Latest News

Jails brace for influx of mentally ill

Houston Chronicle—April 25th, 2011

Dr. Steven B. Schnee, executive director of the Mental Health Mental Retardation Authority of Harris County, offered up an extended metaphor one day recently to illustrate the consequences of what he considers catastrophic cuts in state funding for mental health services. Schnee is a licensed psychologist whose agency assists more than 45,000 county residents annually through a variety of community-based programs.

“It’s like saying, we’re short money — and we are short money - so we’re not going to put oil in our car. Or we’re just going to put a little bit of oil in the car,” he said, sitting in his fifth-floor office on the Southwest Freeway. “But when the engine blows up and we’re spending thousands of dollars on the engine - because now the car doesn’t work - we go ‘Oh, my goodness! What happened here?’ ”

A dozen miles to the northeast, in downtown Houston, the man who runs the largest mental health facility in the state was pondering the same possibility. It’s the Harris County Jail, where, on any given day, approximately a quarter of the 10,000 or so inmates receive constitutionally required mental health services for their diagnosable psychiatric conditions. Sheriff Adrian Garcia expects the numbers to grow.

“The cuts that we’re hearing about are incredible,” he said. “It’s almost as if these people were invisible, as if there were no awareness of the problem within communities across the state of Texas, and particularly in Harris County.”

The jail already has more than 1,000 of its nearly 10,000 inmates housed in jails outside the county because of space problems. An influx of the mentally ill would exacerbate the problem.

At the moment, the jail has a special unit with 108 beds for the severely mentally ill. Nurses and doctors are on duty 24 hours a day. Taking care of the mentally ill behind bars instead of in the community, Garcia said, costs Harris County taxpayers about $27 million a year.

Harris County is not alone.

“In the 1980s, the Legislature reduced funding to MHMR - beds, jobs, contracts - and it has put a lot of people around the state in county jails that would have gotten their problems straightened out elsewhere,” said Midland County Sheriff Gary Painter, president of the Sheriff’s Association of Texas. Painter said he has three deputies who are certified as mental health deputies and handle 800 to 900 calls a year.

Bexar County model

In Bexar County, where Sheriff Amadeo Ortiz runs one of the most successful jail diversion programs in the nation, some 4,000 people with mental illnesses ended up in treatment last year instead of behind bars. Those diversions are credited with saving the county more than $15 million in 2009-10.

San Antonio is the only police department in the country where the police chief has mandated an intensive 40-hour crisis-intervention training program for all officers. Despite those efforts, “our jail is still packed with inappropriate people,” said Leon Evans, chief executive of the county’s Center for Mental Health Services.

A study last year found that Bexar County’s public and private psychiatric hospitals already are swamped by an increasing number of indigent mentally ill patients seeking emergency room or inpatient services. It’s going to get worse, Evans warned, when jails and emergency rooms are the primary alternatives.

“We’ve gone from our state hospitals being the repository of folks with serious mental illnesses to now the jails and the prisons being the repository,” Schnee said. “It’s wrong what we’re doing. We don’t do this for any other medical condition. It’s just flat wrong. And it’s not even cost-effective.”

What happened in 2004

In a state that already ranks near the bottom in per capita spending for mental health care, House members have proposed a cut of 20 percent in services provided by the Texas Department of State Health Services. Targets of the cut are caseworkers, crisis hotlines, clinics and community health centers, where severely mentally ill adults and children receive medications and outpatient treatment. The community-based centers get funding from the federal government, private foundations and individuals, although most of it comes from the state.

The Senate version of the state budget would restore funding for mental health, but there are no guarantees once the two versions are reconciled by a legislative conference committee.

“I think it’s critical that mental health programs not be cut,” said state Sen. Kevin Eltife, R-Tyler. “That’s not going to save anybody a dime.”

Eltife recalled what happened in 2004, after the Legislature cut community mental health programs in the name of reform and efficiency.

County judges from around the state flooded the Legislature with calls, complaining about overflowing hospital emergency rooms and jails. They also complained about increased pressure on law enforcement officers, who, like their counterparts around the nation, have had to become de facto social workers and psychologists.

In response, the Houston Police Department, the Harris County Sheriff’s Department and other law enforcement agencies around the state have developed crisis intervention teams and other units specially trained to deal with the mentally ill. Officers learn about schizophrenia, bipolar disorder and other major mental illnesses from professionals in the field, as well as from people who suffer from the illnesses.

“State government has done a terrible job in giving the responsibility over to law enforcement of dealing with and treating its own most vulnerable citizens,” Garcia said during a recent visit to the Capitol. “It’s a shame, and it’s not the way it ought to happen because law enforcement is law enforcement. We’re not psychotherapists, psychiatrists, psychologists.”

Texas, which ranks 49th in per capita funding for mental health, has chosen not to fund community care and other measures that could help prevent men and women afflicted with an illness of the brain from ending up behind bars.

A revolving door

They are people like Tony Daugerty, 62, who was diagnosed 30 years ago with manic-depression and who has been in and out of jail at least 15 times in five years. For Daugerty and others, it’s easier to get arrested than it is to get treatment. Jail also is a more reliable provider of the treatment he needs.

Wearing a standard-issue orange jumpsuit, the balding, bespectacled man sat at a metal table in the jail’s mental health area recently and spoke about his decades-long battle with his illness. During his manic phases he stays up all night, night after night. “I design the solutions to all the world’s problems,” he said.

Daugerty was on probation last year when he boarded a Metro bus carrying a black canvas bag. When he told the driver, “Keep driving or I’m going to blow up the bus,” the driver called the police.

Daugerty is scheduled to be released next month, although the sheriff and members of his mental health unit, not to mention Daugerty himself, know they are likely to see him again.

“We do incredible work at stabilizing these folks,” Garcia said, “but it’s a shame that we do the work that we do, at the price that we do it, just to have them go back out into the community and have them deteriorate again. They’ll be back in our facility. It’s a horrible revolving door when there’s a lack of capacity out in the community.”

Community-based programs are in jeopardy even as the demand for their services is growing. State Rep. Garnet Coleman, D-Houston, estimates that the cuts proposed by the House would mean at least an additional 3,000 people going untreated.

Barbara Dawson, director of Harris County’s Comprehensive Psychiatric Emergency Program, already is feeling the effects of mental health funding that is, at best, “a maintenance of effort,” to use Schnee’s phrase.

At the Neuropsychiatric Center at Ben Taub General Hospital, Dawson has seen a 45 percent increase in the number of patients during the past two years. “Some 16,000 people walk in our doors annually,” she said. “That coincides with outpatient clinics being filled and putting them on wait lists. We have no more staff, no more space in the facility.”

Jail becomes an ER

Neither does the jail. “We have not recuperated from those cuts from the 2003 legislative decisions that were made,” said Dr. Sylvia Muzquiz, medical director of MHMRA’s mental health division. “When the outpatient system was cut back, there was an increased influx of individuals showing up to emergency rooms and to the jails.”

Since 2003, the Harris County Jail has gone from fewer than three full-time psychiatrists dealing with the mentally ill to 11 on duty 24 hours a day.

“We function, basically, as an emergency room,” Muzquiz said. “We can’t turn people away here. The emergency rooms can close doors and say they’re at capacity. The jail can’t.”