It's a noble and necessary goal to improve access to mental health services in Connecticut. But is it a realistic one, in light of the state's recent budget difficulties?

That's a question some mental health advocates asked following the release last week of a 114-page report detailing the untreated mental illness of Adam Lanza, the Sandy Hook Elementary School shooter.

Lanza, who faced mental health problems for much of his 20 years, murdered 26 people -- most of them children -- almost two years ago, after killing his mother and before turning the gun on himself.

The report on his case by the state Office of the Child Advocate includes pages of recommendations to improve mental health services in the state, including expanding mental health screenings and improving access to programs for youth with autism spectrum disorder and other conditions.

Neither the Lanza report itself -- nor representatives of the advocate's office -- had a price tag for implementing the improvements it proposed. But advocates agree that changes to the mental health system are seldom without a cost. And that cost, whatever it is, might be more than the state can afford.

"The funding (for mental health services) is inadequate right now," said Morna Murray, president and CEO of the Connecticut Community Provider Association, a trade association for health and human services providers in the state. "If we're adding services, and not adding funding, the likelihood of moving forward is not great."

Indeed, the provocative document was released one day after Gov. Dannel P. Malloy announced he was cutting $48 million from the state budget, in attempt to address a projected $100 million budget shortfall. Though state officials are confident the reductions won't greatly affect any programs, some health providers said they're not certain what reductions like these will mean for the future of mental health improvements.

The soul of the Lanza report is the revelation about gaps in the health-care and educational systems that allowed Lanza's illness to go largely untreated for years. The report also recommends changes to mental health, pediatric, educational and other services that could have closed those gaps at every age level.

For instance, the report states, routine screening for developmental and mental health problems among infants could allow potential problems to be spotted, and treated, sooner. It recommends that health-care payers facilitate and support universal screening for behavioral health and development impairments for children from birth to age 21.

The report also recommends creating more services specifically for those who, like Lanza, have autism spectrum disorders.

The document doesn't mention any potential cost to these changes, and Mickey Kramer, associate child advocate, admitted that no price tags have been estimated yet.

"That has not been considered for this specific report, though it will be in the future," she said.

She added that many of the recommendations in the report are "practice-based," and involve health and education officials simply altering their policies.

"Those don't necessarily cost a lot of money," Kramer said. She conceded, however, that when you have to retrain people, there is often a cost involved.

The potential cost of these improvements, and other ones aimed at improving mental health services in the state, is a concern to some, particularly in light of the recent budget reductions.

The rescissions announced by Malloy's office affect every executive-branch agency in the state, including more than $3.2 million from the Department of Mental Health and Addiction Services.

The governor's office also plans to reduce by $6.3 million the account that the state Department of Children and Families uses to pay for room and board for children in residential settings. DCF spokesman Gary Kleeblatt wouldn't comment directly on the cuts, but did point out that the number of children living in these homes has been drastically reduced in the past few years.

In 2011, there were 1,426 young people receiving care in a group setting. As of Oct. 1 of this year, there were 663.

Overall, the impact of the reductions is expected to be minimal -- particularly when it comes to mental health services, said Andrew Doba, spokesman for the governor's office. "We specifically exempted any of the mental health provisions that were passed in response to the tragedy at Sandy Hook Elementary School from these reductions," he said. "The rescissions that were announced are minor and will have a minimal impact on the delivery of services."

Murray said she's still reviewing the reductions, and isn't sure how they'll affect programs in the state. She said she appreciates reassurances from the governor's office that the "safety net" protecting services for the state's most vulnerable residents.

Still, she and other providers worry that, if funds continue to be tight, the opportunity for improvements to mental health programs in the state are slim.

"I believe the governor is sincere in his commitment to (mental health)," said Sherry Perlstein, president and CEO of the Child Guidance Center of Southern Connecticut. But she said her agency is continually underfunded, which makes it hard to provide services to those who need them.

"It's very disheartening," she said.