Hold Hands to Fight the Wrecking Ball

It's hard to be apolitical as a healthcare provider, particularly when the services my clients need are disappearing at the peril of shortsighted budget cuts.

Reclaiming Futures recently reported that in Illinois, the governor sent the General Assembly a fiscal year (FY) 2012 budget with zero funding for non-Medicaid substance abuse treatment programs. That's right, zero state funding. That translates to a loss in services for 55,000 patients, many of whom are teenagers trying to get clean. The cuts also threaten the closure of 150 addiction prevention and treatment agencies, and could put 5,000 employees out of work.

The cuts are scheduled to take effect March 15, not on July 1, when the 2012 fiscal year begins, according to Reclaiming Futures' Benjamin Chambers.

I spoke with Sarah Howe, CEO of the Illinois Alcoholism & Drug Dependence Association, which has been trying to educate legislators and reverse the severe cuts. She said that the problems started last year, when then governor was given broad powers to pare down the budget. The first systems to become Medicaid-only were in mental health and developmental disabilities.  At first, substance abuse providers were not eliminated from the state rolls completely, but saw their budget reduced in half from $120 million in FY 2009 to around $60 million in FY 2011.As a result, many agencies have tightened their caseloads, closed their detox units and restricted non-Medicaid clients.

“We’re operating on a shoestring as it is,” Howe said. 

The zero-ing out of the budget is expected to have an immediate impact. According to Howe, only 20 percent of people who need services in Illinois will meet Medicaid eligibility tests. The rest are underinsured or uninsured, with no way to pay for treatment. 

With people losing their jobs, “we are their last line of defense. That’s what they’re taking away," she said. “Prevention and treatment save this state hundreds of millions of dollars. It’s keeping people out of the criminal justice system, out of the emergency departments, and out of the child welfare system.” 

Howe is right. When teenagers I know don’t get help from local clinics, they wind up in the emergency room for alcohol poisoning, or worse. There, the waits are longer, the costs are higher and aftercare is rare. Teens also get arrested and wind up in detention centers facing charges of possession or violating their probation due to positive drug tests. Howe reported that up to 70 percent of people incarcerated in Illinois are there for substance-related charges.

And what about parents who cannot get help for their addictions? Inevitably, families get broken up, kids are placed in the system and the psychological wounds for all members deepen.

Is Your State Considering the Illinois Approach?

If you’re reading this from one of the other 49 states, you are right to wonder if these cuts will become contagious.  That remains to be seen. There are reports that at least two other states—Maine and Texas—are pursuing similar cuts.

Sarah Howe recently attended a meeting with her counterparts across the country, and told me, “Every state has a deficit. Thus far, none of them [apart from Illinois] have gotten to the point of trying to create this type of Medicaid-only system.”

That doesn't mean, however, that states aren’t considering other ways to save, and they may look to Illinois as a testing ground, and cut already tenuous services. The State Associations of Addiction Services, of which Howe’s organization is a member, says that only 11 percent of people who need substance abuse treatment in this country are receiving help, leaving 21 million people untreated annually. 

What You Can Do

Heart Strings or Purse Strings. As both a counselor and advocate, I've learned that if you can’t appeal to someone’s heart, perhaps you can appeal to their bottom line. According to Howe, the average cost of treatment and case management for someone with a substance abuse disorder is less than $4,500. On the other hand, the one-year cost of incarceration is over $21,000 in Illinois (and up to $80,000 nationally for juveniles).  

When states decide to cut now, residents are sure to be paying later.

Joining Forces Across Systems. I suggest we not wait until "the Illinois effect" comes to our states and chips away at help for the kids and families who need it most.

One of the best ways to make your case is to find allies in the other systems that are likely to carry the burden if your doors become closed.  “During this time when there is a huge deficit everywhere, there can be a tendency for people to hunker down and look at their own budgets, but there is also a need to connect,” Sarah Howe said.

Partnership is key to surviving the looming shortfalls. Put another way, safety nets only works when all the threads are tied together.

The Power of Organizing -- A Small Town Example

 This fight in Illinois reminded me of one of the first budget battles I was part of, barely a few months out of graduate school. A small town mental health agency I worked for in central Massachusetts was about to get the axe. It was a place of refuge for clients who had nowhere else to turn to for  counseling, but now the town was turning on it.  With some organizing, clients became the strongest voices to save their services.  They stood in front of the markets with flyers, made endless calls to the local media and spoke loudly and passionately at a town meeting.

After seeing that these services meant something to people in need, the town found money to keep some of the agency’s doors open. Although some counselors like me lost their jobs, there were still services that youth and families could come forward and access – better that than resorting to the hospital or police station.

In this fight, and others that have followed, I have become resolute. The kinds of cuts we see now are inevitably discriminatory, affecting the poor and marginalized among us. I refuse to accept the idea that as a consequence of being poor, one has to suffer and endure the worst of the cuts to publicly supported services and safety networks. I believe that as professionals in the "helping field," we have a civic responsibility to ensure that those we serve have access to opportunities and resources, even those resources we don't directly control.    

 
 What do you think? And what's happening in your state? Please let us know in the Comment section below!

Eddy Ameen   is an editorial contributor to SparkAction and pre-doctoral psychology intern who counsels teens in the District of Columbia Superior Court. He is formerly the executive director of the Miami homeless youth program, StandUp For Kids.