Harris County pleads case for mental health, probation/diversion funds in state budget

While up at the capitol Friday on other business, I ran into some Harris County folks - including former Judge and current jail czarina Caprice Cosper, as well as Alan Bernstein and Dr. Mike Seale (who Grits readers may recall graciously led me on an extensive jail tour last year), along with a small gaggle of others - who'd come to Austin to brief legislative staff on the effects, in particular, of mental health cuts on the criminal justice system and the Harris County Jail. Unfortunately, they'd just finished the event, but I picked up their handouts and read them this morning. Remarkably, the theme of their materials sounds quite similar to that struck in my reaction post on Grits following my jail tour last summer.

Harris Couty is primarily worried that cuts to community supervision, diversion programming and mental health services for adults and children go so deep that the state won't even qualify to receive federal matching funds. A document from the Harris County Commissioners Court further suggests that, from a fiscal standpoint, state spending for mental health should prioritize funding for the "least expensive services" i.e., community based  services, because they are eligible for federal matching funds through either Medicaid or Mental Health Block Grants, or even (in the case of Medicare), fully paid by the feds. Those types of services should be maintained or increased, they argue, while decreasing use of Crisis Services and state mental hospitals, which are not eligible for federal matching funds, through prevention, diversion, and community-based programming.

I've been aware for years that the state pays 100% out of general revenue for mental and acute health care for the incarcerated, while indigent people with serious health problems on the outside are typically served through programs either paid for or matched by the feds. That makes a big difference, in aggregate, regarding how much their health care costs in the state budget, especially for the seriously ill. But I hadn't considered that the same distinction applies to Crisis Services and state mental hospitals. (Half of Texas' state mental hospital beds are designated as "forensic beds" and there's already a months-long waiting list to get treatment for defendants who've been declared incompetent by the courts to stand trial.)

A few headlines from the documents distributed at the briefing give a sense of the overall gist of their message and mental health and community supervision from their written materials:

• "Cuts to Least Expensive Mental Health Services Increase Demand on More Expensive Services (State Hospital) Article II, Dept. of State Health Services (DSHS)" - ed. note, I didn't say they were all snappy headlines!
• "Most Expensive Level of Care at the State Hospitals and Jails"
• "Community-based Services Cost Less and Bring in Federal Funds." 
• "Article V [Criminal Justice] - Don't Cut Programs That Save Money"

Another document calculates "The Cost of Mental Health Cuts in Harris County," recalling that after the last major round or state cutbacks in 2003 (the 78th Legislature), "persons with severe mental illness who couldn't access services and medications soon destabilized and overwhelmed emergency rooms, law enforcement, county jails and state mental hospitals." Houston PD saw an increase of 241.5% in reports involving a person with mental illness from 2007 to 2010, including a 153% increase involving a person with mental illness who was off their psychotropic medications. Further, over the same period "HPD increasingly responded to calls involving the same person with mental illness.

• "Persons with 2 police encounters - 142.1% increase
• "Persons with 3 police encounters - 148.6% increase
• "Persons with 4 police encounters - 383.3% increase"

Also from '07-'10: Constables transported 32% more patients in psychiatric crisis from one facility to another," and "The number of persons in psychiatric crisis that the Constables picked up pursuant to court order (Mental Health Warrant) increased by 55%. Remarkably, the Harris County Hospital District had a 482% increase in psychiatric emergency admissions from 2007-2010, while the number of detainees at the Harris County Jail receiving psychotropic medications increased from 608 to 2,400 over the same period, according to the handouts.

In lieu of incarceration, hospitalization, or traditional probation, Harris County suggests the Legislature create "additional community-based options, an intermediate level of care (Medicaid Home & Community-based Services) would cost around $20 per day. The federal share would be $12 and the state share $8. (Note: Texas does not have an intermediate level of care.)" They suggest increasing line items for community mental health services to preserve matching funds for federal block grants and restoring prior levels of funding for probation/diversion programs, TCOMMI (mental health) funding, and drug treatment. I agree with all these suggestions and have suggested in the past how TDCJ and the Legislature could cut in other areas to not only justify but leverage that spending.

Pressure on the number of forensic hospital beds, which have remained static in recent years and are threatened with cuts, has been growing at an equally alarming rate: "The number of criminal defenants who needed to stay for the maximum number of days allowed for initial forensic commitments (120 days) rose by 30%." "In FY 2009, 57% of the initial forensic commitments were for the statutory maximum."  Finally, "Since the statewide waiting list for forensic beds began in February 2007, about 300 incompetent defendants wait 4 to 5 months at the jails for an available forensic bed." Good stuff on a topic that's important to jailers and judges but too often ignored in the swirl of capitol budgetmaking (or at least it was in 2003).

They want juvenile probation funding fully restored, which is understandable given the recent de-institutionalization at TYC. "Because of the availability of more community-based alternatives," they declare, "Harris County has reduced TYC commitments by 62 percent since 2007."

Since I caught them in wrap-up mode after their audience had left, I don't know how well the Harris County briefing was attended, but with scarce few exceptions, I couldn't agree more with their principal message as expressed in these handouts. Population-wise, Harris County is itself bigger than twenty-some odd states, big enough to force it to think about these problems in systemic instead of simplistic terms. The jail is a behemoth in the county budget and criminal justice spending is a big driver of county tax rates. So I'm glad to see Harris County advocating for reduced reliance on the "Most expensive level of care at State Hospitals and Jails" for the mentally ill. The officials' presentation to the Lege was precisely on point, as far as I'm concerned, though I'd add that there are also members of their own local judiciary who would benefit from a similar education session about fiscal priorities and the need to prioritize less expensive alternatives to incarceration.