In the last 3 years or so Tennessee has had about 46.7 million dollars of recurring dollars in their mental health budget cut. Extraordinary efforts by advocates from every corner have managed to cobble together budgets based on what is called “non-recurring dollars.” Each year the same battles are fought. Few people hold the illusion of getting out of the quicksand. For most success is not getting any deeper.
At this point there are about 32 million dollars in non-recurring funds in the budget. When time for the new budget rolls around virtually every one of these dollars will have to be refought to simply stay where we are. But unfortunately even that idea assumes that the needs stay stable which they dont.
Accessibility to services needed and in anything close to a timely manner has become the defining problem of the Tennessee mental health system. Most of the people I know in the system are doing the best they can and in some cases an extraordinary job, but there are more people needing help and more people needing serious help than ever before and the system for too many people has become one more disappointment. Not enough programs…not enough kinds of programs….not enough therapists….not enough doctors……….just not enough.
The goal for many advocates this year was to change non-recurring dollars to recurring dollars in the budget. Make things permanent. But news in the last couple of weeks has not been good. The new budget may have as much as 5 million more cut in permanent recurring funds and many very important programs are on the short list for consideration as to being cut. For many not only will the quantity of help continue to decrease, but they will see a real decrease in the quality of what is availible to them.
Into this context steps the whole issue of Assisted Outpatient Treatment for Tennessee. 44 states currently have AOT. And many believe Tennessee will be 45th. What most folks dont realize is that only about 10 of those states, according to E Fuller Torrey, really use it to any real degree. You see there is an elephant in the room that people dont normally think about.
What do you commit them to? It is absolutely senseless to decide to force people into treatment unless you include the new funds to pay for the treatment they need. This is a lesson New York learned well. What happens to those committed?
In Tennessee there are only 2 options as things stand.
Go on the same waiting list as everyone else. This means 12-14 weeks to get an assessment. Even longer to see a psychiatrist. But if you do that how do you justify the idea that in some way this commitment is an emergency.
Put them at the front of the waiting list. This means people who want help are punished for wanting help. The effective way to get help in a timely manner becomes to get committed and then we are cutting off our nose to spite our face.
What do you do?
And that even leaves out the very real question of the quality of services you commit them to. In Tennessee the baseline services are a therapist appointment every two weeks, see a psychiatrist every 2 or 3 months, and minimal case management. Do the proponents of AOT really see this as being what “people in crisis” needs. I can tell you this much from personal experience. When people are in crisis and voluntarily seeking help it is not what they need.
So again you circle back to where we started. What kind of services need to be offered (like for example intensive outpatient programs) and how do you pay for them when your ability to pay for far less costly things has been so impaired. And if you are going to make these programs accessible to people on AOT how can you justify not making them availible to people not on AOT who have a similiar level of need.
This year it will be extremely hard not to be pulled farther into the quicksand. Is this really the time for AOT? How many people can you put on the horse before you realize it has died from the burden and no one is going anywhere?
In the last 3 years or so Tennessee has had about 46.7 million dollars of recurring dollars in their mental health budget cut. Extraordinary efforts by advocates from every corner have managed to cobble together budgets based on what is called “non-recurring dollars.” Each year the same battles are fought. Few people hold the illusion of getting out of the quicksand. For most success is not getting any deeper.
At this point there are about 32 million dollars in non-recurring funds in the budget. When time for the new budget rolls around virtually every one of these dollars will have to be refought to simply stay where we are. But unfortunately even that idea assumes that the needs stay stable which they dont.
Accessibility to services needed and in anything close to a timely manner has become the defining problem of the Tennessee mental health system. Most of the people I know in the system are doing the best they can and in some cases an extraordinary job, but there are more people needing help and more people needing serious help than ever before and the system for too many people has become one more disappointment. Not enough programs…not enough kinds of programs….not enough therapists….not enough doctors……….just not enough.
The goal for many advocates this year was to change non-recurring dollars to recurring dollars in the budget. Make things permanent. But news in the last couple of weeks has not been good. The new budget may have as much as 5 million more cut in permanent recurring funds and many very important programs are on the short list for consideration as to being cut. For many not only will the quantity of help continue to decrease, but they will see a real decrease in the quality of what is availible to them.
Into this context steps the whole issue of Assisted Outpatient Treatment for Tennessee. 44 states currently have AOT. And many believe Tennessee will be 45th. What most folks dont realize is that only about 10 of those states, according to E Fuller Torrey, really use it to any real degree. You see there is an elephant in the room that people dont normally think about.
What do you commit them to? It is absolutely senseless to decide to force people into treatment unless you include the new funds to pay for the treatment they need. This is a lesson New York learned well. What happens to those committed?
In Tennessee there are only 2 options as things stand.
What do you do?
And that even leaves out the very real question of the quality of services you commit them to. In Tennessee the baseline services are a therapist appointment every two weeks, see a psychiatrist every 2 or 3 months, and minimal case management. Do the proponents of AOT really see this as being what “people in crisis” needs. I can tell you this much from personal experience. When people are in crisis and voluntarily seeking help it is not what they need.
So again you circle back to where we started. What kind of services need to be offered (like for example intensive outpatient programs) and how do you pay for them when your ability to pay for far less costly things has been so impaired. And if you are going to make these programs accessible to people on AOT how can you justify not making them availible to people not on AOT who have a similiar level of need.
This year it will be extremely hard not to be pulled farther into the quicksand. Is this really the time for AOT? How many people can you put on the horse before you realize it has died from the burden and no one is going anywhere?