They can either step up funding for thousands of mentally ill poor who lost treatment and medications last year because of changes in Medicaid, or pay to treat them when they wind up in homeless shelters, emergency rooms or jails.

Wary of the precedent set by paying for what was once a federal program, the Legislature balked last year at spending $7 million to replace cuts in Medicaid dollars that, by some estimates, left 4,300 Utahns without behavioral treatment. Instead, they diverted $2 million in emergency one-time money.

But this year, Human Services spent $6.7 million treating the mental illnesses of 3,111 juvenile offenders, children caught up in the child welfare system and others, said Church. That doesn't include what state and local governments spend on behavioral treatment for adult offenders in jails and prisons.

Whether mental illness is becoming more prevalent or more readily diagnosed, calls for treatment are becoming more frequent, said Church, noting about 87 percent of youths in the child welfare system have a mental health diagnosis.

"If that doesn't alarm us, I don't know what would," said Church. "You can either pay for it here or there."

A federal rule change stopped local mental health providers from using leftover funds to help poor people who make too much money to be covered by Medicaid. Last year's $2 million stopgap has helped these centers reach some patients, but it is temporary and it left 1,400 people unserved.

Church couldn't say what has happened to those patients.

But Rep. Steve Mascaro, R-West Jordan, surmises "they're in our ER waiting rooms, jails and out in the streets in viaducts." Under the federal plan to cut Medicaid by $10 billion in five years, Mascaro wagers the funding crunch will only become worse.

Church probably will ask for more money for mental health services this winter, but didn't specify how much.

"We know we can't keep coming back to you and say we need endless money," said Church, proposing to return with ideas for programs aimed at prevention and diagnosing mental illness at an early age.