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Sherrie Crabb went without pay for a third of the last fiscal year, laid off members of her staff, cut benefits for those who remained, and finally, closed the only homeless youth shelter in southern Illinois, all because the state legislature and governor couldn't agree on a budget.
Crabb heads Family Counseling Center, a community mental health provider with 19 facilities spread across Illinois's seven southernmost counties. The organization serves a vast swath of the state with the "highest poverty and unemployment rates," she says.
As Governor Bruce Rauner and house speaker Michael Madigan played what amounted to a game of fiscal chicken, Crabb's agency and dozens of other community mental health clinics had to make due without the hundreds of thousands of dollars promised to them by the state.
Crabb says her agency is owed $700,000 in state grant funding to support a variety of services, including programming for runaway and homeless youth. The missing funds are a substantial chunk of the agency's $6.5 million annual budget.
Family Counseling Center has closed six different office and residential locations, laid off 36 staff members, and cut holiday and personal time off as well as retirement funding, in addition to draining the agency's reserve funds and shutting down a homeless youth shelter that had been up and running for a little more than a year. She says the organization is now operating "month to month."
"There is not one staff member at this agency that has not been affected by the budget impasse," Crabb says.
The last-minute six-month stopgap budget deal cut by Rauner, Madigan, and senate president John Cullerton at the tail end of last month will do little to assuage the uncertainty plaguing Crabb's agency and many others around the state. The budget covers the first half of the current fiscal year through December, but a new budget deal will have to be agreed upon next year—a process that, depending on the political winds, could conceivably lead to another political stalemate.
Although under the terms of the stopgap budget social services agencies will receive payment for a portion of services rendered last fiscal year, enormous damage has already been done to the state's behavioral health-care infrastructure.
"You have thousands of people who have not been able to access services, you have programs that have shut down and a workforce that will never come back into this field," says Marvin Lindsey, executive director of the Community Behavioral Healthcare Association of Illinois.
A survey conducted by CBHA in mid-June revealed that more than three quarters of the organization's 65 member agencies have had to both lay off staff and cut back on the services they offer. One clinic, Delta Center, based in Cairo, Illinois, had to shut down altogether, Lindsey says.
Crabb's agency was able to pick up some of Delta Center's contracts, but not all of them, she says.
"We just did the best we could without trying to take on more liability," she explains.
CBHA's member agencies are also owed more than $85 million in unpaid grant and delayed Medicaid payments. Grant payments constitute the majority of the money owed, Lindsey says, and are intended to pay for services Medicaid doesn't cover.
"Particularly housing or residential- or case-management services," Lindsey says. "They are essential for people with chronic diseases like mental illness or substance abuse. That's why it's called the safety net—the last real form of care other than homelessness or jails or shelters."
Another consequence of the unprecedented budget crisis: lengthy waiting lists for clients. Unless a client is in imminent danger of hurting themselves or those around them, they're placed on a waiting list, explains Bruce Sewick, manager of adult mental health services at the Franklin Park-based Leyden Family Service and Mental Health Center.
Leyden offers programming ranging from substance abuse treatment and psychiatric care to crisis intervention and subsidized housing. The agency is missing more than $750,000 worth of grant payments from the state, according to Leyden CEO Donna Santoro. State grant funding makes up a quarter of the agency's budget, and Leyden has managed limp along the past year by not filling vacant positions, draining reserves, and relying on a line of credit.
"We have longer waiting lists for service, and we have had to turn people away with no ability to pay," Santoro explains. "We would never have done this in the past. . . . The most vulnerable people are being hurt by this."
According to CBHA's survey results, 76 percent of the organization's member agencies have wait lists ranging between two and four months for people in need of a psychiatrist, and 24 percent have wait times from four months to more than six months.
Wait times at Leyden have doubled since the budget crisis began.
Complicating the issue is the introduction of the Affordable Care Act, which has allowed more people to get insured through Medicaid, Sewick says.
"When people want mental health services and they have to wait three, four, or five, six months—that's ludicrous," he says. "There's more people now that can get these services, but with the lack of a budget for the past year, there's this pent-up demand that's not being met in a timely manner."
When someone reaches out for help, whether it's for mental health or substance abuse issues, any delay in getting him the treatment he needs could have tragic results.
Heroin users on Medicaid or with no insurance looking for a residential detox facility are subject to months0long waiting lists. Lindsey says he's aware of at least one case in which young man whose name was on a waiting list died from a heroin overdose before he could he receive treatment. Others have likely landed in jail or emergency rooms, he says.
"That's where they end up. . . . It's not pretty. People don't want to say that," Lindsey says.
Greg Sullivan, director of the Illinois Sheriffs Association, a nonprofit agency that facilitates communication and training between and for state sheriffs departments, says state law enforcement agencies saw an uptick in the number of mentally ill individuals ending up in jail following the closure of psychiatric institutions. That's "a direct result of the budget impasse," he says.
"There is nobody to service these people and they end up in county jails," says Sullivan. "They're really not criminals. They have a severe mental health problem, and they don't belong in jail."
Rauner has said he wants to reduce the state's prison population by 25 percent over the next decade, but Sullivan says that that's an impossible goal if Illinois doesn't adequately fund its behavioral health agencies.
"I honestly believe," he says, "that when you tear down the infrastructure for mental health and drug abuse treatment, you are going to increase the population of the county jails without fail."
With access to community mental health clinics, would-be clients may also find themselves in hospital emergency rooms.
Nearly one-quarter of Illinois hospital emergency department visits in the past year were related to behavioral health needs, including both mental health and substance abuse issues, either as the primary or secondary diagnosis, says Danny Chun, a spokesperson for the Illinois Health and Hospital Association. Chun says the figure represents an increase in visits related to behavioral health, but he did not have the data on hand to say how much of an increase it is. He cautions that there are many factors for why someone may visit the ER.
"The ER is there to help people in emergencies and things that come up, but outcomes are much better if people can get the care when they need it in the right setting," he says.
A cloud of uncertainty still hangs over the future, even in light of the recent stopgap budget deal. Crabb says there's no way she can start reemploying the people she laid off or reinstating the programs she's cut because she doesn't know how human-service providers will factor into the next state budget.
Lindsey, who has worked in the mental health field for 35 years, can't recall a situation quite as dire as this, nor can the lobbyists he's spoken to in Springfield. He says he understands where representatives from both political parties are coming from, and he understands the rationale behind their actions. But he doesn't agree with their priorities.
"I don't think anything warrants people suffering," he says. "When it comes to people having access to basic needs, I think nothing is more important than that. Nothing."