Thursday, April 14, 2011

Assessing local impacts of proposed mental health budget cuts

Patrick George at the Austin Statesman offers up a good localizing story today on a subject familiar to Grits readers: The unfunded mandates for county jails and local law enforcement that would be created by state mental health cuts. Writes George:
as state lawmakers weigh cuts to mental health funding that could require shrinking or closing clinics and hospitals, ... law enforcement officials across the state have become concerned that scarce beds locally will be increasingly common — and that patients unable to get care will end up in jail for extended periods or have violent encounters with police.

"You have someone in your custody who's going through a crisis. They have their ups and downs, and you're in a vehicle with them" driving for hours across the state, [San Marcos police officer Phil] Jackson said. "That's ridiculous."

The current state House budget proposal cuts funding for community mental health services by $148 million , and it cuts $34 million from state and community mental health hospital funding. A proposal on the table would also cut pay to providers of mental and medical health services from Medicaid and the Children's Health Insurance Program by 10 percent, according to the Center for Public Policy Priorities, a nonpartisan research institute.

Law enforcement and mental health officials say budget proposals would extend travel time and take officers like Jackson and Cunningham, who are specially trained to handle those in a mental crisis, off the streets for extended periods. The proposals also would reduce the availability of treatment for people with mental illness by cutting beds, clinics and staffers, said Joe Lovelace, an associate director at the Texas Council of Community Centers.

"These individuals who can no longer get treatment will deteriorate and will end up in contact with law enforcement or in the ER," said Lovelace, whose group advocates on behalf of mental health, intellectual disability and substance abuse services in Texas.

Sheriff Greg Hamilton said the Travis County Jail has an average of 400 inmates with mental illnesses each day, though the Austin State Hospital has only 299 beds. He said he believes that if the proposed state cuts go through, the jail will have twice as many inmates with mental illnesses.

In addition to the cost of added security measures, Hamilton said, his jail would have to increase its stock of medical supplies for those inmates. But until state lawmakers decide the exact amount of the cuts, the effecton the county budget won't be known.

"County jails are already the biggest mental hospitals," Hamilton said. "It's sad that we've criminalized mental health, but we have no other place to take individuals in crisis."
I'm only aware of one piece of policy legislation moving through the process that would in any way reduce pressure on local jails to house more mentally ill inmates - HB 2725 by Hartnett, discussed here, which would count time spent on the waiting list for treatment against time served on sentences and speed up how soon misdemeanor defendants could get their cases dismissed. That's an important bill, given that quite a few misdemeanor defendants spend more time waiting to be declared competent than their maximum sentence would be if they could lawfully plead guilty. But that's just one positive adjustment while, as this article demonstrates, there are lots of ways the current budget proposals increase those pressures in ways that will dwarf any improvements from HB 2725..

See prior, related Grits coverage:


A Texas PO said...

Every time the Lege slashes mental health budgets, local MHMRs end up with more and more restrictions that prevent people from receiving much needed care. And the disparity among the different MHMR departments across the state is baffling. Some provide a very minimal level of service and others go all out for their clients. This will not turn out good for anyone.

Audrey said...

I saw this in Dallas County. Single cells holding Alzheimers and Dementia patients, throwing theirseves up against the walls and wailing. The county jail is no place for these people...and the guards are clearly not qualified to handle or help these people. Its a nightmare.

Sandy said...

My experience tells me county jails already PROMOTE mental illness and further encouragement will only lead to nightmares we cannot imagine.

My hostile neighbor filed false charges against my landlord; said he beat the neighbor's wife (didn't happen). The landlord was jailed and allowed to bring along his prescription medications. He's suffered a series of 15 strokes during the last three years. He's a business owner, civic leader, responsible father, and gentle man, not a troublemaker in any way. I've known him for more than 40 years.

The stress of the situation induced another stroke while he was in county jail. The jailer refused to give him his prescription medications (to prevent/minimize the effects of stroke), refused to summon a physician, wouldn't even let him have blood-thinning aspirin, and lied to his family all through the night about his medical status. Instead, he was given anti-anxiety medications that wreak havoc with the prescription meds he's been taking for years. In essence, they fed him medications intended for mental illness while totally ignoring his very real physical condition.

That's just the tip of the iceberg of injustices and civil rights violations he suffered during his incarceration but it's enough to assure me my county jail is no place for anyone, mentally ill or not. This legislature will only make matters worse for everyone.

Prison Doc said...

I'm no fan of MHMR--by and large I think they do a poor-to-bad job. But at least they are TRYING to treat people for mental issues, which we at the jails are not set up or inclined to do. I would prefer to have them oversedated by MHMR than hollering and acting the fool all over the jail.

Sandy said...

You're right, Prison Doc. Sick people need hospitals and medical care, not jail. Jails and prisons have an entirely different job to do. To think the two can be combined is utter stupidity.

Anonymous said...

The last time I checked it wasn't against the law to be crazy, it is just sad.

The only way I see a way out of this is for the State to promote something like CRAZY HUNTS IN TEXAS...

You could charge people to come to our state and "hunt" the crazy people with a tranquilizer gun...

Maybe even safari style in the more rural areas.

The state would make a fortune off of licenses, fees, etc., and the crazy people would be getting cared for by getting thier injection of whatever they were needing at the time..

Or I guess we could just start dropping them off at someone's home that we don't like.

Anonymous said...

An old problem that's getting older and worse each passing year for us in law enforcement who have known for years that jail is not the proper environment for those with mental issues.

The Homeless Cowboy said...

"County jails are already the biggest mental hospitals," Hamilton said. "It's sad that we've criminalized mental health, but we have no other place to take individuals in crisis."

Elna Christopher , a spokeswoman for the Texas Association of Counties, said the state's budget cuts will simply mean the costs will be passed on to the county level. On average, it costs $12 a day to house someone at a community facility where the person receives mental health treatment, Christopher said, but it costs $137 a day to jail the person.

Well Folks here we go again The great state of Texas will again defy all logic and reason by making a really bad decision. This is the "Screw it it gets it off of My desk" decision that seems to be the popular option whenever we have hard choices for our duly elected representatives to face. It seems all they do is look to the whip of whatever their party is and follow the party line, cant go wrong that way. While we the sheep, the cattle, the great herded masses, wonder how this keeps happening. I for one think we should fire them all, all parties, all counties, and vote in a new batch, if they cant do what they are asked fire them and vote in some more. Criminalize lobbying and force these folks to use their own cognitive powers to make decisions. That is a pretty scary thing to say but, Hey, could it be any worse?????????

Anonymous said...

Annoy 1:06 Rick is that you? Glad to see you toned that idea down to a tranquilizer dart. Still have to do something with them when they wake up though.