Psychotic Reaction

Need emergency psychiatric care in Harris County? Have a seat. Or call a cab.

Larry Newton knows firsthand that psychiatric crisis care in Harris County is a tragic mess. With a 12-year history of manic depression, the 35-year-old Newton routinely depends on the public health care system for emergency mental health care, often with miserable results.

Late last year, Newton was in a manic phase, a recurring period of excitation that alternates with moods of emotional dejection, when he decided he was in urgent need of psychiatric help. He took a cab to the Mental Health and Mental Retardation Authority's crisis clinic on Caroline Street near downtown, arriving around 3 a.m. There, he found just one nurse on duty, who told him to sit and wait. He did so until 5:30 a.m., "when the buses started running again," and was told to take a Metro bus home and then go to a MHMRA clinic that keeps daytime hours. The crisis clinic had seemed like a better bet for Newton that night than the emergency room at the county's Ben Taub Hospital, since, he says, "the line is too long at Ben Taub" and psychiatric patients end up "waiting hours and hours before seeing a doctor."

Newton's previous trips seeking emergency care at Ben Taub's eight-bed psychiatric unit had yielded mixed results. Once he was given a voucher for a cab ride home; two other times he was forced to stay through the entire weekend in the emergency room before he was admitted to the Harris County Psychiatric Center. During another visit, he bolted as he was being led to a cab to be sent home. He ran all the way to a washateria on lower Westheimer, where he passed out and later was picked up by an ambulance and returned to Ben Taub.

Such experiences are the norm rather than the exception for some of the estimated 20,000 Harris County residents who are in need of public mental health services. The eight beds in Ben Taub's psychiatric unit are simply not enough to meet the emergency mental health needs of the county's three million residents.

The Texas Department of Health said as much in June when it cited Ben Taub for deficiencies in its psychiatric unit, warning that the hospital could lose millions in Medicare reimbursements if corrective measures weren't pursued. That seemingly dark threat was in fact good news of a sort for county hospital district officials, who were keenly aware that something needed to be done to improve a situation that on weekends had patients sleeping on gurneys and reclining chairs in the psychiatric unit's hallway.

"They told us, 'You're trying to do too much.' I got told in June that was it," says Ben Taub administrator Mike Bullard. The state's report, which instructed Ben Taub to quit taking so many patients and stop putting them in a locked ward without their proper consent, is being used as leverage by hospital district officials trying to dislodge the inter-agency logjam that for years has crippled the county's psychiatric crisis care services.

"I think we all welcomed this," says Dr. Timothy Bayer, head of psychiatry at Ben Taub. "We knew it was a problem and we thought if we had the state on our side saying something had to be done, people's attention would be gotten."

An additional attention-getter occurred over the busy Labor Day weekend when Bullard, in part because of the state's warning, decided to divert psychiatric patients away from Ben Taub. The hospital district years ago had created a stir by resorting to a similar "drive-by" maneuver when Ben Taub's emergency room overflowed with trauma patients. Such "drive-bys" of psychiatric patients may be more frequent in the future if short-term solutions aren't found for crisis care.

Ben Taub, a familiar choice for the longtime uninsured and a last resort for newly uninsured, ceased to be an option for those in need of emergency psychiatric care on the night of Monday, September 5. Earlier that weekend, Bullard had told the Houston Police Department to take mental patients elsewhere, and close to midnight on that Monday, he gave the same directive to the city's Emergency Medical Services ambulances.

But there is no "elsewhere," at least not in the public sector. The county's MHMRA runs a crisis care clinic, but it has no inpatient beds, no general medicine backup and is unable to hold patients if they refuse treatment and want to leave. The 250-bed Harris County Psychiatric Center is usually full, and even if it isn't, it has no emergency room and is closed on nights and weekends.

Consumer activist Mike Harvey says it's "unconscionable" that the HCPC's admitting doors are open only during weekday working hours.

Harvey has a manic depressive disorder and has been a consumer of mental health services in Harris County for more than 30 years. "Whenever I had an emotional break and had to go to the hospital it was on the weekends, it was after hours or it was on holidays. It never failed. If people out there think we get sick between 9 and 5, Monday through Friday, that's horsefeathers. It does not work out that way. Most people do not get sick in that time frame. Nighttime is very bad for mental patients."

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