Texas mental health system fails to address real problems

Published: Jun. 2, 2017 at 5:15 PM CDT
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The Texas mental health system is failing and thousands of Texans who need mental health care are left with nowhere to turn while experts say things won’t get better anytime soon.

Budget cuts, hospital closures and huge gaps in the mental health workforce have left the system reeling and pushed the problems that result off onto counties and municipalities to bridge the gaps, without state funding help.

In a report released earlier this year, Texas House Select Committee on Mental Health members wrote that mental health “is absolutely one of the most critical areas of concern” facing the state.

Members went on to say if Texas doesn't take more effective steps to repair its mental health system, the consequences could place the state in peril.

Thousands of Texans who could be placed in treatment centers or outpatient programs are being carted off to county jails because there is nowhere else for them to go, and in many cases counties and cities are not prepared to care for them.

The issue has an enormous impact on the state’s criminal justice system and the result is thousands of wasted hours and millions in costs, most of which now are borne by counties and cities rather than by the state.

“It’s a quandary and it needs to be addressed by the Legislature,” said 19th District Judge Ralph Strother, who said he signs a number of orders each week involving defendants in his courtroom that result in commitments for competency hearings or other issues.

“It costs an inordinate amount of time and money and there is no magic bullet,” Strother said.

From patrol officers and deputies on the streets to prosecutors and judges, law enforcement professionals deal with people who have mental health issues who are constantly being brought into the system, jailed locally, prosecuted, and in some cases sent to state prison.

“It is a nightmare for law enforcement,” Waco police Sgt. W. Patrick Swanton said.

“We are first responders and by nature are the first people called to deal with a crisis,” Swanton said.

All Waco police officers receive special training on how to recognize mental health issues and how to deal with them, “but we are not doctors and we should not be the people who have to deal with it, but when funds were cut, we were the only ones left.”

“Our officers deal with (mental health) issues constantly every day,” Swanton said.

The problem in Texas today is “frustratingly impossible,” said Stan Schwieger, a Waco defense attorney who is considered by area lawyers to be a leading authority on the subject.

“The (Texas) Legislature lacks any will to help us with this issue,” Schwieger said.

“I used to be a doubter, but I’m not anymore,” Schwieger said.

“It’s a broken system in desperate need of help because there’s nowhere to turn; no private (treatment) beds, no public services … nowhere,” and “it’s a revolving door.”

That’s a sentiment Swanton addressed, as well: “We pick them up, take them to a hospital and within 24- to 48-hours they’re back on the street and we have to encounter them again.”

Once someone is arrested and jailed, it’s left to the court system to deal with, and “this is not a source of pride in Texas,” Schwieger said, where state law on the issue is antiquated and extremely confusing.

“You try to make sense of (the law in the state penal code) and it’s a swamp, a quagmire of complex procedural issues that’s terrible and very confusing” and the outcome “hardly ever results in anything good happening,” Strother said.

State law says a person may be involuntarily committed to a state mental hospital for 120 days on a competency question, then that can be extended by 60 days by the hospital, but after that a judge must re-visit the commitment.

“That can be a rubber stamp,” Schwieger said, “and in some cases it can result in a life sentence at a mental hospital.”

Schwieger said in some cases, after years, the state loses its interest in the case, but in others, mental health workers at hospitals can teach patients how to respond to competency questions.

“I have a real problem with a mentally challenged person being taught to ‘parrot’ answers so a court can establish competency that allows a trial to go forward,” Schwieger said.

But in other cases those patients are moved from one place to another to make room for new patients.

“They’ve got to move patients around; they’ve got to go somewhere,” Schwieger said.

The problem is, “there’s no place to put (him) and no one’s figured out what’s the best decision for that client,” he said.

Strother said there is no choice but for the courts to deal with these issues because “of the way the statutes are written and the only way to get them help is through the legal system.”

Dr. J.D. Sheffield, a state representative from Gatesville, said the most recent legislative session, took some steps to improve programs, “but we’re not where we need to be yet,” but “we made some very big starts.”

Sheffield said legislators passed a bill that will require private insurance companies to offer coverage for mental health issues just as they do for physical health problems.

Sheffield, a family practice physician, said the problems with the system are serious and very real.

“All you have to do is go to a hospital emergency room on the weekend and try to get someone with a mental health problem admitted.

“We don’t have near enough state hospital mental beds and we need psychiatrists; we need more of them,” Sheffield said

But some specialists have refused to honor Medicare or Medicaid, which lessens the number of providers who can help.

The issues addressed in this report deal only with mental health as it has an impact on the criminal justice system, but a majority of encounters with mentally ill individuals are separate from criminal interventions.

The Hogg Foundation, in its 2011 annual report, said 46.4 percent of adults experience mental illness at least once in their lifetime and 26.2 percent of adults experience mental illness annually.

It went on to say 5.8 percent of adults in the U.S. experience a serious mental illness.

A national study conducted by the Center for Studying Health System Change says of all the primary care doctors who practice nationwide, more than 66 percent say they’re unable to refer their patients to high quality mental health specialists because there aren’t enough of them to go around.

The Texas Coalition for Healthy Minds visited lawmakers' offices early in the current session to ask them to expand the continuum of care, focusing on improvements in prevention and recovery measures for people with mental health concerns.

The coalition also identified a similar concern with potential disparity in insurance coverage for mental health and substance abuse, and an "insufficient" mental health workforce.

The federal government started inquiries into the problem of addressing the nation’s mental health system when President George W. Bush convened the President’s New Freedom Commission in 2002.

A subsequent commission report published in 2003 called for large scale transformation in the country’s mental health care effort toward a “consumer-centered” system that would focus on recovery while providing high quality mental health care free of disparities.

“Such a transformation demands the vast expansion of the workforce through training and initiatives aimed at the redistribution of duties among providers, a 2009 study by Thomas, Ellis, Konrad, Holzer, & Morrissey, said.

Results from a 2013 presentation indicate that 28.3 percent of Texas’ public and charter high school students reported feeling sad or hopeless almost every day for a two week period within the 12 months prior to being surveyed, results similar to the national data.

The proportion of females (36.8 percent) reporting these feelings was significantly higher than that of males (20.2 percent).

As well, 16.7 percent of teens reported seriously considering a suicide attempt and 15.1 percent had a plan for how they would commit suicide.

Rates for both of these measures were significantly higher among females than males.

A recent report published in the Texas Tribune said: “The 109-page report by the Texas House Select Committee on Mental Health, released just days before the start of this year's legislative session, outlines challenges and opportunities for the state in tackling issues troubling the system such as patient access to mental and behavioral health services; increasing the number of beds available in state hospitals; early intervention for schoolchildren with behavioral health issues; investing in jail diversion programs, and beefing up the state's mental health workforce.

“If we fail to adequately invest and earnestly address the issues now, we do so at our own peril because the societal, medical and criminal justice costs alone will be extremely high,” the report concluded.

State Rep. Sylvester Turner, D-Houston, in a recent report published in the Dallas Morning News, complained that lawmakers have made “dramatic reductions” in funding of community-based services since 2003.

Studies show in Texas more than 500,000 citizens struggle with some form of serious mental illness and that number includes 1.5 million Texans are dependent on alcohol or drugs and thousands of Texans commit suicide every year.

The farther away one looks from major metro areas the shortage of mental health services hits harder.

The mental health commission says right now 185 of the 254 counties in Texas do not have a “general psychiatrist”, which includes most of the counties in Central Texas.

A report compiled by the Kaiser Family Foundation says Texas does a “woeful job of serving our citizens with mental health problems.

More than 4.3 million Texans, including 1.2 million children, live with some form of mental health disorder and Texas now ranks 51st in per capita funding for mental health services, even behind even Washington, D.C.

“The national average for state spending on mental health services is $109 per capita. Texas shamelessly spends $36,” the Kaiser report says.

The 2007 Legislature appropriated more funding but only for crisis services, which means now the system includes thousands of people on a waiting list until their situation becomes a crisis.

Even with so many Texans living with mental illness, the Department of State Health Services proposed a $2.1 million reduction to Community Mental Health services for adults in the next biennium, which compounds the devastating $24.8 million in cuts taken in 2011 and the overwhelming cuts from the 2003 legislative session.

The budget request from the department for the next biennium allocated $18.1 million less than the funding levels prior to the 2003 cuts.

The net result would be the department could serve only about 36 more adults in community mental health services statewide than it did in 2003.

Here’s the kicker: according to the Legislative Budget Board, community mental health services cost about $12 per day per patient, as opposed to the $137 per day to keep someone in prison.

In its own analysis, Kaiser proposed the Legislature approve a budget increased by $250 million to care for the mentally ill, which was denied.

“We are in a mental health crisis,” the report said.

”It is a time bomb and it is ticking.

”Let's not wait for another child or adult to die before we decide to act.”

BELTON, Texas (KWTX)--The Bell County Sheriff's Department, faced with a need for deputies trained in mental health issues, formed a special unit to deal with the growing problem.

In 2014 the department organized a Crisis Response Division, (CRD), specifically designed to assist patrol officers with cases where mental health issues arise, unit commander Lt. Bob Reinhard said.

"We partnered with the Central Counties (Mental Health, Mental Retardation) MHMR office and made an agreement with them," Reinhard said.

The division is manned by the lieutenant, a sergeant and four deputies, all of whom are specially trained as Texas Certified Mental Health Peace Officers and all of whom undergo continuing education in the very specialized field every month.

"We just want to keep people out of our jail who don't really belong there," Bell County Chief Deputy Chuck Cox said, "so we got pro-active."

Any police agency in Bell County can call upon the CRD officers to assist them in situations where mental health may be an issue, Reinhard said.

Reinhard said each county along the Interstate 35 corridor from McLennan to Hays has some type of CRD, including Coryell, but not many statewide are as accomplished as Bell County's.

"For the most part we focus our attention on the community," Reinhard said, and "We're growing by leaps and bounds."
"It was rocky at first but it's worked out really well. Now we've got our feet on solid ground," Reinhard said.

Over the three years, he said, even though he could not provide hard numbers, "We've reduced recidivism a great deal."
Reinhard said in about 80 percent of the cases his division responds to they can provide intervention for a subject rather than make an arrest.

Deputies in the division work 7 a.m. to 11 p.m. but they're on call 24-hours-a-day, seven-days a week.

"I sent a deputy to Nolanville just last Saturday at 1:30 in the morning on an attempted suicide," Reinhard said.

Reinhard said the Bell County CRD now is working with the Central Texas Council of Governments to expand the CRD's reach.

Line officers usually don't have a great deal of training on how to deal with mental health issues, and not too long ago, Reinhard said, "I am that same peace officer you just described."

It was the state's budget cuts that drove department like Bell County to assume the responsibility for deal with special subjects on their own. After those budget cuts "the private facilities stood up and said 'We can do it,'" Reinhard said, and for a while that was true, but private resources were limited and before too long the problem grew to the point that private facilities were over-taxed, too.

Bell County's CRD is working with other agencies to try to bolster their operations budget, which would allow them to provide more and better service to Bell County citizens who have special needs and to prevent people from going to jail who don't need to be there. (Paul J. Gately)