So many people think of Ronald Reagan as one of our greatest Presidents.  He is attributed to “winning the cold war,” and reducing the size of government.  I’m not going to debate those issues, but I do know that during that time thousands of people were discharged from mental health facilities where they were being warehoused and sent out to find their own housing and services.  They were supposed to be supported by out-patient community services.  Instead, people with serious mental illnesses started falling through the cracks and not receiving proper medical treatment, if any treatment at all.  Today many people with serious mental illnesses are living on the streets, in prisons or in sub-standard, unlicensed boarding homes.  Some families with mentally ill family members are bearing the expense and emotional roller coasters of living with someone who can be challenging at times because they aren’t diagnosed correctly or the stigma surrounding psychiatric disorders keep them from seeking professional  care -  even though  proper medical treatment works and mental health recovery is a reality.  While our Governor Brewer is a fan of slashing the state’s budget for mental health treatment thinking that will help to solve the state’s financial woes, she like President Reagan,  does not always have our best interests at heart.

So, even if President Reagan was a great man, it was during his presidency that treatment for our nations most vulnerable went from bad to worse.  The following article is a reprint because I found it expresses my concerns adequately and one month after the horrible shootings in Tucson, people seem to be more receptive to learning about this issue.

Ronald Reagan, Mental Health, and Spin . . .

Man Behind the Myth

By Phyllis Vine

For the next twelve months, the Ronald Reagan image machine will be turning out countless vignettes of the nation’s 40th president, the man neighbors called “Dutch.” He will be described as no-nonsense yet kindly, remote but avuncular, a movies-star-turned-politician, and remembered as a local lifeguard rescuing people in troubled waters. With dashing good looks, a sonorous tone that became the voice of General Electric, and an affable smile, even those who disagreed with his policies will say he was genuinely kind-hearted.

So what did this mean practically for policies about mental health? Here we need to  ask how the image departs from the reality.

Contrary to the spin about trimming government, which he called “the problem,” we all know he oversaw increases in federal spending that exploded the national debt, and grew the size of the government he impugned. Another part of the reality, rarely the image, is how he attempted to savage the  entitlement system and roll back supports for people with a mental illness.

When Ronald Reagan arrived in Washington, he inherited the Mental Health Systems Act of 1980. One of the last achievements of Pres. Jimmy Carter, this was passed by the House 277 to 15, in the Senate, 93 to 3. With as many critics as there were special interests, it was far from perfect. Yet it expanded the federal government’s commitment to services, to research, to training professionals, and to patient rights. It identified stigma as an impediment to seeking and receiving services.  It established parity in Medicaid and Medicare. It recognized the link between physical health and mental health. And it dedicated $800 million over 4 years to redress the gross neglect of the commitment to mental health in earlier administrations.  In short, it moved an agenda that minimized homelessness, the reliance on expensive nursing homes, jails and prisons, and one that to more hopeful choices for those who needed help.

The Mental Health Systems Act was a milestone. It came on the heels of four years of hearings and a presidential task force benefiting from First Lady Rosalynn Carter’s active involvement.  Philosophically it affirmed Pres. John F. Kennedy’s Community Mental Health Centers, an attempt to thwart hospitalizations. It fit into the safety-net values championed by Pres. Lyndon B. Johnson with the passage of Medicaid and Medicare.

Still, by 1980 the nation needed more for those with a chronic illness. Many failures accompanied the attempts to close the miserable hospitals, often little more than warehouses, to help patients succeed in the community. The neglect of government support conspired to form a patchwork system with notable gaping holes. A 1977 GAO report said, “Government needs to do more.”  Congressional hearings in 1979 re-affirmed the need to strengthen impoverished services and the failed policies.

Although not perfect, the Mental Health Systems Act responded to these problems. For the first time since the National Institute of Mental Health became part of NIH in 1949, mental health was front and center in federal policy.

Then came Ronald Reagan. Within a month, the Office of Management Budget announced it would curtail the budget of the National Institute of Mental Health (NIMH), phase out training of clinicians, interrupt research, and eliminate services.  Cutbacks to staff followed; chaos ensued. Experienced people left, others remained in government service but were forced into menial jobs. Trained professionals were reassigned to labs to dissect dead rats; science writers were reassigned to typing pools. The Mental Health Systems Act would disappear. Instead, the Omnibus Budget Reconciliation Act (1982) would merge money for mental health programs into block grants, and with fewer dollars going to the states.  They had the discretion to use them however they saw fit, often to perpetuate programs already deemed problematic. The pretense for all this was the president’s concept of a “new federalism.”

“Many of our dreams were gone,” wrote Rosalynn Carter in Helping Someone with Mental Illness. “It was a bitter loss.”

This could have been enough, but it was not. Pres. Reagan attempted to restrict criteria for determining eligibility for SSI, thought to be a safety-net. Nearly 2.6 million people were receiving insurance because their disability prevented them from working. New evaluations for eligibility led to widespread terminations. Of those who were terminated, about half appealed, and in two-thirds of the cases, administrative law judges reversed the decision. The process took nearly a year, during which time they, and their families, were deprived of promised help.

About 340,000 people would lose their insurance before public outcry and courts halted the process. Sen. John Heinz, a liberal Republican from Pennsylvania, told the New York Times the policy was a “meat grinder.” Sen. Carl Levin, Michigan Democrat, said the reviews caused “unconscionable suffering.” In June 1983 HHS Secretary Margaret Heckler announced she would halt suspending about 135,000 people until the government could improve standards for “functional psychotic disorders.”

By then, however, the nation was doubting the president’s kindness. A1982 Louis Harris survey found nearly three-quarters of the respondents said the president was hard-hearted toward the poor.

These are the facts. And they add up to a roll-back of opportunities for people already struggling with a psychiatric illness.  Whatever spin accompanies the birthday celebrations for Ronald Reagan, we should not create yet another mythic figure, larger than life, more pure than Ivory soap, or with qualities he did not have.  He may have portrayed himself as everybody’s lifeguard, but he seemed willing to let people with a psychiatric illness sink.

Originally appeared in MIWatch.org

2009 federal poverty levels have been extended until May 31, 2010 – thank goodness for now. But, given the poor economy the levels may drop and more people could loose their benefits because of it.
It’s all explained in this most recent article from the U.S. Department of Health and Human Services below.

Extension of the 2009 Poverty Guidelines Until at Least May 31, 2010

[ Federal Register Notice, January 22, 2010, (initial extension of guidelines until March 1) — Full text ]
[ Prior Poverty Guidelines and Federal Register References Since 1982 ]
[ Frequently Asked Questions (FAQs) ]
[ Further Resources on Poverty Measurement, Poverty Lines, and Their History ]

Congress has taken action to keep the 2009 poverty guidelines in effect until at least May 31, 2010.

Congressional actions on this matter have been in response to a decrease in the annual average Consumer Price Index (CPI-U) for 2009, projected during 2009 and announced on January 15, 2010 (see http://www.bls.gov/news.release/archives/cpi_01152010.pdf, Table 1A).  In the absence of legislative change, this decrease — the first since the poverty guidelines began to be issued in 1965 — would have required HHS to issue 2010 poverty guidelines that were lower than the 2009 poverty guidelines; that would have led to the “reduction in eligibility” referred to in the Congressional explanatory language quoted below.  Congress took several actions on this matter:

1.  On December 19, 2009, the Congress enacted and the President signed the Department of Defense Appropriations Act, 2010 (Pub. L. 111-118), which included a provision affecting the poverty guidelines.  Section 1012 of this law (as originally enacted, before subsequent amendment) stated that:

Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not publish updated poverty guidelines for 2010 under section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2)) before March 1, 2010, and the poverty guidelines published under such section on January 23, 2009, shall remain in effect until updated poverty guidelines are published.

The Congressional Record (House) (December 16, 2009, p. H15370) provided the following explanation of this Congressional action in Pub. L. 111-118:

Section 1012 includes a provision to freeze the Department of Health and Human Services poverty guidelines at 2009 levels in order to prevent a reduction in eligibility for certain means-tested programs, including Medicaid, Supplemental Nutrition Assistance Program (SNAP), and child nutrition, through March 1, 2010.

A Federal Register notice about this initial extension of the 2009 poverty guidelines was published on January 22, 2010. (See Federal Register, Vol. 75, No. 14, January 22, 2010, pp. 3734-3735.)

2.  On March 2, 2010, the Congress enacted and the President signed the Temporary Extension Act of 2010 (Pub. L. 111-144), which included a provision affecting the poverty guidelines.  Section 7 of this law amended Section 1012 of the Department of Defense Appropriations Act, 2010, by replacing “March 1, 2010” with “March 31, 2010”.  The effect of this was to extend the 2009 poverty guidelines until at least March 31, 2010.

3.  On April 15, 2010, the Congress enacted and the President signed the Continuing Extension Act of 2010 (Pub. L. 111-157), which included a provision affecting the poverty guidelines.  Section 6 of this law amended Section 1012 of the Department of Defense Appropriations Act, 2010 (as amended by Pub. L. 111-144), by replacing “March 31, 2010” with “May 31, 2010”.  The effect of this was to extend the 2009 poverty guidelines until at least May 31, 2010.

We will provide updated information about the post-May-31 period when it becomes available.

The 2009 poverty guidelines figures that will remain in effect are given below.

NOTE:  The poverty guideline figures below are NOT the figures the Census Bureau uses to calculate the number of poor persons.
The figures that the Census Bureau uses are the poverty thresholds.

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia
Persons in family	Poverty guideline
1	$10,830
2	14,570
3	18,310
4	22,050
5	25,790
6	29,530
7	33,270
8	37,010
For families with more than 8 persons, add $3,740 for each additional person.

2009 Poverty Guidelines for Alaska
Persons in family	Poverty guideline
1	$13,530
2	18,210
3	22,890
4	27,570
5	32,250
6	36,930
7	41,610
8	46,290
For families with more than 8 persons, add $4,680 for each additional person.

2009 Poverty Guidelines for Hawaii
Persons in family	Poverty guideline
1	$12,460
2	16,760
3	21,060
4	25,360
5	29,660
6	33,960
7	38,260
8	42,560
For families with more than 8 persons, add $4,300 for each additional person.

SOURCE: Federal Register, Vol. 74, No. 14, January 23, 2009, pp. 4199–4201

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Go to Further Resources on Poverty Measurement, Poverty Lines, and Their History

Go to Frequently Asked Questions (FAQs).

Return to the main Poverty Guidelines, Research, and Measurement page.

Last Revised:  04/19/10

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After attending the forum hosted by the Community Partnership of Southern Arizona last week I am no less concerned about what is going to happen to the covered benefits for the huge population of adults with serious mental illness that do not qualify for the state’s Medicaid system (AHCCCS) after July 1st.  The Assistant Deputy Director from the Arizona Health Services Division of Behavioral Health Services explained some of the impact the cuts would have and offered a few suggestions on how the impacts might be minimized.

“Thinking outside the box” was a phrase heard repeatedly and for many attending that answer was not enough to calm their fears. For a population accustomed to difficulties  finding appropriate mental health care that particular phrase has become a mantra.

One question about how the non-title XIX residents will be covered if they are currently in the Arizona State Hospital was never answered.

Of major concern to me is the misguided thought by some in Phoenix that people that are currently taking some of the more expensive, newer anti-psychotics, mood stabilizers and anti-depressants  can now be administered some of the older, less expensive drugs to save money.  What he forgot to say when talking about the older, less expensive medications is that they don’t work for some people.  Hence the reason for being prescribed the newer, more effective medications. Plus, the newer medications don’t have some of the debilitating side effects  that the older medications cause.  (Although, I must admit all of these medications do have some sort of negative side effect)

Even when a certain medication is successfully treating some of the symptoms today,  next week, next month or next year it may loose it’s efficacy and a new medication will need to be introduced; most likely a newer drug.

The state’s crisis system which had up until recently seen some positive advances is now experiencing limited funding as well.   It was suggested at the meeting that family members “step up” to the plate and do what they can to cover the shortages like manning all night crisis phone lines, etc.  on a volunteer basis.  Hum…….I guess that might work if their loved one isn’t in a crisis because their newly prescribed medication is working!