Screwing the Mentally Ill

The Boston Globe reports that due to the state’s fiscal crisis, a critical mental health support (PACT) will close two of its programs. PACT (Program for Assertive Community Treatment) provides intensive home based services for the mentally ill, not only keeping them out of hospitals, but enabling them to have productive and rewarding lives. Once again, society’s most vulnerable members are paying the price for our financial implosion.

While the economic collapse has decimated state revenues, it was not inevitable that services such as PACT would be cut. The federal government could have provided an adequate stimulus, one that would have backstopped state revenues such that level services could be maintained, year to year. Instead we got a watered down package that was needlessly scaled back because a few Senators seem to think that cutting a couple hundred billion from the bill, for no reason, is good policy. Given that states cannot run budget deficits, this lack of federal support has meant drastic cutbacks in social services across the nation. All at a time when those types of programs are most in demand.

In addition, the state has failed to make the tough choices necessary to bring its budget into balance. Local aid and Chapter 70 education aid have been off the table, due to their political popularity. Such sacred cows, which account for close to 25% of the total state expenditures, only make deeper cuts to other programs inevitable.

This is not to say that cuts to local aid or education would not harm folks. However, if those cuts were made in a way that took equity into consideration the effects would be minimal. There is no good reason for state revenue to be flowing to wealthy school districts and municipalities to the degree it currently does. There is no good reason for minimum aid, which goes to the wealthiest districts in the state, in the Chapter 70 formula.

Massachusetts is prohibited, by its constitution, from having a progressive income tax. Given that reality, it is imperative that its spending programs reflect broadly progressive goals. Aids to wealthy school districts and municipalities does extreme violence to such notions of progressivity, even in times of fiscal calm. But during periods of fiscal upheaval, the true costs of such programs are passed on to those who can least afford it.

Beyond that, cutting a program such as PACT is penny-wise and pound foolish. Absent these intensive community supports, many of the mentally ill will end up in hospitals at an enormous cost to the Commonwealth. So, not only are we shortchanging the mentally ill, but we’re going to be paying more in the long run. This is what you might call a lose-lose. Massachusetts deserves much better.

(full disclosure- I have a family member who is served by PACT, luckily not one of the two that is closing.)

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