The estimated annual economic burden of serious mental illness is $317 billion, excluding costs associated with comorbid conditions, incarceration, homelessness, and early mortality. This sum is equivalent to about $1,000/year for every man, woman, and child in the United States (Kessler et al., 2008). A critical need exists for a thorough examination of public mental health care spending. This information is important so that policy makers, foundations, and community agencies can make informed and rational planning decisions regarding the optimal mix of services to provide. It is commonly believed that the decrease in public funding for mental health has had the effect of focusing money on chronic illnesses to the exclusion of funding for prevention, early intervention, or treatment of acute disorders.
The purpose of this descriptive study was to document how public dollars have been spent on mental health by examining what problems and populations are being addressed and by whom. In addition, the study documented the distribution of county spending by source, identified the top service providers, and ascertained spending priorities amongst the provider agencies. Finally, this research addressed the implications of those spending patterns, likely future outcomes, and offered policy recommendations.
It was necessary to review data from the individual agencies which received and distributed public funds. The data were gathered in Hamilton County, OH, based on the largest providers given the difficulty of state or multi-county analysis. The initial step was obtaining budgets from the Hamilton County Mental Health Recovery and Services Board for fiscal year 2010 (FY 2010) and creating a report which tracked the flow of funds from their sources to the agencies that delivered services. Then, funder expenditures and agency services were integrated and findings were discussed by local mental health experts via individual interviews.
Results showed that ten agencies were responsible for approximately 82% of public mental health spending in Hamilton County. Federal funding represented approximately 52% of total funding, while local tax support contributed 36% and state funding was less than 12%. Total spending on prevention services accounted for only 2% of the total mental health budget. Chronic care was by far the largest expenditure in the county. The top ten agencies spent an average of $10,640 per chronically ill client in federal, state, and local funds on mental health services in FY 2010. Conversely, less than $100 was spent per client on prevention services.
Key informant interviews provided insight into why little systemic attention is paid to prevention. While 100% of agency leaders agreed that prevention is important and critical in stemming the growing unmet mental health treatment need, there were commonly cited barriers to shifting priorities, centering on the difficulty of measuring impact. Preventing an even greater percentage of unmet need in our communities requires a re-examination of funding priorities, activities, and policies. More advocacy for mental illness prevention and mental health promotion is needed. Providers need to create an evidence-based practices prevention clearinghouse. Finally, it is important to increase the percentage of the mental health budget spent on prevention.