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The economic recession has caused many states to cut critical health care service and safety nets. What evidence have you seen of the effect of these cuts on patients and programs in your city?
Certainly cuts can have a serious effect on treatment acccess and quality: in my state ACT teams are told they have to document a certain frequency of contact or attempts regardless of the patient's needs, and there is talk of undbundling ACT, child services have been unbundled, like various services needed for autism, this has made coordinationg comprehensive care harder. In the face of cuts some agencies simply drop some contracts, in many areas of the state outpatient psychiatry is very scarce, some agencies are clearly foundering, and inpatient beds are being reduced, leading to more jamups in the ER's at times.
On the other hand, crisis is opportunity. There are pockets of fat, old deals that are not efficient and need to be reworked, and now that the money is going away I find people more interested in "new" ideas, like medication groups, getting volunteers to do nonbillable stuff, agencies cooperating for coverage. When the woods are on fire the animals stop fighting. Some agencies may have to fail to make space for new blood.
Hopefully healthcare reform will leave space for and encourage innovation in funding at the state level that will encourage the development of new models of better integrated services.
Ben- you are optimistic that the current non-system will tolerate innovation. True innovation is disruptive of old systems and the reimbursement schemes that have been in place all favor large monolithic structures like general hospitals, mental health centers etc. The funding supports the huge administrative overhead of those systems. They will try to keep doing the same thing (psychotherapy) with person with less training, no supervision, shorter and infrequent visits. When that treatment does not work they make an urgent call hoping that there is a new medication to calm an agitated person.
I have been reading "The Innovator's Prescription". Highly recommended.
Our actual cuts to date have been primarily further closure of state beds. At the clinic level our consumers are experiencin much longer waiting periods to access resources such as medicaid and other public insurance programs....I do not have data, but think this is likely to be due to increasing numbrs of individuals applying for these public benefits.