Preserving the County’s Mental Health Safety Net

Over recent months, the media has drawn attention to the role of mental health in several high profile local and national tragedies. What is often not recognized is that most mental health problems are suffered in silence and hardly draw the public’s attention. Even in a community as well resourced as Montgomery County it is not common knowledge that, according to Montgomery County Police statistics, 250 residents managed to commit or attempt suicide last year.

Once assumed an affluent enclave, Montgomery County is awakening to the fact that its increase in foreclosures and job losses may be affecting the emotional health of its residents. In 2010 alone, Montgomery County Police report that they were summoned over 4,000 times to residents suffering severe psychiatric symptoms.

John Hopkins University professor Harvey Brenner found that recessions contribute to the deterioration of a community’s mental health. His classic research revealed how the recession of 1974 was accompanied by an increase in psychiatric hospital admissions, suicide and substance abuse, as job loss and economic uncertainty translated into depression and anxiety. Sadly, history seems to be repeating itself.

Many county agencies and nonprofit mental health providers report waiting lists for mental health services, especially to see child psychiatrists. At certain points last year, individuals in search of mental health treatment often were passed from waiting list to waiting list as multiple providers were working at full capacity and could not squeeze in another person.

Mental health insiders realize that many of the suicides involve individuals who were in treatment, but who disappeared or dropped out. Sadly, many agencies grappling with less county and state aid, and fewer donations and foundation grants, must operate like for-profit businesses. They do not have the luxury to track down missing clients with multiple telephone calls and home visits—a service for which they cannot bill—even though everyone realizes that client outreach is central to treatment.

Montgomery County, known for its generosity, now has fewer resources with which to live up to its ideals. The reduction of funds from county government and the declining rates paid by the state’s Medicaid system have not only shrunken the county’s mental health treatment capacity over the last decade, but has also left many mental health providers in a precarious financial position. In its 2010 study of public mental health services for children, the League of Women Voters of Montgomery County characterized the county's safety net as "frayed.” This was an ironic commentary in a community known for its affluence.

County Executive Isiah Leggett threaded a difficult needle by trimming his budget to preserve the county’s safety net for vulnerable citizens. As nonprofit agencies working with this needy population—and understanding the desperate plight of that population—we applaud Mr. Leggett’s compassion.

However, when the County Executive’s budget gets debated by the County Council, the safety net may again be at risk. With many constituencies competing with mental health providers forthe same scarce dollars, the most vocal and powerful groups will likely shield themselves from the greatest cuts. Regrettably, the mental health community—with the least power and money historically—may be the most vulnerable, despite the objective merits of increasing funding for mental health services while so many residents are suffering in a harsh economy.

Two years ago, when fear surrounding the H1N1 virus gripped our community, we mobilized mass resources to combat a threat that affected fewer than a handful of people. Ironically, suicide and mental illness claim more victims in our community than H1N1. Our weakened economy may be driving up the rates of emotional distress; and Montgomery County should bolster our community’s mental health resources. Preventing residents from falling through the safety net is cheaper and more compassionate than trying to repair them after they fall.

Saint Mark’s Coalition for Mental Health

Scott Birdsong, GUIDE Program Inc.

Charlene P. Blumenthal, Parent Advocate

Kevin P. Dwyer, MA, NCSP

Sharon E. Friedman, Mental Health Association of Montgomery County

Barbara Garlock, Interfaith Works

Thomas E. Harr, Family Services Inc.

Esther Kaleko-Kravitz, Adventist Behavioral Health

Sue Kirk, Bethesda Cares

Craig S. Knoll, Threshold Services

League of Women Voters of Montgomery County

Julie Maltzman, Montgomery County Coalition for the Homeless

Celia Serkin and Fred Marton, Montgomery County Federation of Families for Children’s Mental Health

Cindy Ostrowski, St. Luke’s House

DJ Jones-Reilly and Kent C. Reilly, Mental Health Consumer Advocates

Debbie B. Riley, The Center for Adoption Support and Education

Abe Schuchman, Housing Unlimited Inc.

Katherine Slye-Griffin, NAMI Montgomery County

Marcel Wright, Reginald S. Lourie Center for Infants and Young Children 

This article was written by members of the Saint Mark’s Coalition for Mental Health of Montgomery County. It is a coalition of executive directors and senior managers of the major nonprofit organizations in Montgomery County.