Short on cash, but not demand, Pa. counties press for mental health funding hikes

When the mental health crisis hit a new peak during the COVID-19 pandemic, inpatient psychiatric care beds sat empty in Dauphin County. 

It’s not that there wasn’t an urgent need for immediate care — there simply wasn’t enough staff to maintain the center at full capacity, according to Andrea Kepler, administrator of Dauphin County Mental Health/Autism/Developmental Programs. 

The empty beds are a symbol of strains on county mental health systems around Pennsylvania that county commissioners say are due to a lack of proper funding.

Kepler told the story on May 31 during a news conference in the state Capitol rotunda, as part of an effort to increase funding for county mental health resources in the 2023-24 state budget.

There’s still one treatment center in Dauphin County with beds offline, but it’s expected to be fully staffed on July 1. 

“How, I’m not sure, because they have not made dramatic progress with hiring,” Kepler told the Capital-Star. 

Staffing is hard for county-run operations because they can’t offer the wages that private practices can, Kepler said. 

Counties set a billable reimbursement rate for mental health professionals, such as social workers and clinicians, who record the hours they work and charge the county. When the county pays professionals, the agency that the professional works for takes a cut of the funds. 

Miranda Jenkins has been a social worker for 14 years, the last five in schools, and previously worked for a Pennsylvania county under the billable reimbursement model. Jenkins said she wasn’t making a livable wage. 

In private practice, mental health professionals work directly with insurance agencies, cutting out what Jenkins dubbed “the middle man.” 

Currently, Pennsylvania counties are responsible for Mental Health and Developmental Services, typically used as a referral source to local provider agencies under contract. 

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Mental Health and Developmental Services work with individuals to determine their eligibility for funding, the need for treatment and which program is the best fit, according to the Pennsylvania Department of Human Services website.

Mental Health and Developmental Services in Dauphin County include programs for those with autism and developmental disabilities, crisis intervention and early intervention. 

Counties must provide community mental health services under the state’s Mental Health and Mental Retardation Act of 1966. This includes inpatient treatment, hospitalization, outpatient care, vocational rehabilitation and residential arrangements. 

While the COVID-19 pandemic caused a 25% increase in anxiety and depression according to the World Health Organization, Kepler says the increase in patients is not over. 

‘We’re in a crisis’

In a 2022 report by Mental Health America, a community-based nonprofit dedicated to mental health awareness, Pennsylvania placed eighth on the list of states with the best access to mental health services. 

The research was conducted through a national survey with help from the Centers for Disease Control and Prevention, the U.S. Department of Education and the U.S. Substance Abuse and Mental Health Services Administration. 

The report also showed that Pennsylvania had a lower prevalence of mental illness than 44 other states.

Still, the level of funding provided to counties by the state is not enough, the County Commissioners Association of Pennsylvania said. 

“We’re in a crisis and it’s getting worse,” Kepler said. “I think we will continue to see a tremendous demand in children’s needs for the foreseeable future.”

Commissioners are seeking an investment of $150 million to the county mental health base for fiscal year 2023-24, in addition to the allocation of $100 million from the American Rescue Plan for adult mental health.

Providing extra funding would allow counties to offer competitive pay rates, and have a larger presence in hospitals to help facilitate voluntary admissions into inpatient treatment, Kepler said.

Kepler said that the lack of county presence in emergency rooms puts a larger burden on hospitals, because they need to find staff to facilitate paperwork, engage the family and individual and keep them at the hospital for a longer period of time.

Lack of county-level funding also puts increased stress on county jails, County Commissioners Association of Pennsylvania President Chip Abramovic said. 

“When I started, 40% of our jail might have been mental health patients, and now 80-90% are mental health patients,” Abramovic, a Venango County commissioner, told the Capital-Star. “COs [correctional officers] aren’t trained in mental health. People need to get help, not just be locked up.”  

From Abromovic’s perspective, county mental health services are only running because of massive efforts across county services. 

“It’s taking a penny and stretching it to a dollar,” he said.  

On May 4, the House Human Services Committee approved legislation sponsored by Rep. Mike Schlossberg D-Lehigh, to spend the $100 million in one-time federal American Rescue Plan  money on mental health, split between workforce development, the criminal justice system and public safety systems, expansion of access and service delivery and evaluation of the impact of the appropriation. 

Democratic Gov. Josh Shapiro included a $20 million increase to the base funding for the fiscal year that starts July 1 in his proposed $44.4 billion budget plan, as well as $500 million over five years to increase mental health support for students. 

For the counties, Shapiro’s plan allocates up to $60 million for county mental health services by 2027-28. 

Commissioners say it’s not enough to avoid a complete collapse of the county mental health system, calling for a $50 million total in base funding, and redirecting the money for student mental health support to county mental health support.

“We absolutely agree that we need to take the steps to support the mental health of our children and youth in Pennsylvania, but as counties, we are simply asking the General Assembly and the current administration to recognize the needs of our children,” George Hartwick, a Dauphin County Commissioner and chair of CCAP’s Human Services Committee said at the Capitol.

 “After all, the care a student receives during the other 16 hours of the day, during the holidays, or when they begin their summer breaks in just a few short weeks is just as vital,” Hartwick said. 

Karla Coffman, who’s been a certified school nurse for four years, said that schools desperately need the funding provided in Shapiro’s plan. 

“Every day we see the severe mental health conditions that our students are dealing with, and it affects their ability to learn,” Coffman said. “We’re the ones that see the students, and we’re the ones that should have the control and the power over the mental health resources that go to students.” 

Coffman said that students in mental health crises come into her office every day. Students having panic attacks or experiencing suicidal ideation know that her office is a safe space, Coffman said.

Jenkins works in the same district as Coffman, and agrees that school funding should be a priority, but as a social worker, she also sees the county side. 

“There are so many young people that need access to services and wait lists and availability just keep getting longer and longer,” Jenkins said. “A lot of these expectations are falling back on the schools, and from a county perspective I would love to see more providers, shorter wait lists and easy access to services.”

Jenkins said that for one-on-one mental health services, wait lists are eight months long, and children sometimes present to the emergency room four times before being accepted to inpatient. 

If schools get an increase in mental-health funds, Jenkins said the need for county-based services could be avoided. 

“By providing money to schools, we come from a sense of prevention versus county-based intervention,” Jenkins said. “Schools have the opportunity to be creative in prevention plans, and it would be awesome to be afforded the opportunity to be in control of funding and make it unique to barriers that we work with.”