County officials and others say there’s a lack of adequate funding for mental health services even after the governor approved the 2024-25 fiscal budget and increased funding by $20 million.
Lebanon County officials and leaders from the County Commissioners Association of Pennsylvania (CCAP) say more funding is needed beyond the additional $20 million provided last year and the $20 million that was approved in fiscal year 2024-25’s budget.
“We think the system is underfunded by about a billion dollars overall to fully meet Pennsylvania’s needs,” said Lisa Schaefer, executive director of County Commissioners Association of Pennsylvania. “We realize $1 billion is a big number and the budget is not going to contain something that significant in a single year, so we’re submitting for investments to start a rebuild in a way so that we can invest in services, invest in people. We believe $250 million would really make that difference.”
Schaefer said county mental health agencies were hampered with a cut in the 2012 state budget and funding has remained flat until the 2023-24 budget was passed. However, the $20 million increase last year still falls below what’s needed to sufficiently fund county-based mental health agencies across Pennsylvania.
“Mental health services were flat funded for about 15 to 20 years and they took a pretty significant cut (10 percent) in 2012,” she said. “The current budget had a $20 million increase, which is the first increase we’ve seen in that time period, but for all intents and purposes it really amounted to flat funding. It only really enabled them to keep the lights on. It didn’t even cover the cost of living and CPI (Consumer Price Index) increases over the past year.”
In fiscal year 2023-24, Lebanon County’s share of the $20 million dispersed across all 67 counties totaled $187,000.
Holly Leahy, administrator of Lebanon County Mental Health/Intellectual Disabilities/Early Intervention, said the agency has faced cost increases without adequate funding to pay for those services.
“We have seen a tremendous increase in provider projects over the last five years,” she said. “A lot of that has been due to inflation, the economy and really just trying to maintain the services and supports that we have in place.”
Leahy said the county has had to repeatedly ask their 94 mental health service providers to keep costs in check.
“With inflation and increasing demand on their staff members who are within this field, it’s really hard for them to come in with a flat budget because they need to be able to pay their workers or they’re not going to have anyone to provide those services,” she added.
The governor’s 2024-25 budget increased mental health funding by an additional $20 million for the new fiscal year, which was to begin July 1 but was delayed by about two weeks.
The base mental health funding line item is used by counties to support inpatient services, outpatient therapy, crisis services, working with local schools to support student mental health and more.
John Buffone, CCAP’s public relations director, wrote in an email to LebTown concerning the new budget that states: “Demand for mental health services continue to skyrocket while the funding for those services maintains a slow crawl. Given the severity of the situation, Pennsylvania counties were hopeful that this would be the time for the state to get serious about investing in the mental health services so many members of our communities depend on. However, it will once again be up to Pennsylvania counties to continue providing these critical services with inadequate funding.”
Leahy had reported to the Lebanon County Commissioners at their mid-June meeting that her department is facing a budget deficit of over $377,000 heading into fiscal year 2024-25.
“Even if legislators approve another $20 million statewide here in fiscal year 2024-25 with our share, again, being $187,000, it really will not put a dent into our deficit, giving us no ability to expand services or initiate any new innovative services,” she cautioned the commissioners at that meeting.
Read More: Mental health agency faces budget deficit in 2024, commissioners learn
Leahy added that the federal public health emergency funding initiative paid via Medicaid’s HealthChoices program during the COVID-19 pandemic ended on Apr. 30, 2024, leaving those in treatment but without Medicaid, which covered those costs during the emergency, to foot the bill moving forward.
“We do anticipate that as individuals are seeking funds for services that we will see a tremendous increase in individuals seeking base funding support with the county with the loss of their HealthChoices funding,” noted Leahy.
Further complicating county coffers is the mental health needs impact on other agencies, according to Lebanon County administrator Jamie Wolgemuth. When asked for an estimate across those departments, Wolgemuth said it’s difficult to pinpoint exact costs since some expenditures are intangible.
Wolgemuth told LebTown that the Lebanon County Correctional Facility, Children and Youth Services, and probation are among those departments experiencing a rise in mental health issues with individuals interacting with them.
“When I refer to the jail, the tangible cost is in the PrimeCare cost because they provide direct mental health services, assessments and things like that,” said Wolgemuth. “When I refer to other agencies like Children and Youth and Drug and Alcohol, and I would add to that Emergency Services because they field the calls, dispatch law enforcement and so on, I am talking about indirect costs to the county.”
Wolgemuth said mental health issues are the root cause of societal problems that are far-reaching and require interaction with multiple county agencies.
“It can lead to substance abuse, it can exist with substance abuse, parents who are suffering from mental illness and having difficulty caring for their families and doing the right thing for their children,” said Wolgemuth. “I think you can point to it as a root cause – not the sole root cause – but the contributing factor of so many of our human service and social service agencies that end up trying to address their (clients’) issues.”
It appears that the problem is poised to grow in the coming years with no predictable funding on the horizon as all Pennsylvania counties face the implementation of two new mandated mental health programs.
“These are to be in effect and implemented by the end of 2026,” said Leahy. “Without additional funding, these are extremely expensive models to implement and without additional funding, we’re not going to be able to fully implement them by the end of 2026.”
Wolgemuth noted that the only way those programs will exist under current funding is if counties pick up the tab. Leahy added that these services are estimated to cost “in the millions” and that the county’s mental health agency is incapable of adding any other new programs given the agency’s 2024-25 budget shortfall.
“We’ve looked at that funding and it is probably going to be in the $2 to $3 million amount until we fully implement the SAMHSA (Substance Abuse and Mental Health Services Administration) model and the mobile crisis team,” said Leahy. “That’s really more than our whole budget for mental health services, so there’s absolutely no way that we’ll be able to implement that without some type of additional sustainable funding.”
Wolgemuth said options are limited on what Lebanon County officials can do to address the county’s ongoing mental health needs.
“It’s a decision and a weighing in on the part of the county commissioners as to whether or not that they step up and find the funding to fill the gap or make a cut in services or (create) a (mental health services) waiting list,” said Wolgemuth. “It’s just a decision on how far to fund these things and whether that leads to a tax increase at some point. Again, it’s one of the ingredients to the continuing rise in costs that eventually leads to needing more revenue.”
Lebanon County’s state legislative contingent told LebTown they believe county mental health services deserve to receive more financial support from the commonwealth.
“The short answer is yes. To me, there are a couple of pieces to that,” said state Rep. John Schlegel (R-101). “Number one is the funding issue. There’s no doubt in my mind that there’s a need for greater mental health services and that is even true in our schools… There’s a need in our prisons, there’s a need in our schools and there’s a need for more mental health funding for our children and youth.”
Schlegel added that there needs to be a realization that mental health needs exist long-term, he hopes that the legislature addresses this issue and that it is on his radar.
State Rep. Russ Diamond (R-102) said the mental health crisis in Pennsylvania and across the United States “is astounding.”
“This is what happened when we abandoned our state mental health facilities back in the ’80s. We shut that stuff down at the state level and it is now all on the county,” said Diamond. “Our prison has turned into a mental health ward and it’s a crying shame. The governor says $20 million and the county (association) says $250 million and there has to be somewhere in the middle that everyone can agree upon.”
Neither Schlegel, Diamond nor Sen. Chris Gebhard (R-48) would say how much they would be willing to fund beyond the additional $20 million that passed in this budget.
Gebhard said he is familiar with this issue because his wife is a school guidance counselor who has witnessed firsthand the rise in mental health needs. He added that he’s had extensive discussions with County Commissioners and Wolgemuth on this topic and believes there should be a “bump for community funding to address the mental health crisis.”
“During my very first month in office (June 2021) I sent an email to then chairman of appropriations, Senator Pat Browne, advocating for what the CCAP had requested for Community Mental Health Funding,” wrote Gebhard to LebTown in an email. “It seems like any new spending or new programs typically start with the administration’s ask in their initial budget proposal and I am fully supportive of that increase this year.”
Wolgemuth said it’s difficult to comprehend how one area of the state budget can go flat funded for so long when funding has increased over time for nearly every other agency.
“It’s hard to understand how something of this import can go underfunded for this long and while virtually everything else has received an increase – or at least at some time during that time frame,” said Wolgemuth. “Going back to 2012, it was cut and since 2006 it has been flat funded. … What other function of government is still operating with the same amount of money from 18 years ago? Meanwhile, we should all be willing to admit and recognize that mental health needs have increased over those 18 years for a variety of reasons.”
Leahy said mental health funding is complicated and that misconceptions exist.
“To be truthful, I think there is quite a misconception on the position of the state with regards to mental health-based funding,” said Leahy. “I believe that they think that since the Medicaid HealthChoices system for individuals has been funded sufficiently, that they have done their part for mental health funding.”
For Leahy, who has worked in the profession for many years, that line of thinking is misplaced.
“They do not understand that the individuals being served and supported in our community through mental health-based funding would otherwise not have any funding available to them because the HealthChoices system is not available to every individual within our community,” said Leahy. “There’s reasons why they are not eligible for HealthChoices funding, so they seek help through mental health-based funding. It’s truly a misunderstanding in how the funding works and that the HealthChoices system is insufficient and doesn’t cover everyone in our community.”
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