Missouri spends $636 million a year on mental health, implements new initiatives

Missouri's state government spends more than $636 million annually for psychiatric services for the mentally ill, most of it funded by general revenue and federal Medicaid dollars.

That is up dramatically from five years ago, according to the Missouri Department of Mental Health.

It reflects an increasing commitment to address mental illness on the part of Gov. Jay Nixon and the state Legislature.

"Over the past seven years, we've made Missouri a national leader in the early identification and treatment of mental illness and helped thousands of Missourians lead healthier, safer and productive lives," Nixon said.

The Department of Mental Health manages programs and services that address prevention, education, evaluation, intervention, treatment and rehabilitation for those with a mental illness or alcohol or drug problem.

Most services are provided through local, contracted, community-based agencies, Mental Health Department spokeswoman Debra Walker said.

In addition, the state operates six facilities for treatment of mentally ill adults and one psychiatric hospital for children. Three of the facilities are in the St. Louis area.

The others are in Fulton, Kansas City, St. Joseph and Farmington.

The state operated two mental-health facilities for children before ending its operation of the Cottonwood Residential Treatment Center in Cape Girardeau at the start of last year, following budget cuts made by Nixon in 2014.

Cottonwood, which treats children ages 6 to 17 with severe emotional and mental needs, faced an uncertain future for much of 2014. But in January 2015, the Community Counseling Center took over operation of the facility, converting it from a 32-bed to a 16-bed facility.

Officials at the Missouri Department of Mental Health contended at the time the decision to cease state operation of Cottonwood was a cost-cutting move. Now there is a waiting list for Cottonwood's services.

The Missouri Department of Mental Health currently serves about 170,000 Missourians, including more than 77,000 with serious mental illness, Walker said.

New program

The governor's budget for the 2017 fiscal year proposes an increase of more than $40 million in funding of services to aid Missourians with mental-health and substance-abuse disorders, including a new crisis-prevention program.

The new program, which has the backing of the National Alliance on Mental Illness, or NAMI, would serve about 2,000 low-income Missourians between the ages of 21 and 35 who suffer from severe mental illness or substance-abuse disorders. The program would provide outpatient health care and behavioral health-care services, as well as ongoing care coordination, according to the governor's office.

It would establish a waiver that would let eligible residents obtain needed mental-health care through Medicaid benefits.

Millions of Americans rely on Medicaid benefits for access to mental-health care. Medicaid is the single largest payer of mental-health services nationwide, according to NAMI.

Nixon worked with state lawmakers to establish the Strengthening Mental Health Initiative. That program received an annual budget of $10 million over the last three fiscal years.

The hiring of 31 community mental-health liaisons to work with law enforcement around the state has been a major part of the initiative. The liaisons assist law-enforcement officers and the courts by helping find treatment for mentally ill people caught up in the legal system.

"Cops are really taking to this," Nixon said, adding previously, law-enforcement officers often felt alone in dealing with mentally ill individuals.

To date, mental-health liaisons have had more than 27,000 contacts with law enforcement and the courts, which has led to more than 15,000 referrals to mental-health services, the governor's office said. In a written report on the Mental Health Initiative last year, Nixon wrote about the need to make changes to mental-health care in the state.

"We knew that Missourians struggling with mental illnesses like schizophrenia, bipolar disorder and severe depression were often ending up in police cars, jails and emergency rooms. It was a vicious cycle that put a significant strain on law-enforcement officers, courts and hospitals and left families feeling like they had nowhere to turn."

The initiative includes projects to identify individuals seen in hospital emergency rooms who need mental-health care, as well as mental-health first-aid training, crisis-intervention training for law enforcement and family education programs provided through the Missouri chapter of NAMI.

The ER effort has been implemented in more than 60 hospitals and health centers across the state to develop models of effective intervention, creating alternatives to unnecessary hospitalization and extended emergency-room stays.

Nixon said 4,000 people have received first-aid training on how to help children and teenagers who experience a mental-health or substance-abuse crisis.

Missouri also has embarked on construction of a 300-bed mental hospital in Fulton, Missouri, that will replace a structure built in 1851. The current facility for the severely mentally ill is the oldest state psychiatric hospital west of the Mississippi River.

The new, $211 million hospital, scheduled for completion in October 2018, will include improved vocational and recreational rehab facilities, modern dietary services and a new administration building. The Department of Mental Health said the new hospital will be safer and more conducive to modern treatment.

mbliss@semissourian.com

(573) 388-3641

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Missouri Department of Mental Health psychiatric services revenue breakdown

Missouri Department of Mental Health budget for psychiatric services for fiscal 2016

Total: $636 million

Revenue breakdown:

• $345 million, general revenue
• $279 million, federal (mostly Medicaid) dollars
• $4.77 million, mental-health earnings fund
• $3 million, tax-amnesty fund
• $2.16 million, funding from other state agencies
• $1.9 million, mental-health, tax-match fund
• $2,500, mental-health housing trust fund

Source: Missouri Department of Mental Health