Studies by the U.S. military have shown an 80 percent increase in suicides since the start of the war in Iraq in 2003. According to testimony by Lt. Col. Alba Villanueva, the director of joint family support services for the Texas Military Forces, which includes the Texas National Guard, there have been 15 suicides among Texas soldiers in the last three years, and two in the last 30 days.Further,
Suicides and the mental health problems that lead to them are often a matter of untreated post-traumatic stress disorder and the lingering effects of military training.
the mental health problems that persist, others said, are serious even if returning soldiers are far from thoughts of suicide. "Sometimes the problems aren't surfacing for three or four months, whether it’s drugs or the criminal justice system,” said Rep. Dan Flynn, R-Canton, explaining that returning soldiers do not want to seek mental health treatment because they just want to get on with their lives.
“When they come home, they want to go home, they don't want to be involved with the system,” he said.I reference this discussion to point out how disconnected it seems from the reality facing veterans and others suffering from mental illness: An extremely limited base of providers and little public funding for the levels of mental health services needed to play a preventive rather than a reactive role. In the real world, as opposed to some legislative flow-chart, the criminal justice system is the main location where the system proactively provides services to treat serious mental illnesses. So those who most need treatment too often wait until their behavior deteriorates to the point that they wind up in the county jail or a state penitentiary, where mental health care has also been reduced thanks to budget cuts.
“We're going to have to figure out some way to close that gap.”
Mental health problems often stem from the process of reintegrating into civilian life, [Military Veteran Peer Network statewide coordinator [Sean] Hanna said, adding that "it's not until they begin to enact their plan for what their life will look like that they start to face these struggles."
Hanna said the problem can be addressed by “more boots on the ground” — more funding for hired professionals to coordinate peer networks of veterans, because he says many returning soldiers will only seek help if they get advice from other veterans, and in rural areas of the state other veterans may not be nearby.
Grits also finds it curious that the Tribune account made no mention of how this subject - as with many corrections-related health matters heading into next year - plays into the debate over the proposed Medicaid expansion under the Affordable Care Act to include adults with incomes up to 133% of federal poverty levels, a matter which Texas must decide in the coming legislative session and which may be informed, one might guess, by the outcome of the national Presidential election.
It's fine to say veterans, the homeless and other special populations should receive mental-health care before they enter the criminal justice system, but the harsh reality of operating those systems doesn't allow for "should bes" but must deal with what actually is. Who will pay for preventive mental health care for the indigent if not Medicaid? Counties? I wouldn't hold my breath. And the state's not likely to pony up. Plus outside the largest cities, there's a stark shortage of behavioral healthcare providers, even if there was money available to pay them. Medicaid would create a market for those services and the hope is providers would follow the dollars.
My own view is that, if Texas would participate in the mostly federally funded (90/10, when it rolls out completely) Medicaid expansion under the Affordable Care Act, it would have an enormous palliative benefit for the justice system, particularly as it regards creating a funding mechanism to pay for preventive mental health care for at-risk populations, including but not limited to veterans. It would also make much simpler an array of reentry concerns about continuity of care to have a ready insurance plan available for the 70,000+ people released from Texas prisons each year, not to mention the hundreds of thousands more on the probation rolls.
Right now, the state's approach is mostly to ignore mental health issues until they fall into government's lap via the criminal justice system. Part of the reason the Harris County Jail has become one of the largest mental wards in the nation is that front-end care has been under-valued by legislative budget writers while funding for jails and prisons until very recently was considered sacrosanct. Now the budget crisis has become so severe that even sacred cows like prison and jail funding are on the table for potential reductions, which is a marked change in the terms of debate even from just a few years ago. In that context though, it's also difficult for the state to come up with extra money for up-front care.
Though Governor Perry has already announced his opposition to Medicaid expansion, Grits doesn't for a long shot consider that a fait accompli because of the billions of dollars the state's medical industry would be leaving on the table in the wake of such a decision. Economist Ray Perryman has a column making the rounds in several Texas papers declaring that, from an economic perspective, Texas only has "one rational choice" available, which is taking the money under Obamacare and expanding Medicaid. That's certainly been my view and I suspect once the partisan winds of election season have passed, more than a few Texas legislators struggling with issues like veterans mental health care and recidivism reduction will see the same thing and press to accept the much-needed federal dollars for that purpose.
See prior, related Grits posts:
- Medicaid expansion and addressing severe mental illness through the justice system
- Texas decision to reject Medicaid expansion would hasten trend toward using justice system as mental health substitute
- Obamacare provision a boon to budget writers on state prison health costs but complicates UTMB negotiations
- Banking on Obamacare for future prisoner hospital costs
- Will Texas expand Medicaid coverage under Obamacare to include prisoner hospital costs?