Filling the gap: after years of spending cuts to mental health programs, lawmakers have begun to boost funding for the most effective approaches.

• Author: Weiss, Suzanne
• Position: MENTAL HEALTH

Horrific violence committed by people who are mentally ill has reignited state policy debates over gun control. But it also, much less visibly, has been the catalyst behind concerted action on another front: mental health care.

Over the past two legislative sessions, at least 36 state legislatures have increased general-fund appropriations for inpatient and outpatient mental health care for children, adolescents and adults. And nearly every state has enacted new laws in areas ranging from jail-diversion strategies to school-based behavioral health services to programs aimed at reducing the stigma of mental illness. Thirty state policy initiatives enacted in 2013 received the gold-star "best practices" designation by the National Alliance on Mental Illness.

From the mass killings at Sandy Hook Elementary School to the most recent shootings at Florida State, the gunmen had severe mental disorders that went unnoticed, untreated or unreported.

The Sandy Hook tragedy in December 2012, in particular, "opened up the eyes of governors and state legislators around the country that mental health has been cut enough," says Andrew Sperling, director of legislative advocacy with the National Alliance on Mental Illness. "We've seen largely bipartisan agreement that there are gaps in the public mental health system, and recognition that cutting mental health care has severe downstream consequences."

Former Colorado Representative Cheri Gerou (R), who served on the Joint Budget Committee, agrees. "I think it's clear that we haven't done enough, and we're coming to understand the value of better approaches to prevention, intervention and treatment," she says. She supported a 13.5 percent increase in the general fund appropriation for mental health services, to "make Colorado a healthier state," she says.

Up From Years of Cuts

Sperling and others are quick to point out that recent funding increases are dwarfed by the $4.35 billion reduction in mental health care budgets that states made collectively between 2008 and 2012.

The Texas Legislature, for example, boosted mental health spending in the 2013-15 budget by more than $250 million, or about 15 percent--the largest such increase in the state's history. But "even with the new money," says Texas Representative Garnet Coleman (D), a champion of mental health-care reform, "our per-capita funding for mental health is below what it was in 1999, and we've slipped from 43rd to 48th in the nation."

Coleman says that mental health spending in Texas "really began to get whacked every year, starting in 2003. We were cutting programs and services even when we didn't need to."

Coleman laments the fact that Texas is among the states that declined to opt into Medicaid expansion--which would have increased mental health insurance coverage--calling it "a real missed opportunity. It means we're going to have to do a lot more in terms of indigent care."

Connecting the Dots

Although shootings spurred some legislative action on gun reform and mental health, there's little independent research on the relationship between gun violence and mental health. Certain psychiatric illnesses have been linked to an increased risk for violence, but a compelling body of...