Nowhere to Land

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

Instead of 800 patients, it averaged 1,200 to 1,300 people a month, MHMRA Executive Director Steven Schnee says. Instead of the equivalent of ten full-time psychiatrists, they started with six and a half. Resources stretched, the center became known for long waits before evaluation and treatment, a situation it has yet to correct, although Schnee says they've improved. "We have reorganized the staffing patterns."

Still, he told the MHMRA board at a trustees meeting July 25: "We don't provide the level of active treatment we all are seeking to provide."

There have been frequent staff turnovers among higher-ups. The first medical director quit, leaving the staff directionless and in chaos. They have just recently hired a new medical director, Dr. Avrim Fishkind, and Barbara Dawson, the former director of the Richmond State School, has been on board only three months as acting director of NPC. The director of nursing just started as well.

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.

The second floor, which was to house those 39 beds, has never opened. In fact, at the July 25 board meeting, Schnee suggested it might be better not to ever open it as a hospital, instead licensing it as a "crisis stabilization" center. It would be "very similar in appearance" to a hospital, Schnee said, but wouldn't have to adhere to the higher standards of hospital accreditation and could thereby save money.

Gerald Womack, a member of the MHMRA board, was the only one at the meeting to challenge Schnee about the proposal to step down from hospital status. "I think the people of Harris County really have it in their heart that we would have a hospital," Womack said quietly.

But other board members may be swayed by the money message delivered by Schnee. State tax money isn't covering first-floor operational costs; the revenues coming in aren't doing that either.

On September 6, the second floor will finally open. But it won't have the promised 39 beds. It'll have 16. By cutting it to a max of 16 beds, the facility qualifies for "crisis stabilization unit" status. And they'll be able to bill for certain programs supported by federal funds, payments that wouldn't be allowed if they were a hospital, Schnee says.

Schnee insists this is no betrayal of the public trust. He is working with a limited amount of tax dollars. NPC has established there is a tremendous need for immediate crisis help. They may still open the remaining beds, he says, if that's in everyone's best interest.

Out of necessity, the courts have certain requirements to protect the rights of people in commitment procedures. But relatives of the mentally ill complain they must take off work, jeopardize their jobs and come in at all times of the night and day to fill out paperwork that is already on file with the county's mental health system.

Acting Director Barbara Dawson readily acknowledges that this hasn't been working as it should. Yes, the admittance process is redundant, lengthy and complicated. (Amazingly enough, it is still faster than the Ben Taub emergency room's, MHMRA people say, adding that police prefer to come to them so they can get out on the street faster.)

And people who come to NPC for help but have no third-party insurance, such as Medicaid or Medicare coverage, are sent on to the Harris County Psychiatric Center, where 143 state-funded beds are available. Whereupon they find themselves filling out the same paperwork they just completed, again.

All this has resulted in enough of an outcry that NPC has started meeting with the probate courts (which are in charge of mental health commitments) and the HCPC to come up with some way to streamline the process, thereby rescuing patients and NPC personnel from hours of paperwork and getting to treatment sooner.

Tim didn't last long at Eva's, getting himself ejected in short order for the second and final time. Dale Ramey became a wild woman, looking for a place to put him. She was able to get him into Bayou City Medical Center, but this was short-term. She appeared before the MHMRA board, begging for help. Schnee assured her they would try to do something, and Deputy Director Rose Childs began working on the case.

But promised return calls from Childs didn't come through as fast as Dale wanted. Dale grew more frantic and began contacting any legislator she could think of, any organization that's supposed to represent mental health consumer rights. She was told there's a place in Mount Pleasant with long-term care beds set aside for each county in the state. But Harris County's one bed was taken, and although one county can contract or "buy" a bed from another, Dale was told Harris County has no money for residential care of the mentally ill.

She was told Rusk was not an option. Schnee says they will send people to Rusk, but prefer to keep them closer by. Where was she supposed to put Tim?

Finally Rose Childs resurfaced with directions to what looks like the next best hope for Tim. He is now part of the Continuum Healthcare System Inc. It gives him residential housing on Southmore at night and vans him over for a day counseling program at the for-profit company's Texas Serenity Community Health Center facility on Airline in north Houston.

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