Tuesday, July 27, 2010

Cuts to state mental health treatment would shift costs to local jails

As we approach an 82nd Texas Legislature that will be dominated by big-picture budget decisions, arguably cuts to mental health spending may be the biggest looming crisis for the justice system at all levels. Lillian Aguirre Ortiz of Mental Health America of Greater Houston recently outlined the effects of proposed cuts to mental health services in a column in the Houston Chronicle:
While legislators are expected to face a difficult financial situation during the 82nd Texas Legislature, our state's leadership needs to fully understand and consider the ramifications of the proposed $134 million in cuts. Untreated mental illnesses lead many individuals to cycle in and out of homelessness as well as our emergency rooms, jails and prisons. Lack of treatment also leads to an increase in the utilization of police man-hours since law enforcement personnel are often called in to deal with individuals experiencing a mental health crisis. Any further erosion of the limited services currently provided to the state's most vulnerable mental health patients will exacerbate what should already be considered a serious public health and public safety issue.

The proposed cuts include $80 million that would be taken from the state's 39 publicly supported community mental health centers, which provide psychiatric care for poor or uninsured people. The cuts would also eliminate services to 11,000 adults and 2,000 children across Texas. As it is, more than 900 adults are on a waiting list each day for mental health services from the Mental Health Mental Retardation Authority of Harris County (MHMRA), our area's public mental health center, for treatment of schizophrenia, bipolar disorder and severe depression. The approximately 400,000 adults in our area with other mental illnesses have to try and find services elsewhere regardless of their ability to pay for treatment.

In addition to the adults waiting for care, 75 percent of our community's children in need of help from the public mental health system do not receive treatment services. Perhaps this is why half of the children in the Harris County Juvenile Probation Department have a diagnosable mental illness and 55 percent have been diagnosed with a substance abuse and/or chemical dependence problem.

An additional $44 million in proposed cuts would eliminate 183 beds, or 12 percent of their total capacity, from five state psychiatric hospitals. These facilities are already unable to take many of the state's sickest individuals due to a lack of available beds. As a result, the Harris County Jail houses an estimated 80 inmates each day who are simply waiting for one of these beds, a scenario repeated throughout the state. Eliminating the 183 beds, which have the potential to serve thousands of individuals, will further contribute to the fact that the Harris County Jail is now the largest provider of mental health services in Texas.

To make matters worse, a $10 million reduction to psychiatric crisis services, which would cut care to 6,000 people statewide, is also included in the proposal. An overall lack of community based mental health services, which help keep people stabilized and out of expensive crisis care, has led Texas to rely heavily on its mental health crisis system. Cutting this safety net for the sickest individuals is not only irresponsible, it's inhumane.
Such cuts would inevitably, inexorably create further crises down the line: For example, cutting the number of state hospital beds will increase the backlog of mentally ill people warehoused in county jails awaiting competency restoration. Indeed, county jails are already packed with mentally ill inmates due to a lack of community based services. The FOX station in El Paso reports that 4 in 10 jail inmates there have been diagnosed with a mental illness. Not only does cutting state mental health funding shift costs to locals, dealing with them at the jail is a lot more expensive than community-based mental health treatment, so such cuts would be a de facto decision to treat these offenders in a more expensive, less therapeutic fashion, and then only after they've harmed the community enough to warrant incarceration. That's just not smart policy.

In addition to cuts at the Department of State Health Services, the Department of Criminal Justice has suggested that if it's required to make deep spending cuts it will slash mental health spending, drug treatment and diversion programming first. All told, mental health funding appears to be a likely first choice for the chopping block across the board.

On the corrections budget, I'm reasonably confident it's possible to cut costs safely if the state closes prisons and sustains or preferably doubles down on diversion and community supervision funding. However I'm not nearly so sanguine it would be safe to dramatically slash mental health spending, and my suspicion is that doing so would radically increase costs in other areas, particularly local jails and courts.

For those concerned that state budget cuts next year might harm public safety, don't worry about closing prisons. Worry about the consequences of reduced access to mental health treatment.

RELATED: See "Closing the Barn Doors" from Murray at Life at the Harris County Criminal Justice Center.


Hook Em Horns said...

Other states have done the same thing. This does not,necessarily mean a reduction in services, however, the burden to pay for them shifts from the State to the County or other municipality.

Anonymous said...

TDCJ policy is to release prisoners with a 10 day supply of meds. This is rarely done now, one of their proposals is to release them with no meds and just give them a copy of their med pass. Does anyone at TDCJ know that most MHMR's already have access to the TDCJ EMR and can print these med passes already? What a scary world this place would be if the heads talked to the hands doing the actual work..

Anonymous said...

1. Decreasing services offered takes the burden off of the front line and passes it on down the line to the community and jail/prison system.
2.It would be interesting to see an actual financial "sustainability data" of the proposed reduction and even the current status. I suspect it would be found that more money is really being spent.
3. The harm done by this mind set of our politicians contributes to the stigma of those individuals being different and therefore has ignored how MANY can be returned to become productive members society rather than becoming seen a burden. Their rights are being ignored