Saturday, February 02, 2013

When jails do mental health: Medicaid, local politics and public safety

Rick Perry may have said "no" to Medicaid expansion, but given the economics of the situation, I'll bet Republican legislators all over the state have faced local meetings like the one described in the Waco Tribune-Herald evincing the Legislature's "division with local government leaders" on whether to expand Medicaid. "Top officials with the city of Waco and McLennan County support the Medicaid expansion envisioned as part of national health care reform, saying it would cut the area’s uninsured rate by more than half and bring $58 million a year in new federal funding to the area." Local officials in every county with taxpayers on the hook for a hospital are thinking the same thing.

Grits' particular interest in possible Medicaid expansion lies in the expanded access to mental health care for probationers and parolees and possibly federal cost sharing for inpatient hospital care at TDCJ. The Harris County Jail ain't for nothing the largest mental health institution in the state. Medicaid expansion would allow a continuum of care for folks jails currently treat, stabilize and let go. Not only are there costs to local government from uncompensated care at the emergency room, IMO there's a not-negligible public safety cost from limiting access to mental-health services in an era when we use local jails as front-end mental health providers.

10 comments:

Gadfly said...

Linking to the blog post I did last week about that Waco-area meeting.

Anonymous said...

Reality Check Needed.

1. There's no Medicaid expansion coming. The country is broke, there's no extra dollars. The "expansion" is not free money from Obama's stash, it will have to come from taxpayers or continue to be borrowed from the Chinese.

2. The criminally insane will still have to be incarcerated. The recent mass shootings are incorrectly and conveniently blamed on AR-15s but they are in fact caused by crazy people who need to be locked away. No community psych care for them. We are looking now at two big experiments that have failed: (1) letting the insane out of the hospital courtesy of Advocacy Inc and other do-gooders,and (2) the "tuff on crime" plan to lock everybody up for minor drug crimes and purchasing porn. Right now the wrong group is behind bars. Let them out and lock up the crazies.

3. Public mental health is a joke for the most part. The severe schizophrenics and bipolars are hard to help anyway, even with medication many will have to be institutionalized long term. The depressed and anxious aren't commiting crimes because of mental illness anyway--they need to be told to get a life and get a job, and quit having the State make them into xanax and vicodin addicts.

"Earl Pitts" would say WAKE UP AMERICA! There's no free lunch; Medicaid won't solve a damn thing but will make government deficits worse, increasing the burden on the working middle class.

Grits has repeatedly bemoaned Governor Goodhair's rejection of the "Medicaid Expansion" as have other governors--but they are bright enough to see that the "Affordable Care Act" is a house of cards that is already collapsing on itself and failing in many areas.

The Cavalry ain't coming. Go guy gold.

Gritsforbreakfast said...

8:21, time makes more converts than reason. Two years from now when Texas taxes are paying for Medicaid expansion in other states, please come back to explain how "there's no Meidicaid expansion coming." And sign your name next time.

As for the rest no one denies the criminally insane must still be incarcerated. Nor should anyone deny that when their incarceration ends, they're more likely to commit more crimes without access to meds and treatment.

Earl Pitts, of course, is a satirical character, but I suppose you're free to take his advice.

The Homeless Cowboy said...

There are some horrible realities staring at us here.
1. If you have MHMR problems and you are not in jail then you are pretty much on your own until your lack of meds and un monitored behavior causes you to manifest some type of unacceptable behaviour which 9 times out of ten will land you in the County lockup because even though everyone involved is aware you are an MHMR patient, you go to jail because MHMR is out of money and has no bed for you. I was in the Harris County Jail, in 2008 (Thank GOD for the last time) and the biggest jail they have in their system is called "Big Baker" it is a six floor Jail with 8 tanks to the floor and 4 pods to each tank and 24 men (supposedly) to each pod. That means 4608 men (are supposed to be) in that jail. That jail is ALL MEDICAL. All prisoners in that jail have some type of serious medical condition, or are MHMR. If you have ever been in jail you know that they don't spend a lot of time worrying about you medical condition. That jail runs a nurse to each pod 4 times a day because they have so many MHMR patients that have got to take their meds. When they incarcerate the MHMR patients they then begin making sure that they have all their meds and that they take them as prescribed. The budgets needed to pay for that medication is given to the jails because society feels safer when MHMR patients are locked up like cattle and force fed medicine to make them docile. I have seen inmates who were in bed asleep woken up so they could take their "Clonopin" its a small pill they call "The Green Monster" because people who take them do nothing but sleep. The part they don't tell you is that those inmates are routinely raped and brutalized by other inmates and they miss their meals due to sleeping through them while others eat their food. Mostly the jail staff could care less they are simply there to maintain order and if you leave them alone they will leave you alone. The system is horribly broken and the people who really need protecting are being thrown in with the wolves. Jail officials will tell you a much prettier story, but I was there and I really have no reason not to tell you the truth.

Edward Greff said...

Anon 821 got your goat grits. But sadly he is right. It's noble to think we are going to care for everyone but, it's a fact it is not affordable. Now the unions realize, (despite they early support), they can't pay for Obama Care and want out at tax payer expense. We're all going to be paying through the nose and it still won't work. What difference does it make if it's the feds or the state that takes my money? It will still be gone. Yours is a convoluted argument.

Gritsforbreakfast said...

12:44, in two years time, look up and see whether or not coverage has been expanded in the states that agreed to it. It's a yes or no question. If it's no, then you and 8:21 are right. If yes, then you'll have advocated draining billions from the state's economy to give to other states' health systems, sacrificing the economy on the altar of partisanship. Time will tell. As I said above, quoting Paine, it makes more converts than reason, as it surely will in short order on this yes or no question.

Kerry said...

What a pile of you know what, 8:21. Seriously, tell the mentally ill to just go get a job and that will solve it all, eh? What type of job would you have the mentally ill get, considering that right now, college educated, well trained, young, healthy individuals are having a near impossible time finding work, and that anyone with less then perfect credit, or any type of criminal record no matter how old (easy enough to get when you have a mental illness), or a spotty work history can pretty much forget it.

And should someone somehow get such a job, they will almost certainly not be given medical insurance, since most low wage employers now hire only part time workers so they don't have to pay for insurance, they have no way to get medical care. The ER doesn't treat ongoing metal illnesses.

Diseases like severe anxiety, panic disorder, chronic severe depression, etc don;t just clear up because someone gets a job, any more than schizophrenia does.

So, just lock all the "crazies" up in prison, eh? I hope you never have a family member living through the hell of mental illness in the USA.

Anonymous said...

Funny how all the people on this blog think they know everything about everything.. MHMR's in Texas are used by patients on a voluntary basis, no psychiatrist can force medications on someone in an outpatient setting. Only in an inpatient setting, as outlined in Texas code of criminal procedures, specifically these listed below:

•Article 46B.073, Competency Restoration, for a period not to exceed 120 days.
•Article 46B.102, Civil Commitment Charges pending (Mental Illness), for a period not to exceed 12 months.
•Article 46B.103, Civil Commitment: Mental Retardation.
•Article 46C.251, Not Guilty by Reason of Insanity:Commitment for Evaluation and Treatment, for a period not to exceed 30 days.
•Article 46C.256, Not Guilty by Reason of Insanity: Temporary for a period not to exceed 181 days.
•Article 46C.261, Not Guilty by Reason of Insanity:Extended Commitment for a period not to exceed 12 months.
•Health & Safety Code 574.103 - 574.106 Administration of Psychoactive Medication for Forensic Patients
•Article 46.02, Section 3: Pre-trial evaluations- charges pending

•Article 46.03, Section 4d : Not guilty by reason of insanity (30 day evaluation)

•Article 46.03, Section 4: Not guilty by reason of insanity (temporary- 90 days; extended up to 12 months)

•Article 46.02, Section 5: Incompetent to stand trial, charges pending (maximum 18 months)

•Article 46.02, Section 6: Incompetent to stand trial, charges pending (temporary MH evaluated within 60 days, extended up to 12 months)

•Article 46.02, Section 7: Incompetent to stand trial, charges dismissed (temporary-evaluated within 90 days; extended-up to 12 months)

•Article 46.02 MRPA Section 6 and 7: Patient is mentally retarded; com. terms, same as Sec. 6 & 7 above

•Health and Family Code--transferred to Maximum Security :Mental Health Commitment - (temporary or extended)

•Departmental Rules governing Determination of Manifestly Dangerous

Other than that, unless someone walks in willingly to MHMR to be "treated for their mental ilnees, you are on your own. Even parolees with the special condition "P" on their parole certificates slip thru the cracks because most parole officers have no understanding or training of how the MHMR system works, or is supposed to work. That goes for probation also, they amend their probation requirements to "go" to MHMR and they never follow thru and not many probation officers follow up with MHMR to see if their clients actually make their appointments and take medication. The system is beyond broken and will probably never change because there is nobody ensuring or following up to any kind of standards or oversight of what is actually happening.

ckikerintulia said...

I have shared before on this site the story of a Tulia guy, brother to some of the Tulia accused in the Tulia fiasco, barely to non functional in today's complicated society. Caught in a traffic incident, swallowed what officers thought might be drugs, refused stomach pump, charged and convicted for tampering with evidence, sent to prison. The DA said "I know he doesn't belong in prison, but I have no place else to put him." He died in prison of unspecified causes as a relatively young man.
Tragic situation.

8:21, there is plenty of money available. Our tax rates are at historically low levels. Higher in most of the Reagan years; much much higher in the Eisenhower years; higher in the Kennedy-Johnson and Nixon years. Higher in the Clinton years when we were prospering and had a balanced budget. The GOP has been sold a Norquistian myth which is destroying the government, which is exactly what Grover wants--to drown it in a bathtub.

Mother...and grandma by choice, not by law! said...

Amen, Kerry, Anonymous with the Statutes and ckikerintulia....thank you....the definition of criminally insane is quite different than mentally impaired, ill, or retarded or challenged. Most mental disorders are not controlled with medicationonly, just as physical ailments are not...diabetes takes insulin and an appropriate diet, hbp takes medication and diet changes, high cholesterol takes medication, good diet and exercise. Bipolar, asperger's, adhd, add, pdo, compulsiveness takes, behavior modification treatment or living, change in diet, and medication, proper sleep. These sometimes require inpatient treatments such as drug-related problems, to modify behavior over a period of time...if we treat the children and adolescents early....much of the prison population will not exist, because there are many parents that care enough to seek help, not just for expense of treatment but the resource it self.

Rule followers does not a soldier make or even a good citizen; questioning our methods, thining, reasoning, and learning responsibility for one's self is what makes a good citizen taxayer, employee and soldier in life as well as for country.

I personally have committed to taking care of my own and my family, work hard, keep insurance, and I still must take advantage of all resources available to help survive, in a human law-abiding way, I am thankful for it, and I give back every chance I get. Community service is another great alternative for non-violent offenders, supervised relevant service.