Mentally ill people will have a much easier time accessing care two years from now, thanks to the new federal health care law. But advocates worry that current budget cuts may create a shortage of the very mental health services the newly insured will want to use. In 2008, 67,560 uninsured people in Pennsylvania did not get mental health care because they could not afford the services, according to the Pennsylvania Insurance Department. That number should drop dramatically by 2014, when the Affordable Care Act (ACA) requires all American citizens to have health coverage that will include mental health services.

That is great news both for the health of those patients and for the public pocketbook, advocates say. "To not treat mental illness can really cost you," said Joseph Rogers, chief advocacy officer at the Mental Health Association of Southeastern Pennsylvania. He said mentally ill people end up in emergency rooms, homeless centers, and prisons when they cannot access treatment.

But there have been cuts to mental health services in recent state budgets. The 2012-13 Pennsylvania budget had a 10 percent cut to seven programs. "The current administration is undermining the work people have been building for over 40 years," said Alyssa Goodin, associate director of the Philadelphia Alliance, a society of mental health providers. She worries that budget cuts will reduce staff and programs at clinics that will soon be inundated with newly eligible patients.

Already it can be difficult to get mental help when patients need it. Children have to wait an average of 37 days to start treatment, according to a survey of mental health agencies in Philadelphia compiled by Public Citizens for Children and Youth, an advocacy organization.

Under the ACA, insurance companies will no longer be able to deny people coverage for preexisting conditions, or place lifetime limits on the amount of care they'll pay for — both serious current financial constraints for patients trying to manage lifelong mental health disorders.

The federal government gave states leeway about what mental health coverage will look like, and advocates are now lobbying to make sure insurance plans cover the full range of mental health services.

— Allyn Gaestel