By Lindsay Street, Statehouse correspondent | House lawmakers prioritized boosting mental health spending in the state’s annual budget prior to the pandemic, but plunging revenues could mean a very different budget when the legislature convenes in September.
Some lawmakers and experts say the investment is needed now more than ever as a mental health crisis will likely follow the months of social isolation, economic insecurity and anxiety.
“We thought this year we would champion mental health, without even dreaming this additional stuff would happen,” said House Ways and Means Healthcare subcommittee chair Rep. Bill Herbkersman, R-Bluffton.
He called it the “mental health budget” in a March column. The proposed budget invested $27,289,516 in recurring funds to the S.C. Department of Mental Health, including $5 million for expanding in-patient services and $400,000 in recurring funds for emergency services over phone or virtually.
But now revenues have been continually adjusted downward for the state. So far, revenue forecasters estimate there will be $701.8 million less than what the House initially anticipated, leaving lawmakers with about $9.5 billion to spend in 2020-2021 — and possibly only $60 million in surplus funds from the 2019-2020 fiscal year.
T
he Senate will draft its version of the budget during six legislative days in September. Senate Finance Health and Human Services Subcommittee Chair Sen. Thomas Alexander, R-Walhalla, said mental health will continue to be a priority, but that “it’s too soon to know” if the extra spending will get axed.
The coming ‘flood’
Mental health experts say isolation, financial insecurity and anxiety over one’s health or that of a loved one, all of which is tied to the coronavirus pandemic, could lead to an increased number of anxiety and depression cases across the state.
“Anxiety and depression has significantly increased across the board with adults and kids,” said Alyssa Rheingold, professor and clinical psychologist within the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston. She added there has been an increase in substance abuse too. “Early on the pandemic, there’s a lot of heightened anxiety. More recently, it has shifted to this kind of exhaustion, fatigue … It’s going to be evolving.”
Deborah Blalock, deputy director of Community Mental Health Services at the S.C. Department of Mental Health, described it as a coming “flood of people” needing services, similar to what the state has seen after other crises such as hurricanes or the 2015 Charleston church shooting.
“Every crisis we’ve been involved in over the decades we saw it three to six months post-crisis,” Blalock said. “This is a weird one because it is so prolonged.”
In response to the ongoing pandemic, the Department of Mental Health has rolled out initiatives paid for by a $2 million grant, aimed at aiding mental health during the pandemic. One program created a statewide phone number, 1-844-SC-HOPES, to help connect residents to state services, including mental health care. Another rolled out a virtual program for health care workers called Health Care Outreach Teach, or HOT.
Growth in telehealth
Meanwhile, providers are working to keep helping patients by going into people’s homes virtually and by phone.
The Department of Mental Health had a robust telehealth program prior to the pandemic, Blalock said.
“After the pandemic, we immediately flipped from about 5 percent of our services through telehealth to 95 percent telehealth, and now it’s about 85 percent because there are some people who have trouble with access,” she said.
In private medicine, mental health struggled to expand into telehealth for years because “third party payers weren’t paying for it,” Rheingold said.
“Now because of this pandemic … third party payers are allowing for telehealth mental health resources,” she said. “The access to care for mental health, on some level has improved somewhat or the pandemic hasn’t hurt that because we’ve been able to shift 100 percent over telehealth.”
Rheingold said when the legislature convenes in September, telehealth for mental health should be among the priorities.
“Ensure that telemental health continues to be a reimbursable approach to providing services,” she said.
Part of that equation will be expanding broadband access, which the legislature agreed in June to begin expanding access with $50 million in federal funds.
“We’ve spoken in a unified voice and bipartisan voice of the importance of broadband and telemedicine for the citizens of our state, especially in rural areas and underserved areas,” said Alexander, the key state senator in the budget process. “We will have to be realistic to the confines of our financial situation in what that will look like come September but the willingness will be there.”
Many unknowns before September
As with much in the pandemic, there is a lot of uncertainty about the state of mental health.
“We don’t know what kind of flood we’re going to get, we really don’t know,” Blalock said. “We don’t know what our budget is going to look like. That’s an issue. We know the state has lost revenue, lost income from loss of taxes, so we don’t know if our budget is going to be cut.”
But Herbkersman and Alexander said they will work to keep mental health a budget priority.
“I asked to be on the conference committee for this exact reason. We can’t back down on this,” Herbkersman said. Conference committee assignments have not been announced yet. “The COVID pandemic would be part of (additional need) … but every year, we see things get worse and worse and we can really turn it around. Financially, we had a good year but whether we had a good year or not it needs to be a priority.”
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