Pennsylvania’s Mental Health Care Shift Faces Funding Challenges

Funding cuts and legal challenges have undermined Pennsylvania’s initiative to close state psychiatric hospitals, shifting care to community-based programs. A recent investigation by Spotlight PA reveals that the state’s strategy, designed to support individuals with severe mental illness, has instead led to a system that increasingly relies on institutional care.

The Community Hospital Integration Project Program (CHIPP), established in 1991, aimed to transition patients from restrictive state-run hospitals to more effective community care. The program was envisioned as a way to allocate funds saved from closed hospital beds directly to counties, allowing them to enhance local mental health services. According to Sherry Snyder, a former official in the Office of Mental Health and Substance Abuse Services, this funding was meant to serve as “like the mortar between the bricks” of a robust community care system.

Initially, CHIPP succeeded. Between 1993 and 2003, the state successfully reduced its psychiatric hospital population and closed several facilities, including Woodville and Somerset, resulting in nearly 1,500 fewer beds. Funding through CHIPP grew significantly, reaching over $100 million by 2001. However, following a shift in state policy in 2015, Pennsylvania halted the closure of vacant hospital beds, which was essential to the program’s effectiveness. This decision coincided with a dramatic slowdown in new funding for community care.

In recent years, the state has redirected significant resources—over $175 million—toward expanding psychiatric treatment for individuals charged with crimes. This shift comes after two settlements with the American Civil Liberties Union (ACLU) addressing unconstitutional wait times for “competency restoration” treatment. According to Brandon Cwalina, a spokesperson for the Department of Human Services, the increased spending for competency restoration is a legal obligation rather than a priority.

Despite these claims, a prior investigation by Spotlight PA and the Pittsburgh Institute for Nonprofit Journalism highlighted a troubling trend: many individuals referred for competency restoration face low-level charges often linked to mental health crises. A recent state-backed report corroborates these findings, indicating that the competency system disproportionately affects those with minor offenses, leading to prolonged stays in state hospitals.

The original goal of CHIPP was to ensure that funds earmarked for psychiatric hospital care remained dedicated to mental health services following facility closures. However, as funding cuts began in 2012 under Governor Tom Corbett, the state faced increasing difficulties in fulfilling its commitments. The budget cuts, which included a reduction of approximately $9 million from CHIPP, initiated a cycle of distrust among counties, causing them to hesitate in accepting state funding for community services.

The repercussions of these funding challenges have been severe. The patient population in state hospitals has become more complex, necessitating higher levels of community support. Yet, as counties have received fewer funds, they have been less willing to release state hospital beds for community funding. This has resulted in a lack of adequate resources to care for individuals with severe mental health needs. The funding provided per patient for closing a bed—around $125,000—is insufficient for the comprehensive care required by those remaining in state hospitals.

As of 2019, the Department of Human Services began to request less funding for hospital discharges, reflecting a growing inability to meet the commitments outlined in the Olmstead plan, which aimed to return individuals from state hospital settings to their communities. This shift has led to a significant increase in the number of individuals with mental health issues being incarcerated rather than receiving treatment.

The legal landscape has further complicated matters. Individuals unable to aid in their own defense due to mental illness are often subjected to competency restoration treatment, which is primarily focused on preparing them for trial rather than addressing their mental health needs. As a result, many individuals remain in jails for extended periods, awaiting treatment.

The ACLU lawsuit filed in 2015 highlighted these concerns, claiming that the state was violating due process rights by allowing individuals to deteriorate in jail. Following the settlement, the state allocated additional funds to community services, yet the impact has been minimal. A year and a half after the settlement, the ACLU reported that the situation had not significantly improved, with a growing number of individuals entering jails rather than being discharged to community care.

The current focus on forensic care—treatment intended to restore competency for legal proceedings—has drawn criticism from mental health advocates. Jerri Clark, resource and advocacy manager for the Treatment Advocacy Center, argues that this approach prioritizes punitive measures over effective mental health treatment. Since 2020, Pennsylvania has invested more than $30 million annually in forensic projects, while traditional CHIPP funding has dwindled to less than $2 million per year.

The changing landscape of mental health funding in Pennsylvania raises critical questions about the state’s commitment to providing adequate care for individuals with mental health needs. As funding priorities shift, the implications for community-based care and the treatment of vulnerable populations remain uncertain.