Downing

Texas Lottery. Let's buy our tickets and bet on the day that Robert Arthur Pearson finally kills himself in public while we all watch

Okay now, everyone, is there anybody who needs any more CLUES? Robert Arthur Pearson is a man in serious danger of killing himself and maybe hurting or killing some other people on his way out. The brain-dead can see this one coming.

So what does that say about the mental health system in Houston? All polite qualifiers aside, what it says is: It's not working. In fact, you might say it is inadequate. You might even say, if you were a rude and vulgar person, frustrated by a seeming obliviousness on the part of mental health experts, well, if you were that kind of rude and vulgar person, you might even say it sucks.


Mental health folk aren't allowed to talk about "specifics." What that means is without a patient's permission, they can't discuss specific cases. They can talk only in generalities. And while those generalities are certainly understandable for the necessary good of protecting an individual's privacy, they can make for a very roundabout path to understanding why Robert Arthur Pearson keeps getting hauled in and turned out on the street again within days.

Basically the system works like this: If someone exhibits signs of mental distress that could be a danger to himself or others, he can be voluntarily committed. A person can also be involuntarily committed for the same reasons, if someone else can legally prove those criteria to a court's satisfaction. Another route is for a person who is hauled to county jail to behave in a strange enough way to be assessed on the third floor there and if needed, taken on to Ben Taub's aforementioned psych unit.

The Ben Taub facility is designed for 24-hour crisis management: an assessment, stabilization as much as possible and a quick stay. If it can be established that someone needs longer treatment, the person can be moved on to the Harris County Psychiatric Center, where, spokeswoman Geri Konigsberg says, the average stay is ten days. Again, though, this is not long-term treatment. This is the acute care inpatient facility serving the county's indigent population and is part of the University of Texas-Houston Health Science Center.

If someone is really messed up and a case can be established for longer treatment, the patient is referred to Rusk State Hospital.

Or, as happens much more often, a patient brought in for initial assessment will be referred to one of the clinics throughout the city operated by the Mental Health and Mental Retardation Authority of Harris County.

The clinic system is far from perfect. Clients must take buses to get there. They must make it to their appointments on time. If they don't, or if they don't show, they are bumped from the system and have to reapply to be admitted.

What's most crucial, the clients themselves are responsible for taking their medicine. Many do not. In fact, according to Lieutenant Robert Cain, head of HPD's hostage negotiating team, 90 percent of the people having psychotic episodes when picked up by police are not taking their medicine. They don't like the side effects, which can be debilitating, or they get to feeling better and they just don't think they need it. They cannot be forced to take their medicine.

Steve Schnee is the executive director of the MHMRA, the gatekeeper of public mental health dollars for the indigent in Harris County.

As he explains it, the law requires that a mentally ill person be placed in the least restrictive environment possible. A person may need continued treatment and care, but once a person stops being a danger to himself and others, he is expected to receive that care in the least restrictive way. If a patient makes it only as far as Ben Taub's psych unit, the next step down is back out in society.

When patients reject mental health treatment, they become the recyclers in the mental health system. And this is costly. "They recycle back into the most expensive parts of the system," Schnee says. "We see people in the community who go in and out of the system."

Any talk of mental health in Harris County gets back to money rapidly. There are limited mental health dollars available for treating the indigent. Texas is 43rd in the United States in per capita spending on mental health. The system is stretched beyond belief.

Critics say that thanks to the directions of the Texas Legislature, the mental health authority has become pretty much a service industry for Medicaid patients, giving them preferences for slots, and is leaving the uninsured indigents who don't have Medicaid.

"Funding streams for the uninsured are woefully inadequate," Schnee acknowledges. MHMRA has to identify the people who have "third party resources," i.e., Medicaid, and set aside treatment spaces for them, he says. It used to be that 40 percent of all the patients it treated had Medicaid, he says. That has increased, which means that the numbers of uninsured patients it is able to see are shrinking.

Betsy Swartz, executive director of the Mental Health Association of Greater Houston, an advocacy group for the mentally ill, says, "At least half if not more of the current MHMR population are not Medicaid eligible."

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