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However, far more than agencies may be affected. Robert Hager, a local attorney who specializes in the representation of the mentally impaired, says the budget shortfall should be cause for concern for public safety as well.
Of special interest to Hager, a member of the county's MHMRA's Adult Mental Health Planning and Advisory Council, is the threat of funding cuts for new-generation medications, anti-psychotic drugs with fewer side effects than older pharmaceuticals.
"There are a lot of [clients] at MHMRA that go on and off of treatment because they can't stand the bad side effects of the cheaper medications," says Hager. "That's all the more reason in the name of public safety to try and figure out some way to get everybody on the better medications so that people will stay on them, and not be dangerous."
A case in point, says Hager, is death row inmate Larry Keith Robison, who was scheduled to be executed last Tuesday for the 1982 murder of Bruce Gardner near Fort Worth. Robison's family members say they tried in vain for months before the killing to get Robison treatment for his schizophrenia.
Steven Schnee, executive director of MHMRA of Harris County, agrees that a reduction in mental health dollars will have a ripple effect on other state and local agencies.
"We are indeed concerned about the potential implications of any funding reductions," Schnee says. Officials are worried that there will be an increase in the number of mentally impaired people who wind up in emergency rooms and jails instead of treatment centers.
In the current fiscal year, MHMRA of Harris County received just under $31 million in state funds. It is still unclear where the cuts will be made for the next budget year. However, Schnee says there could be a $5 million reduction in the allocation for the purchase of new-generation medications statewide.
Thus far, Schnee says, MHMRA of Harris County has received no official notice of the budgetary problems.
Attorney Hager, in addition to sounding alarms about public safety, also criticizes MHMRA for its lack of emphasis on signing up patients for Medicaid, especially in light of the anticipated budget shortfall. Medicaid would subsidize the treatment costs, freeing more funds for other programs by the agency.
Recently the Rand Corporation, under a National Institute of Mental Health grant, did a two-year study on the homeless in Harris County. Its findings showed that only 28 percent of the county's MHMRA clients had been signed up for Social Security and Medicaid benefits, compared to more than 90 percent of similar clients in California.
"I'm irritated because the Rand Corporation released their findings in November of 1998," says Hager. "So, you can't go around complaining and whining and crying about 'woe is me,' and then basically avoid what is an almost endless stream of potential funds [via Medicaid]."
Hager makes the same complaints about the agency's failure to get patients Social Security funds, which would provide basic living expenses for them.
"Can you imagine what it's like to be mentally ill and have no money," says Hager. "The bottom line is that local MHMRA centers in Texas have not been effective in getting [mental health] consumers on SSI and Medicaid.
To some extent, Schnee agrees with the criticism.
"Mr. Hager's comments are very important," says Schnee. "And certainly to the degree that folks could qualify for SSI, and thus be eligible for Medicaid, would be very beneficial."
Schnee says Texas makes it more difficult than other states to get SSI coverage for potential clients. He did not provide specifics on the issues he raised.
"The rules are the same for every state and established by the federal government," says Hager. "You either [qualify or not] based on federal regulations, not on something the state does or doesn't do."
Hager, however, believes the state Department of Mental Health and Mental Retardation is taking steps toward getting local agencies to more aggressively pursue SSI and Medicaid coverage. Part of the problem, he says, is that the local MHMRAs are basically autonomous from the state agency.
"They are independent to a great extent," says Hager. "It's not like the folks in Austin can actually force the local folks to do anything."