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:

• Few bills proposed at Lege to remedy statewide competency restoration crisis
• Budget cuts would force police officers, jails to care for mentally ill
• Harris County pleads case for mental health, probation/diversion funds in state budget
• Jail deaths implicate state oversight, competency restoration funding
• Mental health cuts by state would shift costs to local jails, emergency rooms
• 'Harris County jail not the place to treat mental illness'
• Competency restoration often best performed on outpatient basis 
• The making of an unfunded mandate: Cuts to mental health would dump costs on county jails
• Cuts to state mental hospitals would be massive unfunded mandate for county jails
• Mentally ill languish in Bexar jail awaiting assessment, competency restoration
• Cuts to state mental health treatment would shift costs to local jails
• Cutting state psych hospital budgets could backfire
• Legislature's underspending on competency restoration beds creates havoc
• Priorities: Mentally incompetent inmates languishing in Texas county jails
• 75-year old mentally incompetent grandmother stranded in Lufkin jail most of 2006
• Legislature should prioritize mental health funding that relieves local jails
• Chincy state hospital funding leaves mentally incompetent defendants stranded
• Unfunded mandate: Counties struggle to pay for mentally incompetent defendants' care
• More counties grumbling at backlog of incompetent defendants in county jails
• When I was sick, did you imprison me?