Donovan Richards first attempted to take his own life at age 4.
The Wisconsin boy, who has bipolar disorder and autism, already had been kicked out of three day care programs, and his doctors were sure he would be in an institution before he turned 10.
To get the intensive treatment her son needed, but she could not afford, Paula Buege, Donovan's mom, had to win approval from a review board made up of Dane County officials.
"I had 10 minutes to present his case. And my argument was, 'If we don't help him now, you're going to read about him in the paper one day,' " said Buege, of Middleton, who now helps the parents of mentally ill children with a Madison-based nonprofit, Wisconsin Family Ties.
After years of treatment, Donovan is now a 17-year-old who plays in a band and wants to be a music teacher. While he continues to struggle, he has not been hospitalized for mental health problems in 10 years.
What saved Donovan from suicide or another tragic fate was a mother's perseverance and taxpayer-funded mental health services.
But those public mental health systems in Wisconsin and across the nation increasingly face cuts as they compete for scarce resources, according to an investigation by the Center for Public Integrity, prepared in collaboration with the Wisconsin Center for Investigative Journalism and other nonprofit newsrooms.
States, desperate to close cavernous budget gaps, have cut $2.1 billion from their mental health budgets over the past three fiscal years, according to a study from the National Association of State Mental Health Program Directors' Research Institute, an independent nonprofit that collects and analyzes mental health services data.
The problems go beyond money. In interviews with mental health advocates and county and state officials, the Wisconsin Center for Investigative Journalism found that Wisconsin's public mental health system - once viewed as a national model - has become fragmented and underfunded. And many experts fear that as Gov. Scott Walker moves to close the state's budget deficit, the mental health system will be weakened even further. One county official predicted Walker's changes could "devastate" taxpayer-financed mental health care in Wisconsin.
Among the problems facing the state's public mental health system:
• Significant cuts are expected in Medicaid and county funding, two of the main funding sources for mental health services for the poor in Wisconsin.
• Services for children and teenagers are insufficient.
• The system is complex and difficult to navigate, making it hard for people to get the right treatment when they need it most.
• The availability and quality of mental health services varies greatly from county to county. Funding per client is up to six times higher in some counties than in others.
The Wisconsin Council on Mental Health, the governor's mental health planning council, estimates 232,932 adults and 106,149 children in Wisconsin have serious mental health conditions.
Overall, 100,238 people received taxpayer-subsidized mental health services through their local county in 2009, according to the nonpartisan Legislative Fiscal Bureau.
Walker warned in his March 1 budget address that a "serious and long-term solution" is needed for Medicaid. Demand for existing Medicaid-funded services is expected to create shortfalls of $150 million by June 30 and $1.8 billion in Wisconsin over the next two years as federal stimulus funding ends.
The state Department of Health Services (DHS) plans to replace $1.3 billion of that gap with state funds and make up the difference with $500 million in cuts to the Medicaid program -possibly by cutting eligibility, benefits or reimbursement rates.
"Services have been underfunded with the current budget, and now we're going to see a $500 million cut to providing essential services to vulnerable populations," said state Rep. Sandy Pasch, D-Whitefish Bay, a member of the Assembly's committee on public health.
Pasch estimates Medicaid cuts could leave 65,000 Wisconsin residents without subsidized health insurance to pay for mental health treatment.
Untreated mental illness isn't just a personal hardship; it's a major driver of Wisconsin homeless and prison populations. Nearly one-third of all inmates in the state prison system are classified as mentally ill, the state Department of Corrections estimates.
DHS secretary to make big changes
As part of Walker's controversial budget-repair measure, Dennis Smith, the Republican governor's DHS secretary, has been given a mandate to reshape Medicaid-funded services to close the budget gap.
Smith hinted that big changes may be coming. In a statement, Smith said the state will focus its mental health care dollars on models that are centered on people's needs, are community-based and are statistically proven to work. Mental health experts say such programs are in short supply in Wisconsin.
Smith said state officials will "examine the entire continuum of care at every age" and coordinate mental health care with other medical needs -a move long sought by mental health advocates.
Integration of mental health care with physical health care would help identify and prevent mental illnesses and reduce social stigma, said William Greer, president and CEO of the Mental Health Center of Dane County, a nonprofit agency that provides mental health and substance abuse services.
"The human mind and body are one and the same," Greer said at a February symposium, adding that treatment should be available "under one roof."
The new health secretary vowed to work with legislators, consumers, advocates and taxpayers in an "an open and deliberative process," to identify ideas that will improve health while controlling spending, DHS spokeswoman Beth Kaplan said.
County problem in state
In Wisconsin, unlike in most other states, county governments run the publicly funded mental health care system, which is supported primarily by three funding streams: Federal Medicaid dollars matched by the county, state funding and local property taxes. Walker has proposed cuts to Medicaid and funding to local governments. He also is seeking to freeze local property taxes to prevent officials from making up for the loss of state funding by raising taxes.
Some local officials are alarmed by Walker's plan.
"This could significantly devastate mental health and substance abuse (services)," said William Orth, director of the Sauk County Department of Human Services.
While many states have cut funding in recent years, Wisconsin has maintained support for mental health services - although advocates say the system still falls far short of meeting the state's needs. Mental health expenditures in Wisconsin at the county level actually increased by about 16 percent between 2005 and 2009, to more than $428 million, according to the Legislative Fiscal Bureau.
But those increases may not mean more services, considering that "the cost of doing business has gone up" in health care, according to Ted Lutterman, director of research analysis for the National Association of State Mental Health Program Directors Research Institute in Alexandria, Va.
It's not clear what's in store for mental health care in the current budget. The few broad categories in the governor's budget that mention mental health care, including operation of the state's two mental health institutes, show small increases from current funding levels, but little detail is available.
"Funding is being cut everywhere and mental health is getting increases. I think that shows where Walker's priorities are. It clearly displays he has compassion for the mental health community," said state Sen. Mary Lazich, R-New Berlin, a member of the Senate public health committee. But Pasch said she is "very concerned" how well services for the mentally ill will fare when local governments start cutting their budgets.
"When resources start becoming more and more scarce, my experience being a psychiatric nurse for 30 years is that mental health services are one of the first things to get cut," Pasch said.
If fewer poor people are insured under Walker's proposed budget, counties still will be on the hook to pay for core mental health services, including hospitalization, according to Kathy Roetter, director of Wood County Unified Services, which provides mental health care to residents in central Wisconsin. But counties would lose federal Medicaid matching funds for those newly ineligible people, she said.
Care for mentally ill shifts, leaving gaps
Over the past 50 years, public mental health care in the United States has moved away from locked hospitals to community-based programs. Shifting federal budget priorities, a movement that advocated for the least-restrictive environment for the mentally ill, and a new generation of drugs for psychiatric disorders allowed more people to remain in the community.
In 1955, psychiatric hospitals housed more than 550,000 people, according to research by Dr. E. Fuller Torrey, a research psychiatrist and founder of the nonprofit Treatment Advocacy Center, which is based in Arlington, Va. By 1994, that number had dropped by 87 percent to 71,619 people.
But as hospitals emptied out, the funding didn't necessarily flow to those community programs.
Much of it simply disappeared. A recent study from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) found that when adjusted for population and increased medical costs, the United States spent $261.7 billion in 1955 and only $30.9 billion in 2006 in funding for mental health care.
Wisconsin lacks services for young
Hugh Davis, executive director of the nonprofit Wisconsin Family Ties, says funding isn't the only problem afflicting Wisconsin's public mental health system.
One of the greatest problems he and other advocates see is the lack of adequate mental health care for children and teenagers.
"There is ample evidence that that system has been neglected by our state for a long time," said Davis, whose organization helps families with children who have emotional, behavioral and mental disorders.
-Center reporter Kate Golden contributed to this report.
The Wisconsin boy, who has bipolar disorder and autism, already had been kicked out of three day care programs, and his doctors were sure he would be in an institution before he turned 10.
To get the intensive treatment her son needed, but she could not afford, Paula Buege, Donovan's mom, had to win approval from a review board made up of Dane County officials.
"I had 10 minutes to present his case. And my argument was, 'If we don't help him now, you're going to read about him in the paper one day,' " said Buege, of Middleton, who now helps the parents of mentally ill children with a Madison-based nonprofit, Wisconsin Family Ties.
After years of treatment, Donovan is now a 17-year-old who plays in a band and wants to be a music teacher. While he continues to struggle, he has not been hospitalized for mental health problems in 10 years.
What saved Donovan from suicide or another tragic fate was a mother's perseverance and taxpayer-funded mental health services.
But those public mental health systems in Wisconsin and across the nation increasingly face cuts as they compete for scarce resources, according to an investigation by the Center for Public Integrity, prepared in collaboration with the Wisconsin Center for Investigative Journalism and other nonprofit newsrooms.
States, desperate to close cavernous budget gaps, have cut $2.1 billion from their mental health budgets over the past three fiscal years, according to a study from the National Association of State Mental Health Program Directors' Research Institute, an independent nonprofit that collects and analyzes mental health services data.
The problems go beyond money. In interviews with mental health advocates and county and state officials, the Wisconsin Center for Investigative Journalism found that Wisconsin's public mental health system - once viewed as a national model - has become fragmented and underfunded. And many experts fear that as Gov. Scott Walker moves to close the state's budget deficit, the mental health system will be weakened even further. One county official predicted Walker's changes could "devastate" taxpayer-financed mental health care in Wisconsin.
Among the problems facing the state's public mental health system:
• Significant cuts are expected in Medicaid and county funding, two of the main funding sources for mental health services for the poor in Wisconsin.
• Services for children and teenagers are insufficient.
• The system is complex and difficult to navigate, making it hard for people to get the right treatment when they need it most.
• The availability and quality of mental health services varies greatly from county to county. Funding per client is up to six times higher in some counties than in others.
The Wisconsin Council on Mental Health, the governor's mental health planning council, estimates 232,932 adults and 106,149 children in Wisconsin have serious mental health conditions.
Overall, 100,238 people received taxpayer-subsidized mental health services through their local county in 2009, according to the nonpartisan Legislative Fiscal Bureau.
Walker warned in his March 1 budget address that a "serious and long-term solution" is needed for Medicaid. Demand for existing Medicaid-funded services is expected to create shortfalls of $150 million by June 30 and $1.8 billion in Wisconsin over the next two years as federal stimulus funding ends.
The state Department of Health Services (DHS) plans to replace $1.3 billion of that gap with state funds and make up the difference with $500 million in cuts to the Medicaid program -possibly by cutting eligibility, benefits or reimbursement rates.
"Services have been underfunded with the current budget, and now we're going to see a $500 million cut to providing essential services to vulnerable populations," said state Rep. Sandy Pasch, D-Whitefish Bay, a member of the Assembly's committee on public health.
Pasch estimates Medicaid cuts could leave 65,000 Wisconsin residents without subsidized health insurance to pay for mental health treatment.
Untreated mental illness isn't just a personal hardship; it's a major driver of Wisconsin homeless and prison populations. Nearly one-third of all inmates in the state prison system are classified as mentally ill, the state Department of Corrections estimates.
DHS secretary to make big changes
As part of Walker's controversial budget-repair measure, Dennis Smith, the Republican governor's DHS secretary, has been given a mandate to reshape Medicaid-funded services to close the budget gap.
Smith hinted that big changes may be coming. In a statement, Smith said the state will focus its mental health care dollars on models that are centered on people's needs, are community-based and are statistically proven to work. Mental health experts say such programs are in short supply in Wisconsin.
Smith said state officials will "examine the entire continuum of care at every age" and coordinate mental health care with other medical needs -a move long sought by mental health advocates.
Integration of mental health care with physical health care would help identify and prevent mental illnesses and reduce social stigma, said William Greer, president and CEO of the Mental Health Center of Dane County, a nonprofit agency that provides mental health and substance abuse services.
"The human mind and body are one and the same," Greer said at a February symposium, adding that treatment should be available "under one roof."
The new health secretary vowed to work with legislators, consumers, advocates and taxpayers in an "an open and deliberative process," to identify ideas that will improve health while controlling spending, DHS spokeswoman Beth Kaplan said.
County problem in state
In Wisconsin, unlike in most other states, county governments run the publicly funded mental health care system, which is supported primarily by three funding streams: Federal Medicaid dollars matched by the county, state funding and local property taxes. Walker has proposed cuts to Medicaid and funding to local governments. He also is seeking to freeze local property taxes to prevent officials from making up for the loss of state funding by raising taxes.
Some local officials are alarmed by Walker's plan.
"This could significantly devastate mental health and substance abuse (services)," said William Orth, director of the Sauk County Department of Human Services.
While many states have cut funding in recent years, Wisconsin has maintained support for mental health services - although advocates say the system still falls far short of meeting the state's needs. Mental health expenditures in Wisconsin at the county level actually increased by about 16 percent between 2005 and 2009, to more than $428 million, according to the Legislative Fiscal Bureau.
But those increases may not mean more services, considering that "the cost of doing business has gone up" in health care, according to Ted Lutterman, director of research analysis for the National Association of State Mental Health Program Directors Research Institute in Alexandria, Va.
It's not clear what's in store for mental health care in the current budget. The few broad categories in the governor's budget that mention mental health care, including operation of the state's two mental health institutes, show small increases from current funding levels, but little detail is available.
"Funding is being cut everywhere and mental health is getting increases. I think that shows where Walker's priorities are. It clearly displays he has compassion for the mental health community," said state Sen. Mary Lazich, R-New Berlin, a member of the Senate public health committee. But Pasch said she is "very concerned" how well services for the mentally ill will fare when local governments start cutting their budgets.
"When resources start becoming more and more scarce, my experience being a psychiatric nurse for 30 years is that mental health services are one of the first things to get cut," Pasch said.
If fewer poor people are insured under Walker's proposed budget, counties still will be on the hook to pay for core mental health services, including hospitalization, according to Kathy Roetter, director of Wood County Unified Services, which provides mental health care to residents in central Wisconsin. But counties would lose federal Medicaid matching funds for those newly ineligible people, she said.
Care for mentally ill shifts, leaving gaps
Over the past 50 years, public mental health care in the United States has moved away from locked hospitals to community-based programs. Shifting federal budget priorities, a movement that advocated for the least-restrictive environment for the mentally ill, and a new generation of drugs for psychiatric disorders allowed more people to remain in the community.
In 1955, psychiatric hospitals housed more than 550,000 people, according to research by Dr. E. Fuller Torrey, a research psychiatrist and founder of the nonprofit Treatment Advocacy Center, which is based in Arlington, Va. By 1994, that number had dropped by 87 percent to 71,619 people.
But as hospitals emptied out, the funding didn't necessarily flow to those community programs.
Much of it simply disappeared. A recent study from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) found that when adjusted for population and increased medical costs, the United States spent $261.7 billion in 1955 and only $30.9 billion in 2006 in funding for mental health care.
Wisconsin lacks services for young
Hugh Davis, executive director of the nonprofit Wisconsin Family Ties, says funding isn't the only problem afflicting Wisconsin's public mental health system.
One of the greatest problems he and other advocates see is the lack of adequate mental health care for children and teenagers.
"There is ample evidence that that system has been neglected by our state for a long time," said Davis, whose organization helps families with children who have emotional, behavioral and mental disorders.
-Center reporter Kate Golden contributed to this report.