A perfect storm: Health care reform, state budget cuts and a crisis in rural community mental health agencies

Objective: Community mental health agencies (CMHAs) in rural communities are under significant financial stress as a result of state budget cuts. At the same time that states are announcing budget reductions to CMHAs, federal policy changes created by the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act are likely to increase the number of individuals who can afford to seek services for a mental illness.

Methods: Structured interviews were conducted with executive directors of rural CMHAs to determine the impact of federal policy changes and state budget cuts on behavioral health services. The directors represented 15 CMHAs serving 33 rural counties in southern Illinois (population 1.2 million). The counties are depressed agricultural and manufacturing locales that have been hard hit by the economic stagnation and recession in the decade between 2000 and 2010.

Results: 100% of the executive directors decided to restrict the number of patients accepted for future services, 55% have reduced current services, 91% plan to reduce services in the future, 87% have left open staff positions unfilled, 46% have laid off staff, 73% have used the agency's reserve funds, and 28% have borrowed money against future state payments.

Conclusion: The independent but inter relate trends of state funding cuts and federal health care policy changes are leading to a perfect storm at rural CMHAs. By 2014 the gap between the number of people who can access behavioral health services and the capacity of those services will reach a crisis point.