LYNN ARDITI’S front-page article, “Downturn also taking its toll on mental health” (Dec. 19), provides the opportunity to let you in on a dirty little secret about Rhode Island’s state’s mental-health care: None of the people she worries about newly needing mental-health care can get it.

We have the fiction that our community mental-health centers (CMHCs) provide a safety net for those in need. Not so: It’s actually very difficult to qualify for care at a CMHC. You have to have one of a small number of very serious mental-disorder diagnoses, been hospitalized several times, and/or met other criteria for severity or high service use. Even those with substance-use disorders fare better, with nonprofit facilities such as SSTAR to provide services to the indigent.

When I was a consulting psychiatrist at Access-RI, a program for the chronically homeless in Pawtucket, it was a day of celebration whenever we could get one of the folks we were working with accepted by a CMHC. This was typically because they had finally qualified for Medicaid, a long and arduous process. Those days were few and far between.

What of the person just out of work who has lost his or her insurance and develops panic attacks or depression or marital stress or spasms of hard-to-control anger? A very, very common scenario, as Arditi’s article documents. Without some sort of funding you need not bother applying to a CMHC. The best that these people can do is get a one-shot hospital emergency-room visit, maybe a follow-up medication from a primary-care provider at a community health center, or maybe a slot in one of the very few sliding-fee clinics staffed by Brown Medical School psychiatry residents.

In contrast, for the very, very lucky ones who are military veterans, the Veterans Administration provides mental-health services willingly. The VA’s open-door policy, in contrast to CMHC policies, has ironically contributed to the bad press that VA medical centers elsewhere occasionally get when a veteran takes his or her own life: At least the VA opens its doors and tries.

Is this the fault of the CMHCs? Not really — it’s a matter of how we as a society fund them. This bears very close watching since Rhode Island has just received a Medicaid waiver from the federal government to let it take much more control over how Medicaid funds are spent, in return for cutting costs (Steven Peoples, “State gets federal approval for Medicaid waiver,” news, Dec. 20). Watch this carefully — mental-health care for those few that the CMHCs do accept may erode as well.

Mark S. Bauer, M.D., an occasional contributor, is a professor of psychiatry at the Harvard Medical School, and director of the Harvard South Shore Psychiatry Residency Training Program. He has lived in, and practiced psychiatry in, Rhode Island since 1991.