At the Ohio Department of Mental Health, Christy Murphy's days are filled with calls from people seeking help she can't seem to give.
They plead with her, but budget cuts have trimmed services so much that she is not sure where to send them.
The desperation on the other end of the line hits painfully close to home for Murphy. Her 19-year-old son, Christopher, suffers from a range of mental problems, including one that's linked to a short-tempered, hostile attitude. Although he has coverage through Medicaid, he can't get the services he needs. His mother says he has no psychiatrist, no case manager and no medication.
"I think it's 100 percent about money," said Murphy, who lives in Columbus with her son.
An onslaught of budget cuts has hit mental health services in states struggling to weather economic woes. Even in better times, help could be hard to find. Now, just as demand is soaring, billions of dollars in cuts have shuttered facilities, prolonged waiting times to get services and purged countless patients from the rolls.
"We're getting some epidemic-proportion demands for services," said Mary Ruiz, chief executive at the Manatee Glens mental health facility in Bradenton, Fla., which has had to cut charity care for the indigent by $2 million a year.
State mental health funding was on a steady upward trajectory for three decades until the Great Recession hit in 2007. Over the last two fiscal years, states have cut a combined $1.8 billion from the public mental health system, according to a recent report by the National Alliance for Mental Illness, an advocacy group that tracks mental health spending in all 50 states.
All of this comes as experts see the dueling economic stresses of job losses and home foreclosures escalating depression, anxiety and suicide. Nine state mental health agencies have reported increased emergency-room visits for psychiatric care since the recession began, and five more reported higher suicide rates, the state mental health association reported.
The cuts have hit every aspect of state behavioral health systems, which served 6.4 million people nationwide in 2009, according to the most current federal government statistics. Only four states made no cuts to mental health services between fiscal 2009 and the fiscal year that will end in 2012, according to the National Association of State Mental Health Program Directors. As states face the end of federal stimulus spending, mental health advocates expect the situation to get much worse this year and next.
"I'm begging for help. Begging. And there's no one who can help me," said Sandra Roskilly of Denver, whose 15-year-old son Gregory left the Colorado Mental Health Institute at Fort Logan when its children's ward was shuttered last year due to budget cuts.
Roskilly's son has returned home, where his grandmother has moved in to help care for him. But she worries the boy is getting worse without residential treatment, sometimes breaking furniture and shoving his grandmother. She wonders aloud if he might pose a threat to others without the proper care.
"What's going to happen when he kills somebody?" she remembers asking a doctor.
Mental health advocates often say every dollar cut from their budgets ends up being spent elsewhere, particularly in prisons. In some instances, violent crimes involving the mentally ill have raised new questions about the risks of funding cuts.
An Idaho man released from a state mental health program faces felony charges after a shooting last year that wounded a man walking out of a coffee shop. Emergency room nurses from Ohio to Vermont have reported being attacked by patients seeking psychiatric services in recent years.
In Arizona, 22-year-old Jared Loughner caught the attention of staff and administrators at his community college and was told he could not return until he had been evaluated by a mental health professional. There is no indication the man who is charged in the attempted assassination of Rep. Gabrielle Giffords and shot six others to death ever sought such services.
Arizona Gov. Jan Brewer, whose adult son is mentally ill, took office in January 2009 as an advocate for mental health and persuaded lawmakers to restore $18 million in proposed midyear budget cuts to social programs, including behavioral health.
But two years later, tough times have led Brewer to call for dropping 280,000 people from Medicaid coverage, including an estimated 5,000 adults with serious mental illnesses. Over the past two years, Arizona cut counseling, case management and virtually all other services except medication for an estimated 14,000 mentally ill patients.
More than half the states surveyed by the state mental health association have cut staff at state mental health agencies and reduced funding for community mental health services. Of those, almost half closed state mental hospitals or wards. Nationwide, states closed 2,158 beds for mentally ill patients over the last three years, and another 1,772 beds may be closed next year to meet budget cuts, the organization says.
In Colorado, staffing at state mental health hospitals is so short that the state no longer complies with federal Medicaid and Medicare funding rules, putting some $14 million at risk for next fiscal year.
Colorado lawmakers responded by adding enough money to hire five nurses at two mental-health hospitals. Budget writers said they would have liked to add twice as many nurses, but the money was not available.
"They are so severely understaffed it has become a serious safety issue for patients and caregivers," Colorado state Sen. Mary Hodge said.
Texas ranks near the bottom in per-capita mental health spending, one of nine states that spend $66 or less per person, and officials there have proposed cutting an additional $134 million in mental health services in the 2012 and 2013 fiscal years.
Those cuts could mean immediately halting behavioral health services for thousands, even though Texas sheriffs have complained the cuts would mean more mentally unstable people ending up in county jails.
"Mental health is right down there at the bottom of the priority list, it seems," said Colleen Horton, policy program director for the Hogg Foundation at the University of Texas-Austin, which advocates for mental health services in that state.
In Ohio, funding for state mental health programs was reduced in the current budget from about $1.1 billion to just over $900 million. A separate agency that specializes in combatting alcohol and drug addiction had its budget cut by 30 percent.
Dick Paterson of Brunswick Hills, Ohio, grows emotional when he talks of the effects of cuts in Ohio. His 39-year-old son suffers from schizoaffective disorder and has lived a life marked by hospitalizations and imprisonments, relapses and stabilizations, violent outbursts and suicide attempts.
Three years ago, Paterson and his wife Marlene found their son a place at a mental health facility operated out of a townhouse about 100 miles away. The staff has kept him on his medication, away from other drugs and in the best state he's been in years.
The Patersons worry the facility could be the target of further budget cuts. They don't know where their son would go if that happened.
"I don't know what price tag you put on a human soul," Dick Paterson said.