sense. It looks first to correct the homeless person's housing problem and then address the other problems that have contributed to homelessness. Housing First programs provide housing, treatment and 24/7 support to ensure that the formerly chronically homeless stay healthy enough to be good tenants and good neighbors.

Housing First studies have shown that by providing an apartment and community treatment to the chronically homeless with mental illness, we can reduce their use of high-cost services (e.g., emergency room visits, hospitalizations, incarcerations, etc), and thereby reduce the taxpayer's burden.

Greater Trenton Behavioral HealthCare operates the state's first Housing First program. A consortium of government agencies, the Greater Mercer United Way and the Mercer Alliance to End Homelessness jointly funds this pilot project. Researchers from Tufts University provide program evaluation.

Of the 55 chronically homeless adults and families served by the Greater Trenton program since it began 30 months ago, none has been evicted or hospitalized. Although one was incarcerated briefly, he is back in the program and doing well.

These results are better than expected. Most studies found success rates of 70 percent to 90 percent. These studies also found that Housing First not only paid for itself but also produced net savings during the study period of $4,745 per person in Denver, $9,400 per person in Massachusetts, and $8,839 per person in Rhode Island. It is too early to count the savings from the Greater Trenton program, but we are clearly headed in the right direction.

The human cost savings, however, may be even more important. For example, Anthony, age 35, who was homeless for six years, has been in his own apartment for two years for the first time in his life. He has also been in recovery for 18 months from substance use, actively engaged in mental health treatment and working part-time.

After being homeless for 10 years, Marie, age 47, has been a Housing First tenant for 14 months. Although she still uses alcohol, it is much less frequent. She is working with her psychiatrist and housing counselor to find an alternative to drinking to reduce her distress. Also with help from her counselor, she is addressing for the first time post-traumatic stress from early childhood sexual abuse. Marie has returned to photography and has had several shows at local galleries. She says this is the first time she has felt happy and has hope for her future.

Investing in community mental health helps people like Anthony and Marie recover lost hope and get a second chance. Such investments save tax dollars and solve community problems by saving lives.

Cutbacks and over-regulation of community providers weaken their cost-saving capacity and ultimately lead to hospitalization, incarceration and other higher cost outcomes.

Rather than whittle away at community mental health's capacity to reduce the taxpayer's burden, let's continue to invest in what works and focus budget reductions on what does not.

John Monahan is the president and CEO of Greater Trenton Behavioral HealthCare and a past president and current board member of the New Jersey Association of Mental Health and Addiction Agencies.