Mental health services run deficit despite taxpayer’s growing share

Andrew Keiper

Over the past decade, taxpayers across Summit County have shouldered an increasing share of mental health funding while state dollars have sharply declined.

Summit’s Alcohol, Drug Addiction and Mental Health Board (ADM) has seen its overall budget decrease by nearly $20 million since 2006 — despite a growing demand for its services due to the opioid epidemic ravaging the county.

In 2006, budget review showed taxpayers supported 35 percent of ADM’s budget. By 2015, that number had grown to 78 percent.

The opioid epidemic — and the demand of services that it necessitates — has forced the Summit County ADM Board to operate at an unsustainable deficit spending plan, according to Jerry Craig, executive director of the agency. The finances are tricky, but the state has pulled much of its direct funding of county ADM Boards with the expansion of Medicaid.

“I know the state is working hard to assist local government from, I guess, more of a technical perspective than a resource perspective,” said Lori Pesci, an official with Summit County’s Division of Public Safety. “I don’t necessarily know that we’ve seen an increase in financial or other types of resources that have come to Summit County.”

Addiction is certainly at the forefront of public health concerns in the state; however, it’s only one of many focuses for the local ADM Board.

“Our priorities are always persons with severe and persistent mental illnesses,” Craig said. “We want to make sure we have strong crisis services and we also (work to) keep people who are engaged in the criminal justice system out of the criminal justice system and into treatment.”

Craig said one of his top concerns is the noticeable rise in suicide among young people and middle-aged white men.

In a 2013 survey, the ADM Board found that nearly 30 percent of Summit County high schoolers reported feeling “clinically significant depressive sadness.” Almost 17 percent of students said they considered suicide and over 10 percent attempted it.

“One of the things we’re focused on right now is suicide,” Craig said. “There has been a spike in suicides, and I think that’s also been seen on the statewide level. We’re not really sure what to attribute that to, but we have taken on some initiatives to address that, particularly with our most vulnerable populations.”

There are three main programs the ADM Board is pushing to respond to the suicide trend.

The Zero Suicide and Crisis Text Line campaigns aim to raise awareness and support for mental health among high school youths. The Man Therapy program is intended to help men broach mental health issues through “irreverent” humor, Craig said.

No line item costs were available for the programs in the ADM Board’s most recent budget review.

Overall, the ADM’s resources have dropped from more than $61 million in 2006 to $42 million in 2015. The budget funds programs and initiatives across at least 30 agencies around the county, Craig said. The state decreased its contributions from $31 million to $9 million in 2015, with taxpayers picking up slack to the tune of about $32 million annually.

A levy, renewed in 2013, generated most of the revenue for the county’s mental health services over the past several years. Craig said the county’s residents have been immensely supportive of the ADM’s work, and he expects the levy to pass again in 2019.

Summit County has become an epicenter of the opioid epidemic radiating across the state.

In 2015, Ohio led the nation with 3,310 drug overdose deaths, and Summit County accounted for an estimated 225 of them. The same year, the ADM’s budget fell to its lowest mark since 2006 at just $42.5 million.

Craig said there is no causation between the state’s decreased mental health support and the opioid explosion, but there certainly is a coincidence complicated by the state’s Medicaid expansion. This is not to say Ohio hasn’t helped fund the opioid fight, but there is a marked decrease in direct financing of county ADM Boards.

Ohio Gov. John Kasich’s administration invested in the statewide fight against the opioid epidemic.

Tracy Plouck, director of Ohio’s Department of Mental Health and Addiction Services, noted in a testimony to the Health and Human Services subcommittee that the state provides $72 million annually to ADM Boards. In 2016 alone, the executive branch invested nearly $1 billion toward drug abuse prevention, addiction, treatment and recovery across the state.

Complicating the budgetary obligations of state and local agencies is Ohio’s Medicaid expansion, which was facilitated by the Affordable Care Act. Plouck said in her testimony that more than 500,000 Ohioans have gained and maintained access to mental health services through the expansion. The Ohio Department of Medicaid increased its spending from $1.9 billion in 2012 to $3 billion in 2017. Craig said the expansion allowed his agency to save about $5 million per year, which has been reinvested in treatment, jail and educational prevention services.

“Right now we’re in a position where, because of Medicaid expansion, a lot of the (behavioral) treatment services that we used to fund are now covered by Medicaid,” Craig said. “And so we’ve been able to make a larger investment in prevention services, and you can see the fruits of that have been that we’re embedded in preschools, we’re embedded in grade schools and also in the high schools.”

One of the most popular school-based intervention programs is the PAX Good Behavior Game, which has been in motion in Summit County for two years. The program has trained over 50 teachers across four school districts, predominantly Akron Public Schools. The PAX program is increasingly popular, and Craig said the board doesn’t have the funds to meet training demands.

“No. In a word, we don’t,” Craig said. “We’ve invested a couple hundred thousand dollars in this program over the course of the past two years, and we’re training more and more teachers every year. But we could make a much bigger impact if we had more funds to invest in this program.”

In Summit County, mental health consideration begins early. The ADM Board has programs that begin as early as maternal depression in pregnant mothers and follow residents from preschool until their elderly days. With the added stress of the opioid epidemic, Craig said the agency can’t sustain the deficit spending plan they’ve been forced to adopt.

“This opiate epidemic, the likes of which we’ve never seen, has sucked all the air out of the room,” Craig said. “It’s devastating families, and how can we treat this like a job? It’s really almost a ministry … It’s not just an eight-hour job and we go home at the end the day and forget about it. We live this.”

Andrew Keiper is a senior reporter, contact him at [email protected].