Mental health funding is fast becoming “the bipartisan issue of our time”

It’s widely acknowledged that there’s a desperate need for improved and expanded mental health services across the country—so much so that this is one of the few issues that appears to be gaining traction in both red and blue states. Significant investments have been made in recent months in bright red Montana and Texas and in deep blue California and New York.

“We’re seeing record breaking investments across multiple states. Mental health is the bipartisan issue of our time,” says Stephanie Pasternak, the director of state affairs at the National Alliance on Mental Illness. “We review mental health legislation each year and the majority of them are bipartisan.”

Consider North Carolina. In late September, the state invested $835 million in mental health care. The investments coupled with structural and operational reforms were developed through a partnership between the Republican legislature and the health and human services secretary, an appointee of Democratic Gov. Roy Cooper.

In fact, a key ingredient for bipartisan agreement in North Carolina was the close relationship that developed between Secretary Kody Kinsley and state Sen. Jim Burgin, the Republican chair of the Appropriations on Health and Human Services committee.

Increased understanding, constant communication and mutual respect provided a solid basis for the state’s new investments in the 2024 budget. The mental health reform plan is designed to decrease overcrowding in emergency rooms, better serve rural residents, increase pay for multiple behavioral and mental health positions, fund crisis teams and respite facilities, and supply expert assistance to primary care physicians on the frontlines rather than just depending on often unavailable specialists.

According to a report by the addiction treatment company, American Addiction Centers, California spends the most on mental health care with about $7 billion dedicated to the effort. Other states with over $1 billion dollars allocated towards mental health spending include New York, Pennsylvania, New Jersey, Arizona, Michigan, Texas, Maryland, Ohio and Minnesota. As the company points out, this list of states “includes a variety of sizes and population, showing that the total amount of spending by state isn’t necessarily dependent on the size of the state.”

One of the fundamental reasons states are investing in mental health now is a realization that a cost effective and humane way to deal with addiction is needed. We can’t keep placing those struggling with addiction behind bars. Beyond that, mental health care can help to reduce the homeless population, a major issue in California and other states. There’s also a growing awareness that one of the best ways to fight violent crime is to reach offenders with mental health care before they hurt themselves or others.

“I think we’re seeing the most innovation in crisis care,” says Pasternak. “It’s really how communities across the country are thinking about how they respond to people if they’re in a mental health crisis. For so long, we’ve treated them as a public safety issue when they’re really a health care issue.”

In Texas, for example, Gov. Greg Abbot proclaimed in an NPR interview that his state is working to deal with violence by addressing what he called its “root cause”—mental health problems. “People want a quick solution,” he said. “The long-term solution here is to address the mental health issue.”

To date, The Texas Tribune reported, the state “has invested $25 billion during Abbott’s watch as part of a statewide behavioral health plan to address the state’s floundering mental health system.”

In California, a bond issue that will devote nearly $6.3 billion to mental health will be voted on in March. If passed, the money will help to build new behavioral health housing and treatment settings across the state. “It’s a signature piece of the governor’s agenda,” says Chris Hoene, executive director of the California Budget & Policy Center. “He wanted this on the March ballot and made sure that other ballot measures were pushed to the November election. So, this is the only ballot measure in March.”

While Hoene is reluctant to make any predictions, he points out that “in a state that has a major homelessness crisis, a package that has at its core an effort to connect behavioral health with people who are unsheltered, will be viewed favorably by a lot of Californians.”

Meanwhile, in Montana, Gov. Greg Gianforte said in a June press release that, “After decades of previous administrations applying Band-Aids and kicking the can down the road, we’re making a generational investment in our behavioral health care and developmental disabilities service delivery systems. Instead of turning our backs on those struggling, we’re investing in hope and opportunity to get Montanans healthy. The time for kicking the can down the road is over.”

With that in mind, he signed a bill to put $300 million toward a variety of mental health services including expanding intensive and community-based behavioral health care services across the state. That was the largest investment of its kind in state history.

In New York, months after a state-of-the-state address in which Gov. Kathy Hochul said that “the state has for too long underinvested in mental health care,” the 2023-24 budget increased spending dramatically with more than $1 billion in new resources to expand access throughout the public health mental system bringing the Office of Mental Health’s total appropriations to more than $6.4 billion.

Hochul's plan provides funding to establish and operate 3,500 new residences for New Yorkers with mental illness. These aren’t just beds in psychiatric hospitals, but rooms that provide housing and intensive services to individuals with serious mental illness who are at the highest risk of homelessness. They are also transitional step-down units after a hospital stay and supportive housing units that serve individuals with a serious mental illness who have less acute needs but still need to live in a supportive community. In addition, the plan provides funding for the operating costs for 60 community step-down housing units in New York City to serve formerly unhoused individuals who are transitioning from inpatient care.

The federal government supports state mental health services through an additional block grant program of a little over $1 billion a year to the states, according to Tison Thomas, deputy director of the Center for Mental Health Services.

“The block grant represents about 1.5% of all expenditures for mental health including all federal and state funds,” he says. “However, it is a flexible source of funds that states can use to cover gaps and current priorities in their services. I always say it’s a driver of change in the states.”

Editor's note: This article was changed Dec. 14 to correct the attribution of a quote, which was mistakenly credited to Dr. Anita Everett of the Center for Mental Health Services instead of Tison Thomas.