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The Impact of an Economic Recession on the Delivery of Mental Health Services
This study is a multi-dimensional look at how the economic crisis affects the delivery of mental health services from the perspectives of providers, consumers, and agencies. Because of the mult-dimensional perspective, the study is comprised of four sub-studies.
Study #1: Impact of the Recession on Community Mental Health Provider Organizations

This study will document things that have happened to providers’ operations in this era of budget cuts, what their strategies have been in response, and what they think will occur in the future. Part of the instrumentation will mirror the approach used in the “Mental Health Act of 1988” study, regarding perceptions of threats/opportunities and how these perceptions predict future actions.

Basic questions include:

  1. How have provider agencies been impacted by the recession/budget cuts in a number of areas: budget reductions, staff layoffs, other cutbacks, service provision differences, perceived impacts on consumers, access differences, waiting lists, restructuring, agency reengineering, etc? What has happened already and what do they think will happen in the future?
  2. What strategies have agencies used to respond to budget cuts? Have there been any positive changes, coping strategies, and new ways of doing business?
  3. Similar to the approach used in the “Impact of the Mental Health Act of 1988” study, what are the perceptions of agencies regarding threats and opportunities, and how do these perceptions predict agency behaviors and actions?
  4. How do all of these variables change over time as the recession either deepens or abates?

Significance/Policy Application Potential:

  1. Deeper understanding of recession impacts on providers.
  2. Information to use in advocacy efforts on behalf of the mental health system.

Phase 2 survey

Study #2: A Longitudinal Perspective on Service Patterns

This study will document changes that have taken place in patterns of service delivery in the community as budget cuts, and the recession, have gotten deeper. It will also look at whether changes have differentially affected different age or racial groups or geographical areas.

Basic questions:

  1. Have patterns of mental health services utilization across the state changed over time? If so, in what ways have they changed?
  2. What differences in service patterns have occurred across the state for various service population groups (e.g., early childhood, school-age, youth, transition age, adults, older adults; and minorities)?
  3. Have patterns of mental health services changed in various geographic areas of Ohio?

Significance/Policy application potential:

  1. Provide information about the extent to which budget cuts have affected the capacity of mental health system to deliver essential services.
  2. Provide information to complement results from utilization reviews.

Report of Findings: An Investigation into the Impact of Ohio's Economic Downturn on Service Use
This report provides a contextual overview study data and presents results of baseline analyses of several explanatory variables associated with duration, the selected indicator of service patterns over time.

Executive Summary: Longitudinal Study of Change in Service Patterns
A two-page summary of report highlights.

Graphic of Study 2 Design
A visual respresentation of the study's Interrupted Time Series Panel Design.

Study #3: Consumer & Family Perceptions of Economic Recession

This study will document the perceptions of consumers and family members about whether changes have occurred in their access to services, service patterns, or relationship with their provider, as well as the nature of those changes. The impact on special consumer programs will also be assessed.

Basic questions:

  1. What are consumers’ and family members’ perceptions of the impact of the budget reductions? To what extent are consumers and family members aware of the impacts of the budget reductions?
  2. Has access to mental health and other services (including health services) changed in the last year? (More specific questions will be developed about access to key services, including medications, case management, counseling, etc, and about potential effects on cultural competence aspects of service delivery and on journeys toward recovery/resiliency.)
  3. Have the budget cuts affected or changed consumers’/family members’ relationship with providers? If so, in what ways?
  4. What has been the impact of the budget reductions on Consumer Operated Services and Peer Support services?
  5. What has been the impact of the budget reductions on consumer and family advocacy groups & programs?
  6. How would consumers prefer services be modified to accommodate a smaller budget?

Significance/Policy application potential:

  1. Gain better idea of system-level issues important to consumers and family members.
  2. Identify system-level issues important to monitor over time.

Phase 2 survey

Study #4: Macro Impacts on the Mental Health System

This study will assess the impacts of a variety of factors, which are outside the mental health system, on the mental health system’s customer population and operations. Factors to be considered are Medicaid growth and penetration, Board levies, property tax valuations and policy changes, among others.

Basic Questions:

Baseline Questions:

  1. What are the growth rates and penetration rates of Mental Health (MH) consumers, total Medicaid enrollees for the State of Ohio, and the unemployment rate for a base period starting in January 2002 and ending in June 2008?
  2. For MH consumers and Medicaid enrollees, what is growth rate by sub-funding programs, e.g., Aged, Blind, and Disabled (ABD) and ADC kids for the defined base period?
  3. How does the growth pattern of MH consumer counts compare to the growth pattern of total Medicaid enrollees and unemployment for the base period?
  4. How many boards had levies in CY 2002 and how much potential revenue were these levies expected to raise within the board area?
  5. What types of levies did boards pass between CY 2002 and CY 2008 and what was the pass/fail rate for levies for the baseline period?
  6. How is assessed real property valuation changing in the board areas between CY 2002 and CY 2008?
  7. For FY 2009, what economic or financial barriers and facilitators did MH boards list in their Community Plans?
  8. Between FY 2002 and FY 2008, what state policies (e.g., Medicaid, tax) have been enacted that impact an MH board’s financial capacity?

Longitudinal Questions:

  1. How do the growth patterns and penetration rates for MH consumers, total Medicaid enrollees, and unemployment in FY 2009 and FY 2010 compare to the baseline pattern?
  2. How do the MH consumer growth rates for FY 2009 and FY 2010 compare to the growth rates for Medicaid enrollees and unemployment?
  3. How many boards place a levy on the ballot for 2009 and 2010 and how much revenue is expected to be raised by the levies?
  4. What types of levies are placed on the ballot for 2009 and 2010 and what were the pass/fail rates for each year?
  5. How is assessed real property valuation changing in the board areas in 2009 and 2010 and how do these changes compare to the baseline period?
  6. For FY 2010, what economic or financial barriers and facilitators did MH boards list in their Community Plans and how do these listed barriers/facilitators compare to those listed for FY 2009?
  7. What significant state policy changes that were implemented in FY 2009 and FY 2010 affect the MH boards’ fiscal capacity?
  8. How do MH boards perceive the expansion/contraction of Medicaid enrollees and unemployment as affecting the MH board’s fiscal capacity?
  9. What services have MH boards curtailed due to state budget cuts?
  10. What is the ability of a local MH board to pass levies in the future?
  11. What flexible funding arrangements have the MH boards used and will they be potentially using to lessen the financial impact of the economic downturn on capacity to maintain and expand service levels?
  12. How have economic conditions affected MH service delivery in other Great Lake States (Indiana, Illinois, Michigan, Minnesota, and Wisconsin)
  13. How have the other Great Lake States leveraged federal and local dollars to lessen the impact?
  14. What tools do other Great Lake States use to project MH consumer demand for services?

Significance/Policy Application Potential:

  1. Gain a better understanding of state policy and economic impacts on the System.
  2. Possibly gain more knowledge about potential flexible funding and leverage arrangements used by MH boards and other states.
  3. Identify external variables that affect the MH System’s ability to sustain and expand fiscal capacity.
  4. Develop tools that can be used by the Office of Fiscal Administration and other stakeholders to predict MH consumer demand for services. Research Results link Bulletins: Bulletin 1: Delinquent Property Taxes Bulletin 1.pdf In Calendar Year (CY) 2007, the overall state-wide delinquent property (uncollected) taxes for mental health levies amounted to $24.7 million.