In the face of cuts in state appropriations to institutions across Kentucky, Dr. Michael Bordieri with the Murray State University Department of Psychology speaks with Tracy Ross on Sounds Good on the impact those cuts will have on mental health care in Kentucky.
“It’s hard to quantify that impact directly. It’s hard to say yes, the loss of this percent will mean this decline in care. But it’s clear that there is an impact. And one of the most unfortunate pieces is that sometimes the impact isn’t even truly known because part of what happens when we have these cuts is we lose our ability to track and surveil and see what is happening to mental health status,” Bordieri said.
Bordieri says one way to grasp a deeper understanding of the current state of mental health care in the United States is to take a step back and look at the progress that has been made. He says before the 1960s, people with psychological difficulties and developmental disabilities were ushered away from society to be treated at institutions in the country.
“The expression ‘out of sight, out of mind,’ applied.… There were some horrific abuses and lack of treatment in those facilities and it was a system that needed to change,” Bordieri said.
Change came with the idea of deinstitutionalization, according to Bordieri, or bringing people home from institutions and integrating mental health care back into the community. Between 1965 and 2009, there was an 85 percent reduction in the number people with intellectual disabilities living in institutions, Bordieri says. But, he says the infrastructure necessary to care and support these individuals is broken and chronically underfunded.
Bordieri says one of the first indicators that mental health care is underfunded is chronic difficulties with mental health problems in homelessness.
“Many folks out of the institutions are now homeless. And so the burden of homelessness is really, it’s almost impossible to parse out mental health problems from homeless problems and the homelessness issue,” Bordieri said.
Another indicator of a lack of funding is the treatment of mental health problems through the criminal justice system, which Bordieri says has already had an enormous societal cost. He says that jails often serve as mental health treatment centers.
“It’s far more expensive to treat in those sorts of facilities and those sorts of facilities and those facilities are not particularly designed to be therapeutic environments in the way that is consistent with best quality of care,” Bordieri said.
In budget cut situations, Bordieri says one of the first things on the chopping block is the frontline preventative care that helps catch mental illness early.
“And that’s really a shame because we’re getting more and more data suggesting that preventative care is far more cost effective than waiting for the problem to fully emerge and then trying to treat it.”
The World Health Organization ranks depression at the top of its disease burden list for its effect on relationships and productivity, according to Bordieri.
“What happens when our infrastructure for community mental health is cut, it often affects the most vulnerable among us, those who don’t have resources to seek out private care or care otherwise,” Bordieri said.
Bordieri says the voices of those affected by mental illness are not often heard because of stigma surrounding the issue. He says this makes mental health funding an easy target for budget cuts. He says he hopes mental health advocates will find ways to continue to provide a voice for those who might not be heard otherwise.
