Danielle Ohl of Spotlight PA wrote the story.
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Pennsylvania pledged in 2011 that all patients in its state mental health facilities will return home.
It would no longer be necessary to choose between freedom and life-saving medical care because of a major mental illness.
A changed mental health system was promised, where receiving treatment for schizophrenia, bipolar disorder, or depression would be similar to receiving treatment for lupus, cancer, or bronchitis.
Pennsylvania’s ambitious plan served as a road map for completing a federal mandate to create a system that would not imprison people due to a treatable condition.
Hidden in that plan, however, was a stark warning that, should the commonwealth fail, those with severe mental illnesses would face a more bleak future: homelessness, unemployment, relapse, and incarceration.
This prediction, not the promise of care, has become reality in Pennsylvania as a result of 30 years of decisions made by seven governors, hundreds of lawmakers, and innumerable local officials who repeatedly promised to provide better care, failed to do so, and knew what would happen if they didn’t, according to a two-year Spotlight PA investigation.
The following are the main conclusions drawn from the Spotlight PA’s work.
Broken promises
Pennsylvania has been unable to establish a community-based mental health system for almost forty years.
The commonwealth has consistently recognized since the 1980s that community-based care is superior to restrictive, involuntary care for those with severe mental diseases in state-run psychiatric facilities.
Pennsylvania decided to close its remaining state hospitals and redirect the funds that were previously used to maintain them to community-based treatment in response to state and federal civil rights cases.
Three state hospitals in Pennsylvania were successfully closed in the 2000s and the first part of the 2010s. However, since 2011, no other one has been completely closed by the state government.
The resources required to enable community-based care were not supplied at the required levels, even in spite of those earlier closures.
Cut funding
In Pennsylvania, counties are responsible for providing mental health services, but the majority of the funding for these programs is provided by the state.
The goal of this so-called basic financing is to assist counties in developing the community mental health care infrastructure required to assist those who are leaving state hospitals and to continue providing that assistance to those who would have been served by those facilities after they close.
This infrastructure was regularly cited by state officials as being essential to guaranteeing that individuals with severe mental illnesses may obtain resources and care regardless of their insurance coverage or financial situation.
However, because the Great Recession had a negative impact on state revenue, former Governor Tom Corbett implemented budget cuts in 2013, which resulted in the elimination of that financing.
His successor, former Governor Tom Wolf, did not reinstate that cut. The flat financing contributed to additional losses for counties as inflation increased over the past ten years because the same dollars had less purchasing power.
Governor Josh Shapiro increased base funding by $40 million during his first two years in office. His budget for 2026 includes an extra $20 million. However, when combined, these infusions do not restore the Corbett cut or compensate for inflation, even if the most recent one is authorized.
Between 2017 and 2023, county mental health administrations spent almost $150 million less on mental health, according to research by Spotlight PA and the Lehigh Valley Justice Institute. Approximately 85,000 fewer persons have received state-funded mental health treatment over that time.
The court system became one of the only avenues for treatment as access to community care decreased.
Behind bars
Counties have struggled to create a unified, easily accessible health system for those with severe mental illness in the absence of base funding. Pennsylvania has been unable to close more public hospitals without that mechanism.
Jails have stepped in to fill the void left by the advancements of the 2000s and the first part of the 2010s.
According to research by Spotlight PA and LVJI, county jails now house a greater number of inmates with mental health needs, as well as those requirements’ intensity. Suicide and mental health medication rates have also gone up.
However, many who work in the legal system easily acknowledge that it is not appropriate for their needs.
Missed chance
The American Rescue Plan Act provided the state with billions of cash during the COVID-19 pandemic. As more and more people in the state reported mental health problems during the pandemic, the state government allocated $100 million in 2022 to support the adult mental health system, which was already under stress.
A commission that was tasked with researching the mental health system concluded that it was fragmented and stressed, and it offered suggestions on how the one-time financing can effectively fill in the gaps caused by years of underfunding.
However, the funds were diverted to schools for student safety and mental health grants in a last-minute budget agreement between Democrat Shapiro and the Republican-controlled State Senate.
Once more, the promised money was stolen.
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