DES MOINES - Dozens of states have slashed spending on mental health care over the last four years, driven by the recession's toll on revenue and, in some cases, a new zeal to shrink government.
But that trend may be heading for a U-turn in 2013 after last year's shooting rampages by two mentally disturbed gunmen.
The reversal is especially jarring in statehouses dominated by conservative Republicans, who aggressively cut welfare programs but now find themselves caught in a crosscurrent of pressures involving gun control, public safety and health care for millions of disadvantaged Americans.
Caseworker Cheryl Boone talks to a client during a therapy session at the Johnson County Mental Health Center Wednesday. in Shawnee, Kan. Lawmakers across the nation are rethinking cuts in mental health care spending in the wake of recent shootings.
In many states, lawmakers have begun to recognize that their cuts "may have gone too deep," said Shelley Chandler, executive director of the Iowa Alliance of Community Providers. "People start talking when there's a crisis."
About 30 states have reduced mental health spending since 2008, when revenues were in steep decline, according to the National Alliance on Mental Illness. In a third of those states, the cuts surpassed 10 percent.
As a result, nine state-run psychiatric hospitals were closed and another 3,200 beds for mental health patients were eliminated, dramatically reducing treatment options for the poor and people in the criminal-justice system. Thousands of patients were turned onto the streets.
Making matters worse, the cuts came as unemployment was rising, causing more people to lose private insurance and forcing them to shift to public assistance.
The steepest drop by percentage was in South Carolina, where spending fell by nearly 40 percent over four years - an amount that Republican Gov. Nikki Haley has called "absolutely immoral."
Now Haley, who took office in 2011, has pledged to bolster a mental health system that dropped case workers, closed treatment centers and extended waiting lists. She also wants to expand remote access to psychiatrists through video conferencing.
Both Pennsylvania and Utah have put aside plans to scale back their mental health systems.
And Kansas, which cut mental health spending by 12 percent from 2008 to 2011, announced this month a new $10 million program aimed at identifying mental health dangers.
"I don't think we're well set as a state at all to be able to deal with these intensive cases" of mental illness, acknowledged Kansas Gov. Sam Brownback, usually an avid proponent of downsizing social programs.
The sudden pause reflects anxiety from last year's shootings in a Colorado movie theater and a Connecticut elementary school. Although little is known about the mental health of either gunman, the attacks have shaken state legislatures that until recently didn't intend to consider more social spending. In some cases, gun-rights advocates are seeking mental health reforms as an alternative to more gun laws.