Psychotic Reaction

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

Betty Cobb of the West Houston Alliance for the Mentally Ill says much of the problem the county faces in providing emergency psychiatric care stems from inadequate funding and poor organization, not a lack of effort.

"We admit that everything stinks, but there are good people trying to do their jobs. That's what is sad -- those good people get their names bloodied," Cobb says. "I only know good things about Ben Taub. You can't blame them if they don't have

a bed."
Cobb recalls the story of one mother whose son did not seek the psychiatric care he urgently needed because of his past experiences with the crisis care network. One day he left home and disappeared. His parents notified the authorities, posted fliers and did everything that parents in such a

desperate situation would do. Cobb saw the mother several days later. She was smiling "I said, 'How's your son?' She said, 'Oh, I'm so thankful. He's in jail.' That's how sick it is."

A mental health worker employed by one of the agencies says the system gives patients only cruel choices. "It's a Catch-22. If you're in the midst of psychosis, you might have to wait two hours. But if you can sit still two hours, you're probably not in the midst of psychosis."

Harvey says the problem, if not the solution, is simple: "Basically, you can't get timely service. You can't get relief for your episode within time to do any good. It just exacerbates the problem."

The desperation of Ben Taub's resort to the Labor Day "drive-by" has led to a heightened awareness of the problem. The Mental Health Needs Council, composed of officials from the county agencies that deal with mental health, will meet this week to discuss crisis care, and representatives of MHMRA and the hospital district already have met with County Judge Jon Lindsay to discuss ways to improve the situation. They hope to have a plan ready by the end of this month that will include interim improvements. The long-range goal is to have an expanded outpatient crisis center, possibly in leased space at West Oaks Hospital, a private facility.

But insufficient state funding will remain a problem. Texas ranks among the bottom five states in per capita spending on mental health, and Harris County is below average for the state's counties, receiving $22.13 per capita from the state compared to an average of $27.56. Harris County MHMRA director Steven Schnee says he's not "terribly optimistic" about more funding. Others speculate the MHMRA budget statewide will take a big hit during next year's legislative session.

MHMRA has responsibility for most of the county's public sector outpatient psychiatric services, while the county hospital district runs Ben Taub and the 24-bed psychiatric unit at Quentin Mease Hospital. The Harris County Psychiatric Center, funded by the state and county and staffed by the University of Texas Health Science Center at Houston, provides inpatient care.

"You have these agencies, each of whom have some mandate to provide some mental health care but it's not clear who is supposed to be doing what," Bayer says.

As MHMRA and the hospital district negotiate solutions, officials hope the Harris County Psychiatric Center can find ways to admit patients during off-hours and to free up beds. That won't be easy, partly because of the opposition the HCPC faced when it first opened on South Macgregor. Concerns by residents of nearby neighborhoods over the type of facility it would be led to an agreement that the HCPC would not have an emergency room and would only admit patients during something akin to normal business hours.

"When the hospital was proposed, the community was in an uproar about the possibility of the hospital having an emergency and [outpatient] setting and having problems accepting [that] there might be mentally disturbed individuals at all hours of the night walking around the neighborhood," says David Small, the center's administrator.

These concerns are still perceived to exist, to the degree that when a patient is transferred to the HCPC from Ben Taub at a relatively unusual hour, a "stealth admission" is conducted by sending the patient over in a cab rather than an ambulance.

It is also argued that opening the center to night admissions will be futile if it's already full. "What's the point of being open at night if we're full at 4 p.m.?" asks one HCPC psychiatrist.

In addition to expanding the HCPC's hours, another proposal being considered calls for county patients in need of longer-term psychiatric treatment to be shipped to the state hospital at Rusk in East Texas. The intent would be to free local beds for patients needing shorter stays, but Small thinks the benefit would be marginal and short-lived. The move would create a few bed openings the first time it was done, but they would soon be filled by the overwhelming demand. "It would be a one-time gain that would be quickly used up and you'd never see it again," he says.

Shipping more patients to Rusk also would result in a reduction of state funding to Harris County for psychiatric care. "Rusk wouldn't be anxious to start many more patients from Harris County, since we are their largest supplier of patients," Small says. "And every patient at Rusk, those funds are counted against funding that would come to the county."

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