Last year more than 23,000 people received treatment through Hamilton County's community mental health care system.
Voters will decide May 7 on a property tax levy to help provide care for those suffering the most.
"It's something that's a major health issue in our community," says Patrick Tribbe, president of the Hamilton County Community Mental Health Board. "I think Hamilton County has always been a county that takes care of individuals with disabilities."
The proposed 2.74-mill levy would generate $32.8 million a year for the next five years. The levy includes a renewal amount of 2.47 mills and an increase of 0.27 mill.
The current levy costs the owner of a $100,000 house $40 per year. If the renewal and increase pass, the cost will be about $48 per year, an increase of 20 percent.
Left untreated, people with serious mental health problems often end up needing costly hospitalization, Tribbe says.
"Our emphasis is to try and keep individuals in less expensive, less restrictive services," he says.
The Mental Health Board contracts with 49 service providers. Ninety percent of the dollars the board spends goes toward the care of children who are seriously emotionally disturbed or adults who are seriously mentally disabled, according to Tribbe.
"Most of the folks who come into our services are indigent folks," he says.
Many times mental illness has prevented clients from working. Treatment can help them get their lives on track.
"In many cases we have folks that are getting better and going back to work," Tribbe says.
Budget cuts to other agencies have forced the Mental Health Board to increase its spending for children in need. Part of the new tax will help cover those costs and allow for increased efforts.
"We're earmarking a million of that toward additional children's mental health services," Tribbe says.
In many cases, children with mental health needs have multiple problems, such as family problems or drug and alcohol abuse. In some cases, the parents of children who need care have insurance that does not cover the complete cost.
"I think that the services have grown, but also we're seeing kids with a lot deeper needs than we had in the past," Tribbe says.
The county is working on establishing a mental health court for severely disabled persons who commit nonviolent misdemeanors. Caseworkers would try to ensure that those who need medication take it and direct them to treatment, rather than jail.
'Awful twists and turns'
Elliott Ruther, who was diagnosed with manic depression three years ago, has experienced the turmoil that comes with it.
"I've crashed," he says. "I've had to leave jobs before. There's a phenomenal amount of stigma with it, especially when it comes to employment."
Ruther is an aide to Cincinnati City Councilman John Cranley.
"As an employer, when it comes to these issues that I'm dealing with, he's phenomenal," Ruther says.
Ruther thinks mental health has to be part of the discussion of problems facing the inner city.
"Countywide and especially in the city, the ravages of mental illness leave their mark everywhere," he says. "I think this is an ingredient that needs to be included as well."
He believes the fight for civil rights for the mentally ill has benefited from other movements, such as the quest for equal rights for gays and lesbians.
"Breaking down invisible stigmas — I sort of see it as the next phase," Ruther says.
People suffering from mental illness often experience guilt and self-loathing, according to Ruther. He believes a support group helps people work through those emotions.
"There's just awful twists and turns," he says.
Ruther has written songs about his experiences, for a CD to be released soon. He is also organizing a concert of local bands to build support for the mental health levy.
"It's an opportunity for our community to raise awareness on many issues that touch upon all of us," he says.
Breaking down the budget
The Coalition Opposed to Additional Spending and Taxes (COAST) is against the tax levy.
"We have a notoriously poorly managed mental health system in Hamilton County," says Christopher Finney, vice chair of COAST. "Their spending has wildly exceeded the rate of inflation."
But Tribbe says the board's spending is below the rate of inflation for medical services.
Finney chaired the Hamilton County Tax Levy Review Committee in 1998. He says the board's poor fiscal management was evident to him at that time.
"They couldn't even explain their own budget to us — it was that bad," Finney says.
Placing the levy on the May 7 ballot ignores the detailed timeline set forth for review of proposed levies by the tax levy review committee, according to Finney.
"They got approved for this amount with no scrutiny whatsoever," he says. "It's an attempt to snooker the voters."
But Tribbe says Finney's criticism is outdated. In 1998 the Mental Health Board and the Levy Review Committee jointly agreed to make improvements, he says.
"My sense from the committee was that we met or exceeded all of the requirements they asked us to do in 1998," Tribbe says. "It was a 5-0 unanimous vote to support the mental health levy and the increase. We feel we have a very accountable and very effective mental health system in Hamilton County."
The 18 members of the Mental Health Board are volunteers. The paid staff of about 40 must include a medical director. That position is vacant, but requires a psychiatrist to work 30 hours per week for $124,000 per year.
"It really is not out of line for services of a physician," Tribbe says.
Administrative costs consumed 4.5 percent of the board's budget in fiscal year 2002, according to Mental Health Works. Kelly Allen, director of community education for the board, says the budget in fiscal year 2001 was about $71 million. ©