In 2011, Pennsylvania made a promise: Everyone living in a state psychiatric hospital would come home.
No longer would having a serious mental health condition mean choosing between freedom and life-saving health care.
The promise was a transformed mental health system, where getting care for depression, or bipolar disorder, or schizophrenia would be like getting care for bronchitis, or lupus, or cancer.
Pennsylvania’s plan was ambitious, a roadmap to fulfilling a federal requirement to build a system that wouldn’t lock people away because of a treatable illness.
But tucked within that plan was a dire warning against a darker future for people with severe mental illnesses should the commonwealth fail: Homelessness, unemployment, relapse, and incarceration.
A two-year Spotlight PA investigation found this premonition, not the promise of care, has become reality in Pennsylvania — the result of 30 years of choices by seven governors, hundreds of legislators, and countless local officials that continually pledged to provide better care, failed to do so, and knew what would happen if they didn’t.
Here are the key takeaways from the Spotlight PA’s work.
Broken promises
Over nearly four decades, Pennsylvania has failed to build a community-based mental health system.
Since the 1980s, the commonwealth has repeatedly acknowledged that restrictive, involuntary care in state-run psychiatric hospitals for people with serious mental illnesses is inferior to community-based care.
After national and state civil rights cases, Pennsylvania made a plan to close remaining state hospitals and push the dollars that used to support them into community-based care.
Pennsylvania successfully closed three state hospitals in the 2000s and early 2010s. But the state government has not fully closed another one since 2011.
Despite those earlier closures, the resources needed to support community-based care weren’t provided at the needed levels.
Cut funding
Counties administer mental health services in Pennsylvania, but the state provides most of the funding needed to do so.
This so-called “base funding” is intended to help counties build the infrastructure of community mental health care needed to support people leaving state hospitals and continue that support for people who would have been served by those institutions after they close.
State officials repeatedly identified this infrastructure as crucial for ensuring people with serious mental illnesses could access care and resources regardless of their financial status or insurance coverage.
That funding, however, was cut in 2013 after former Gov. Tom Corbett made cuts to the budget after the Great Recession took a toll on state revenue.
That cut was not restored under his successor, former Gov. Tom Wolf. As inflation rose over the last decade, the flat funding amounted to further cuts for counties because the same dollars did not have as much buying power.
Over his first two years in office, Gov. Josh Shapiro raised the base funding by $40 million. He has proposed an additional $20 million in his 2026 budget. But even if the latest one is approved, taken together these infusions do not restore the Corbett cut nor make up for inflation.
Spotlight PA and the Lehigh Valley Justice Institute have found county mental health administrations have spent roughly $150 million less on mental health between 2017 and 2023. In that same time, state-funded mental health services have reached about 85,000 fewer people.
As community care grew less accessible, the justice system became one of the few ways people could receive treatment.
Behind bars
Without base funding, counties have not been able to build a cohesive, easily accessible health system for people with serious mental illness. Without that system, Pennsylvania has not been able to close additional state hospitals.
The progress of the 2000s and early 2010s has come to a halt — and jails have filled the gap.
Spotlight PA and LVJI found that the number of people with mental health needs, as well as the acuity of those needs, have increased in county jails. Rates of suicide and people on psychiatric medication have also increased.
But people involved in the justice system readily admit it isn’t suited for these needs.
Missed chance
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 stressed and disjointed, and made recommendations on how the one-time funding could best patch holes left by years of disinvestment.
But a last-minute budget deal between Democrat Shapiro and the Republican-controlled State Senate redirected the money to schools for student mental health and safety grants.
The promised funds were once again ripped away.