A Spotlight PA investigation found Pennsylvania politicians and local officials broke promises to replace institutionalized care with community options — despite knowing the devastating consequences.
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A photo of a notebook, paper, a cross, and sobriety chips. Nate Smallwood / For Spotlight PA
by Danielle Ohl of Spotlight PA
For the full version of this investigation, please visit:
Sue, Robert, and Jonathan are pseudonyms. Their names and some details have been changed to protect their privacy.
When Sue thinks back on that cold spring morning in 2022, there are things she knows and things she doesn’t.
She knows her son Robert, who has had a serious mental illness for nearly a decade, turned up half-naked at her mother’s house, freezing, and in the throes of psychosis. She doesn’t know where he’d been or how he got there.
She knows she drove him home, tried to get him to take a hot shower, and put on warm, clean clothes. She doesn’t know why he refused.
She knows Robert begged for help getting to the hospital because there was something wrong inside his head. She doesn’t know why, when he saw the ambulance arrive, he went for the knife drawer.
She knows she threw her body across the kitchen island in time to stop her son from ending his life.
She doesn’t know if she made the right decision.
“I just play this over and over in my mind.
Maybe I shouldn’t have taken that knife out of his hand.”
Like no plan at all
By the time Robert was born in the mid-1990s, Pennsylvania had been closing its psychiatric hospitals for decades.
The hospitals provided intensive, publicly supported care for people with mental illnesses that were severe enough to interfere with everyday life.
But by the late 1980s, some had become notorious for violence and abuse. Inside these institutions, even people who did not experience headline-grabbing conditions could languish for months and sometimes years beyond what their treatment required.
Some never left.
Studies following closures at Philadelphia and Woodville State Hospitals showed that patients enjoyed far better lives when receiving care in their communities than while institutionalized.
In 1999, the U.S. Supreme Court affirmed this sentiment in Olmstead v L.C., requiring states to provide people with mental disabilities access to community-based care.
Just over a year later, a group of psychiatric patients sued Pennsylvania to win their promised care.
In his 2005 ruling, appellate Judge Max Rosenn was scathing in his assessment of the commonwealth’s plan to deinstitutionalize the rest of the state hospital system: It amounted to no plan at all.
The state’s cornerstone program for getting patients — and the funding supporting them — out of state hospitals also showed little promise, Rosenn wrote.
Called the Community Hospital Integration Project Program, or CHIPP, it was established in 1991 to preserve the dollars used to run state hospitals for use in the community.
But while it initially identified concrete goals and benchmarks the department “inexplicably” failed to follow through on the steps laid out to reach them, Rosenn wrote.
Rosenn wasn’t convinced and pushed the state to act, not just plan: “General assurances and good-faith intentions neither meet the federal laws nor a patient’s expectations.”
Downward spiral
Slowly, and then all at once, Robert started to change.
He had always been health-conscious, Sue said, but his preferences grew peculiar.
He started avoiding the microwave and eyeing his mother suspiciously when she used it. Robert’s once-diligent grooming regimen began to slip.
His first year of college became stressful when he became a father. Robert was the same age as Sue when she had him.
Then, his cousin Jonathan died.
Jonathan met up with Robert while visiting home during his first semester in college. On his way back that night, Jonathan fell asleep at the wheel and drove off the road. Robert was likely one of the last people to see him alive.
Looking back on the decade that followed, Sue sees this moment as an inflection point in not only her son’s life but her own. As grief and guilt began to unravel her son, navigating Pennsylvania’s disjointed mental health system began to unmoor Sue.
As Robert began to cycle in and out of paranoia and psychotic breaks, the next years of Sue’s life became dominated by unspeakable choices.
Should she help her son, even as he burrowed further into distrust and sent her texts full of bile and accusations? Or should she give up?
Should she let Robert go?
Devastating cuts
Former Gov. Tom Corbett’s 2013 budget was catastrophic for county mental health departments.
The state made progress, closing three state hospitals between 2006 and 2010, but the 2008 economic recession had taken its toll.
State revenue plummeted when the market crashed, and by Corbett’s second year in office, federal stimulus dollars had dried up. Left with state spending in excess of the revenue coming in, and unwilling to raise taxes on state residents, Corbett took a hard-line on spending.
“The 2013 budget decisions, made over a decade ago, reflected the economic realities of that time,” Corbett told Spotlight PA in a statement. “We aimed to balance compassion with fiscal responsibility, and I stand by the tough but necessary decisions we made to steer Pennsylvania through a fiscal crisis.”
Nevertheless, the results were devastating for local mental health systems.
For years, Pennsylvania has required counties to provide mental health services but provided most of the funding to do so. Alongside the money the state sent counties as it closed hospitals, it also provided so-called base dollars. That funding allowed counties to create services for vulnerable people who either do not qualify or are not signed up for medical assistance.
Before the Corbett cuts, that funding flowed through a discrete program alongside funding for other social services. To lessen the blow, the administration offered a block grant that combined the programs, creating one cash infusion counties could use for different needs.
For counties that chose to use the grant, the flexibility provided some help but couldn’t paper over the reduced funding.
But even as voters, frustrated with the austerity of the Corbett administration, selected Democrat Tom Wolf to lead the state, the money did not return.
Gov. Josh Shapiro proposed and the legislature approved a $40 million increase in county base funding in his first two years in office. Shapiro has proposed an additional $20 million in his 2025 budget.
But so far, the infusions have not reversed years of underfunding.
Spotlight PA partnered with the Lehigh Valley Justice Institute to analyze mental health income and expenditure reports from all 67 counties between fiscal years 2017 to 2023, the most recent year available from the Department of Human Services.
The analysis found counties are doing less with less. Between 2017 and 2023, statewide spending on mental health declined by roughly $147 million and mental health services reached fewer people statewide, declining from about 435,000 people served to under 350,000.
A desperate struggle
When Sue grabbed the knife out of Robert’s hand, the kitchen exploded into chaos.
The state trooper dove onto Robert and Sue, yelling and fumbling for his handcuffs. Unable to grab Robert’s wrists, the trooper shackled his bare ankles.
Sue pleaded as Robert writhed underneath her and beat against the trooper, who radioed for backup. The officer pulled his Taser, shocking Robert twice.
But Robert fought on. He managed to get upright, and lunged at Sue, knotting his fingers in her hair.
The three tumbled through the kitchen door, onto the porch. Officers stood on the lawn, weapons drawn.
Sue screamed to the nearby EMTs for help. Police wrestled Robert to the ground, ripping out the chunks of Sue’s curls still tangled in his fingers.
The medics sedated Robert once, then twice. His body went limp, but his eyes fixed on his mother.
Sue watched the responders load her son into the ambulance, Taser prongs still embedded in his back.
Ripped away
Pennsylvania had an opportunity to help its struggling mental health system.
During the COVID-19 pandemic, the state received billions of dollars through the American Rescue Plan Act.
In 2022, the state legislature set aside $100 million to support the adult mental health system that had become strained as more and more state residents reported mental health needs during the pandemic.
A commission tasked with studying the mental health system found it not only stressed and disjointed but increasingly replaced by the justice system.
“The Department of Corrections and county jails have unintentionally become the largest providers of behavioral health services in the Commonwealth,” the commission found.
Spotlight PA’s findings back this up.
PrimeCare, a private contractor that provides health care to 37 jails across Pennsylvania, supplied Spotlight PA and the Lehigh Valley Justice Institute with 10 years of mental health care data.
An analysis by the newsroom and the research group found that of people who jail staff screened for mental health needs, more than 60% needed services while incarcerated.
The state’s local jails have seen an increase both in the number of detainees needing mental health services and the seriousness of their need, even as jail populations have declined.
Between 2014 and 2022, the rate of jailed individuals on suicide watch per 1,000 has more than doubled. In the same period, the percentage of the daily adjusted population on psychiatric medication has increased from under a quarter to roughly 40%.
The mental health commission report recommended directing $23.5 million of the federal pandemic relief funds to the justice system to pay for care for incarcerated people, services for those leaving jails and prisons, diversion programs, and crisis intervention training for police and emergency responders.
The report argued the rest of the $100 million should sustain the mental health workforce, create more services, and integrate the mental and physical health systems.
But in 2023, the first year of Shapiro’s term, the money was diverted at the last minute to support school mental health and safety initiatives, part of a budget deal struck between the Democratic governor and the Republican-run State Senate.
The elusive dollars, once again promised, were ripped away.
Coming soon: Inside the downfall of the state’s CHIPP program
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