Advocates for the mentally ill say a government shutdown could be devastating for people who rely on state medical assistance to pay for care.
Some groups who care for the mentally ill say they are prepared to deal with a government shutdown using county funds and reserves. But as they look down the road, mental health providers also fear that a budget compromise — once it comes — could leave critical programs underfunded.
Minnesota has been providing mental health services since early in its statehood. Back then, patients were sent to sprawling residential facilities. But now, all but the most seriously ill live independently and receive care in small community facilities. In the Twin Cities, a nonprofit called People Incorporated helps thousands of clients a year, including 42-year-old Kevin Branting.
"I've been a mental health consumer, I guess, for many years," Branting said. "That's not really a claim to fame or anything, but I do have some severe mental illnesses.
Branting has post traumatic stress disorder that comes as a result of childhood abuse. He also suffers from depression. Lack of sunshine on Minnesota's short winter days worsens his condition. Branting said last January it got out of control.
"I felt like I couldn't manage my symptoms at home, but I felt like the hospital was not necessary," he said.
Branting turned to People Incorporated's Nancy Page Crisis Residence in Minneapolis. He said staff adjusted his medication and helped him through his problems. Branting said without care like this, he would have had to go to a hospital — an environment he says is stressful and not conducive to his recovery.
People Incorporated CEO Tim Burkett said services like this will probably continue through a government shutdown because state money comes through the counties, which have already paid.
But Burkett is more concerned about what will happen six months from now if a proposed $1.5 million, or a 50 percent cut to crisis care comes to pass. Gov. Mark Dayton vetoed the GOP budget, but Burkett fears the cuts could remain as part of a compromise.
"Three thousand people in a year ... are they going to clog the ERs?" Burkett said. "I just don't know what would happen systemically. I think it would be chaotic and tragic, both."
While People Incorporated has a financial cushion, many smaller providers don't. More than 100 mental health advocates held a vigil outside the Capitol last night.
Julia Pawlenty, whose husband is a distant cousin of the former governor, is a social worker with a private care provider in Burnsville. She helps teenagers, many of whom receive Medical Assistance — Minnesota's health care program for the poor.
"So if medical assistance shuts down, we lose our clients, and those people are without services," Pawlenty said. "They're without the therapy; they're without the chemical dependency services that they receive each day. They're kind of left in the dust."
What happens to mental health care will depend on whether it is ruled by a judge to be an essential state service. State Rep. Jim Abeler, R-Anoka, who chairs the Minnesota House Health and Human Services Committee, can't predict how services will fare in a shutdown.
"There's all kinds of hyperbole about what might happen. But no one knows for sure," Abeler said. "And I can tell you one thing for sure: If we don't change something, many people will find themselves without coverage that they can actually get."
Though the proposed cuts passed Abeler's committee, he admits they'll be painful. However Abeler said the budget crisis is an opportunity to address inefficiencies in the system that could grow with time.
"I don't think all the money we've spent is very well spent at all. And sometimes it takes a crisis to look at a system and say how can we do it better?" Abeler said. "The reason that's so important is that suddenly what it costs makes every bit of difference."
Mental health advocates argue the effects of a government shutdown combined with budget cuts will mean paying more in the future. If people go untreated, they'll wind up in emergency rooms and jails — which advocates say cost far more than preventative care.