The state of Pennsylvania’s initiative to close psychiatric hospitals and transition care to community-based programs has faced significant setbacks due to funding cuts, legal challenges, and operational changes. An investigation by Spotlight PA reveals that the Community Hospital Integration Project Program (CHIPP), designed over three decades ago to facilitate this transition, has not only stalled but has also reversed progress made toward more effective mental health treatment.
CHIPP, established in 1991, aimed to divert resources from state-run psychiatric facilities to community-based care. The expectation was that savings from hospital closures would be reinvested into local mental health services. Former officials, including Sherry Snyder of the Office of Mental Health and Substance Abuse Services, emphasized that the funding was intended to be a long-term commitment—not merely a temporary solution. “It was supposed to be like the mortar between the bricks,” Snyder stated, highlighting the program’s foundational role in mental health care.
Despite initial successes, including the closure of three hospitals by 2005 and substantial investment in community resources, the state’s approach shifted significantly beginning in 2015. The closure of hospital beds came to a halt, and funding for community care slowed dramatically. Over the past decade, the state has allocated more than $175 million primarily for expanding resources aimed at individuals involved in the justice system, rather than supporting community-based care for those with mental health issues.
This transition has raised concerns about the adequacy of mental health support for vulnerable populations. According to a recent analysis by Spotlight PA, more than one in four patients in state hospitals are currently there due to criminal charges, often stemming from mental health crises. The system has become increasingly reliant on incarceration instead of treatment, a trend criticized by mental health advocates.
The shift in focus has put Pennsylvania at odds with its commitments under the Olmstead v. L.C. U.S. Supreme Court decision, which mandated community care for individuals with mental illnesses. In response to a letter from Spotlight PA, a spokesperson for the Department of Human Services, Brandon Cwalina, defended the state’s actions, stating that the increased spending on competency restoration is a legal obligation rather than a prioritization of resources.
As part of the ongoing legal landscape, the ACLU of Pennsylvania has taken action against the state for failing to provide adequate mental health care. A class-action lawsuit filed in 2015 resulted in settlements requiring the state to improve treatment access for individuals unable to stand trial due to mental health issues. This led to the establishment of additional community care spots, but as reports indicate, the overall investment in community resources has not kept pace with the rising demand.
Historically, Pennsylvania was on a proactive path to reduce reliance on institutional care. Under former administrations, including that of Gov. Tom Corbett, the state made significant strides in closing psychiatric facilities. However, Corbett’s budget cuts in 2012, which slashed $44 million from community mental health programs, marked a turning point. Snyder recalled the profound impact of these cuts, stating, “It felt like a foundation was falling out.”
Since then, the rate of hospital closures has slowed considerably. Between 2003 and 2013, the civil patient population in state hospitals decreased by approximately 42%. However, from 2013 to 2023, this decline was only about 25%. The consequence of fewer closures has been the erosion of community resources, as counties have become increasingly hesitant to rely on state funding.
In recent years, the focus on forensic mental health care has intensified, with the state converting civil beds in psychiatric hospitals to forensic step-down beds for individuals undergoing competency restoration. This has led to a significant increase in the population of individuals in state hospitals due to legal entanglements rather than genuine health needs.
A concerning trend has emerged where funding for forensic projects has surged, exceeding $30 million annually, while traditional funding for CHIPP has dwindled to under $2 million per year. This shift indicates a prioritization of legal adjudication over community-based treatment, a concern voiced by advocates like Jerri Clark of the Treatment Advocacy Center. She argues that the punitive nature of forensic beds does not constitute an effective solution for individuals with mental health issues.
As the state grapples with these challenges, the future of mental health care in Pennsylvania remains uncertain. The need for a balanced approach that prioritizes both community support and legal responsibilities is more critical than ever. Without substantial investment and commitment to the principles of community care, the most vulnerable populations may continue to fall through the cracks.
