The Ohio chapter of the National Alliance for the Mentally Ill compares the public system of mental health care in the state to Charles Dickens’ “A Tale of Two Cities.” Just as the story describes a world of inexplicable opposites, the mental health care system in Ohio brims with “gloomy corners and suggestive shadows.”

Although factors contributing to this crisis are complex, the most pressing are the opposite trends of declining state funding and increased demands on treatment providers.

Blair Young, director of development for NAMI Ohio, said Ohio has seen slight increases from the state’s budget for fiscal years 2004 and 2005. Fiscal year 2004, which began July 1, saw a 3.1 percent increase from the previous year, while 2005 only received a 1.7 percent increase.

The budget increases, however, still do not paint a hopeful picture for mental health care in the Buckeye state.

These increases continue a six-year trend of less-than-inflation increases for mental health care.

Young said he believes the increases occurred because the legislature realized how severely under-funded mental health care programs were.

“Budget increases haven’t kept pace with inflation. There is not as much money as there was approximately ten years ago,” said Sam Hibbs, spokesman for the Ohio Department of Mental Health.

“The budget is tight, so until the economy turns around, we have to live within our means,” Hibbs said.

Young said the mental health care system in the United States is in shambles. He said the problem needs to be addressed from a reorganization perspective, which would lead to a system that is consumer and family driven.

“The slight increases have prevented the mental health care system in Ohio from becoming a disaster,” Young said. “Unfortunately at this point in time, services are provided based on the availability and funding, not on the client’s need.”

Eric Poklar, legislative liaison to the Ohio Department of Health, said the department was not cut as much as it could have been. He noted that other agencies “got it worse.”

“We’re certainly working with an eye to increase future funding and our constituency groups are constantly active,” Poklar said.

On the national level, President Bush established the President’s New Freedom Commission on Mental Health in April 2002 as part of his commitment to eliminate inequality for Americans with disabilities.

The President identified three obstacles preventing Americans with mental illnesses from getting the excellent care they deserve: Stigma that surrounds mental illnesses, unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance, and the fragmented mental health service delivery system.

The Commission outlined six major goals that will transform mental health care in America. These goals include Americans understanding that mental health care is essential to overall health, changing the system to be consumer and family driven, eliminating disparities in services, early detection and assessments, excellent care and acceleration of research and increase in the use of technology.

With the promises of the Commission, expectations are high. Once the best provider of mental health services in the country, Ohio is now sliding back into the middle of the pack.

Fortunately, unlike many other states, Ohio is in an excellent position to address the challenge of reform, said Terry Russell, executive director of NAMI Ohio.

“The ingredients are all here – leadership at the state level, some of the country’s most experienced and dedicated mental health professionals and a history of cooperation between the system and the advocates,” Russell said to a NAMI representative.

“The timing is right – everyone has recognized there is a significant problem, and the system has not yet collapsed,” Russell said.