Pennsylvania’s Shift in Mental Health Care Faces Severe Backlash

Funding cuts and legal challenges have severely disrupted Pennsylvania’s initiative to close state psychiatric hospitals and transition to community-based care for individuals with severe mental illness. An investigation by Spotlight PA reveals that this strategy, established over 30 years ago through the Community Hospital Integration Project Program (CHIPP), has not only stagnated but has reversed progress in recent years.

Originally designed to divert funding from costly state-run psychiatric institutions to more effective community services, CHIPP aimed to enhance the quality of care for those transitioning out of hospitals. According to former officials, the funds allocated to counties were meant to be a reliable investment in mental health services. Sherry Snyder, a former official in the Office of Mental Health and Substance Abuse Services, noted that CHIPP was intended as “like the mortar between the bricks” of a more comprehensive care system.

Despite initial successes, including the closure of four hospitals that eliminated nearly 1,500 beds, the program’s effectiveness has waned. Since 2015, Pennsylvania has halted closures of most vacant hospital beds, substantially impeding the goal of reducing reliance on state institutions. Concurrently, new funding for community care has significantly diminished, which has led to a troubling trend: the state has invested over $175 million in expanding psychiatric resources primarily for individuals involved in the criminal justice system.

The shift in focus has been influenced by two settlements with the ACLU concerning unconstitutional wait times for “competency restoration” treatments—essential for individuals unable to comprehend their legal situations due to mental illness. Brandon Cwalina, a spokesperson for the Department of Human Services, emphasized that the funding directed toward competency restoration is not simply a priority, but a legal obligation.

A previous investigation by Spotlight PA, in collaboration with the Pittsburgh Institute for Nonprofit Journalism, highlighted that many individuals referred for competency restoration face low-level charges that stem from mental health crises. A recent state-supported study corroborated these findings, indicating that the system disproportionately affects those with minor offenses, often resulting in prolonged hospital stays.

The CHIPP initiative, launched in 1991, was intended to ensure that funds associated with state-run psychiatric care would remain dedicated to mental health services. The program allowed counties to utilize the funding to develop community-based services that extended beyond insurance coverage. Initially, the program saw substantial growth, with grants increasing from $6.5 million to over $100 million by 2001.

However, the momentum began to stall after significant budget cuts were implemented following Gov. Tom Corbett’s fiscal policies in 2012, which slashed $44 million from community mental health spending, including a reduction of approximately $9 million from CHIPP. Snyder expressed her dismay at these cuts, describing them as a “foundation falling out.” The impact was profound, leading to a stalled progress outlined in the Olmstead plan, which aimed to reduce the state hospital system significantly.

Subsequent years saw a decline in the closure of hospital beds, leading to a stagnation in funding for community resources. Between 2003 and 2013, the civil patient population decreased by about 42%, but this decline slowed to 25% from 2013 to 2023. Funding under CHIPP, which had previously exceeded $110 million in the second decade, fell to less than $40 million in the third decade.

As counties became increasingly hesitant to relinquish state hospital beds in exchange for funding, a cycle of distrust emerged. County administrators noted that the funding provided for closing a bed—approximately $125,000—was inadequate to cover the complex needs of patients who remained in the hospitals. Many counties faced the dilemma of choosing between accepting state funds and maintaining hospital beds.

By 2019, the state’s budget requests indicated a troubling trend, with the Department of Human Services seeking funding to support only half of the hospital discharges promised under the Olmstead plan. The lack of investment in community resources led to a rise in arrests of individuals with serious mental health issues, exacerbating a system that had promised to support them.

In cases where individuals could not aid in their defense due to mental illness, Pennsylvania judges could mandate competency restoration treatment. Yet, the state provided this treatment in only two facilities, Torrance and Norristown State Hospitals, with fewer than 300 beds available. The ACLU’s 2015 class-action lawsuit against Pennsylvania argued that allowing individuals to deteriorate in jail constituted a violation of their constitutional rights.

The subsequent settlement led to increased funding for community services and a shift in CHIPP’s flexibility, allowing counties to accept funds without relinquishing hospital beds. Despite these changes, the overall investment in mental health care remained insufficient, and the focus continued to shift toward individuals involved in the criminal justice system rather than those in need of community-based mental health support.

Nationally, advocates have criticized the trend of prioritizing legal adjudication over treatment for mental health issues. In Pennsylvania, the state has allocated over $30 million annually for forensic projects since 2020, while investment in traditional CHIPP spending has dwindled to under $2 million a year.

As the state moves forward, the challenges within Pennsylvania’s mental health care system highlight a critical need for renewed commitment to community-focused solutions that prioritize treatment over incarceration, ensuring that individuals with mental health needs receive the support they deserve.