Nowhere to Land

Crisis care for the mentally ill crumbles under the weight of not enough money, too much beauracracy

Tim Ramey is an unfortunate 26-year-old soul whose mother loves him dearly even though four years ago he almost raped and killed her. Mentally ill, he will always need structure, medication and guidance. Because of his problems he won't be able to get that living with his parents.

"I want to take care of Tim, but I am deathly afraid of him," Dale Ramey says sadly about her son.

For the most part, his life is a not unusual pattern of partial victories followed by devastating defeats. His latest crash and burn commenced on July 30 when he was transported to the NeuroPsychiatric Center from Eva's Personal Care Home after he took a razor blade and made superficial cuts on his arms, threatened to kill a caregiver at the home and then said he was going to kill himself. His ACT (Assertive Community Treatment) team, a sort of roving unit of troubleshooters working for the Mental Health Mental Retardation Authority, hustled him to the emergency facility in the Ben Taub Loop. Things were being handled and would get better soon.

Tim Ramey is okay now -- at least for the next 90 days.
Deron Neblett
Tim Ramey is okay now -- at least for the next 90 days.
Tim Ramey is okay now -- at least for the next 90 days.
Deron Neblett
Tim Ramey is okay now -- at least for the next 90 days.

Except that's not the way it went. At least not according to Dale and Tim Ramey.

Tim's father, Bobby, got a call around 1 p.m. from Eva's that his son was being taken to the psychiatric center. Bobby immediately called NPC to get his son's status and to give authorization for treatment. In the next two hours, Bobby made three attempts to work with the center's staff. All failed. They refused to acknowledge his guardianship. He was told he would have to come to the medical center facility from their Spring Branch home and show them legal proof. He kept being told someone would talk to him about it further, but no one came to the phone.

Tim finally called his father himself from the psychiatric center around 3 p.m. and told Bobby he was going to have to come down to the medical center. But Bobby had to be at work by 3:30 p.m., and Dale was out of town on business. Bobby told his son he was just going to have to wait for Dale.

By 6 p.m. Dale got back and spoke with the center's staff, which had gone through a shift change, meaning she was starting all over again. Dale learned her son had been sitting in the waiting room since his arrival about five hours before. She was told he had received no treatment, no medication and had not been seen by a doctor because consent papers had not been signed. Dale wanted to know why the ACT team hadn't handled the paperwork for Tim's admission since it has the authority to do so. She was told her son had just been dumped off at the door. Both Tim and the ACT team say this was not true; that the ACT team representative talked to the center staff and was assured an evaluation would begin shortly.

Dale told NPC staffers they already had her son's information in the center's own computers; past NPC administrators had assured her anytime Tim came in, they would have all the information they needed. Within 15 minutes NPC faxed her the consent forms. Five minutes later she faxed back signed forms and guardianship proof.

The next call came around 8:30 p.m. when another NPC staffer said Tim was about to be discharged, without medication, without a treatment plan. Dale pleaded with them to keep him overnight, and they finally agreed.

Half an hour later she got another call. Nope, Tim couldn't stay without a mental health warrant. The doctor on duty refused to keep him there without one. The warrant would have to come from the owner or acting house manager of Eva's Place, firsthand witnesses to Tim's outburst. Dale asked if her husband could file it after he got off work around 12:30 a.m. since Tim had told him he was going to commit suicide over the telephone. No.

Around 11 p.m., an ACT team member talked to NPC and was told the mental health warrant was not needed, that NPC had dropped the ball on the admissions process, a special waiver was being granted and Tim could stay the rest of the night, Dale says.

Which he did, sleeping in a waiting-room recliner.

Tim Ramey has no clout, no leverage, no way to wheel and deal. Toss someone like him into a stressed-out, understaffed facility like NPC, too many of whose personnel clutch to rules and regulations like a life jacket, and sometimes things go very wrong.

Of course, this was not the way things were supposed to be.

MHMRA, the agency authorized by Texas to allocate state mental health services money in Harris County, opened the $5 million NeuroPsychiatric Center last October, far later than planned. Designed as an emergency center replacing the downtown Crisis Center, it was to relieve the load of people who'd been going to the adjacent Ben Taub emergency room.

Equipped to handle about 800 patients a month in so-called 23-hour care and to provide 39 beds for overnight stays of three to five days, NPC was overwhelmed from the start.

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