Funding cuts and legal disputes have severely undermined Pennsylvania’s initiative to close state psychiatric hospitals and transition care to community-based programs. This shift was intended to fulfill the state’s legal commitment to individuals with severe mental illnesses but has instead led to a regression in support services, according to an investigation by Spotlight PA.
Established over three decades ago, the Community Hospital Integration Project Program (CHIPP) aimed to divert funds from state-run psychiatric facilities to more flexible community care options. The initiative was designed to eliminate the reliance on restrictive hospital environments and to foster a sustainable care model for both current and future generations. Former officials, including Sherry Snyder, who served in the Office of Mental Health and Substance Abuse Services, emphasized that while CHIPP was never meant to be the sole source of funding, it was crucial for building a robust community care system.
Despite initial successes in the first decade, when the state closed three psychiatric hospitals and significantly increased funding for community initiatives, the trend shifted after 2015. The state halted the closure of vacant hospital beds, undermining CHIPP’s stated objective of reducing the need for institutional care. Alongside this stagnation, funding for community-based services experienced a dramatic decline.
Recent reports indicate that the state allocated more than $175 million toward expanding psychiatric resources for individuals charged with crimes, a shift driven by two settlements with the American Civil Liberties Union (ACLU) regarding unconstitutional wait times for treatment. According to Brandon Cwalina, a spokesperson for the Department of Human Services, this increased funding is not a matter of priority but a fulfillment of statutory obligations.
The consequences of these funding shifts are evident in the state’s mental health system. A recent study corroborated the findings of Spotlight PA, revealing that the competency restoration system disproportionately impacts individuals facing low-level offenses, often stemming from mental health crises. Alarmingly, more than one in four state hospital patients are now there due to criminal charges, highlighting a troubling pivot toward more restrictive care.
When Pennsylvania launched CHIPP in 1991, the aim was to ensure that funds from closed psychiatric facilities would continue to support mental health services. This was intended to facilitate the creation of community-based services that could adequately replace the institutional model. The successful closure of multiple hospitals in the early years of CHIPP resulted in a reduction of nearly 1,500 beds and a significant increase in funding for county-level services.
This progress began to falter in 2012, when then-Governor Tom Corbett proposed substantial cuts to mental health programs, including a $9 million reduction from CHIPP. The budget cuts sparked immediate concerns among stakeholders about the sustainability of community services. Snyder described the impact of these cuts as a “foundation falling out,” indicating widespread fear among mental health advocates and officials regarding the future of community care.
As a result of these funding reductions, counties became increasingly reluctant to accept state dollars, fearing instability in future funding. The shift in funding priorities has made it challenging for counties to provide adequate support for individuals with complex mental health needs, leading to a troubling cycle of fewer resources and increased reliance on institutional care.
The situation has worsened in recent years, with law enforcement increasingly arresting individuals with serious mental health issues. These individuals often find themselves trapped in a legal system ill-equipped to address their needs. In Pennsylvania, judges can order competency restoration treatment for those who cannot participate in their own defense. However, this treatment primarily aims to prepare individuals for prosecution rather than provide comprehensive mental health care.
In 2015, the ACLU filed a class-action lawsuit against Pennsylvania, arguing that the state was violating individuals’ rights by allowing them to deteriorate in jail while waiting for treatment. Following a quick settlement, the state allocated an additional $8 million to community services in an effort to alleviate the burden on jails.
Despite this progress, the structural issues within the mental health system remain unresolved. A year and a half after the settlement, the ACLU reported little improvement, as the number of individuals entering jails continued to rise. By 2019, the state began converting civil hospital beds to forensic beds for individuals who had received competency restoration, further complicating the landscape of mental health care.
Currently, forensic beds account for a growing percentage of the patient population in state psychiatric hospitals. In 2006, only 9% of patients were in forensic beds; today, that figure has tripled. This shift has not provided a viable alternative to treatment but rather exacerbated the punitive aspects of the mental health system.
Advocates, including Jerri Clark from the Treatment Advocacy Center, argue that resources have increasingly been directed toward legal adjudication rather than effective treatment for mental health issues. Since 2020, Pennsylvania has invested over $30 million annually in forensic projects, while funding for traditional community programs has dwindled to under $2 million per year.
The Department of Human Services insists that it encourages counties to invest in programs that benefit both individuals facing criminal charges and those not entangled in the justice system. Nonetheless, a review of county proposals revealed a focus on programs that cater primarily to those already involved in legal proceedings.
In light of these developments, the future of mental health care in Pennsylvania remains precarious. As funding for community-based services continues to decline, the state faces mounting pressure to address the systemic issues that have led to a reliance on restrictive psychiatric care, ultimately jeopardizing the well-being of vulnerable populations.
