Due to budget pressures at the local and state levels, gaps in services are growing larger as more Americans are obliged to seek treatment at community care centers, often after waiting for a length of time to be seen. Shortages in available residential services have been mentioned by health care professionals as a major gap in services. This includes housing for chronically ill patients, group quarters, halfway houses and transitional shelters, and other support services.
This has caused spillover of psychiatric emergencies into hospital emergency rooms, which then ties up those emergency rooms. Shortages of key staff, especially psychiatrists, have been reported in Community Tracking Study cities in America, creating longer waiting times, which in some cases means six months. And the psychiatrists who are available are often reluctant to accept uninsured people or people on Medicaid. At the state level there has been a better recognition of the need to increase mental health funding and some states are increasing funding for community-based services.
States like New Jersey, New York and California have pledged funding for medications and services. Utilization management has reduced inpatient length-of-stay and reduced costs by substituting other mental health personnel for psychiatrists and reduced professional remuneration. Community responses to mental health service gaps have been more incremental and narrower in scope but have shown promise in addressing patient needs in the 21st century.
Capacity expansions, new programs aimed at handling the overflow of people and increased coordination of services have taken root, though most the people asked about these changes indicate that these measures still fall short of meeting the amount of need in their communities. Communities such as Cleveland and Syracuse are trying to increase service coordination between agencies and providers to improve quality and stretch limited funding.