By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
Gerry McKimmey, TDMHMR director of community services, denies that the state wants local agencies to serve insured people at the expense of the indigent. However, he concedes, "economics often force the choice."
Everyone agrees that one key to better mental health care for the poor is more public money. But MHMRA could do a better job with the money it has, say some patients and advocates. They were outraged to learn, for example, that MHMRA had offered to return $2 million in state funding for the latest antipsychotic medications because the agency was slow getting the drugs to the people who need them.
MHMRA also has been criticized for its handling of federal housing grants awarded between 1993 and 1996. A local committee charged with monitoring the grants in June 1997 found that MHMRA had spent little of the $5.4 million it had received. Subsequently, MHMRA's application for a grant renewal was ranked 31st out of 31 proposals. Unless federal housing officials decide to reject several higher-ranking proposals, 113 mentally ill people could lose their $437-a-month housing allowances.
To many critics, MHMRA is strangely out of touch with the reality of mental illness. The agency has discontinued or scaled back education and training programs that help the mentally ill lead more stable, independent lives. And while many mentally ill people are eligible for Medicaid or disability insurance, less than a quarter of the patients who applied for those benefits through MHMRA last year were approved by government reviewers. Robert Hager, an attorney who handles disability claims for the mentally ill, says MHMRA doesn't aggressively pursue these all-important benefits for its patients. "If they wanted to live up to their mission statement," says Hager, "MHMRA would be getting every damn person they can in the safety net and out of uninsured status."
Such problems could not have come to light at a worse time for MHMRA. Since taking over as executive director in 1992, Schnee has kept local mental health advocates focused on a common goal: more state funding. Indeed, MHMRA is part of a statewide "community coalition" whose goal is to convince the Texas legislature to add more than $1 billion to the state's mental health budget by 2007; MHMRA wants $50 million more a year for Harris County.
"I don't know how many times I can say that the state of Texas is 43rd per capita in the United States," Schnee says. "Or that Harris County is $10 million a year below the average for the rest of the state in per capita funding. Ten million would buy a lot of services for the uninsured."
No one disputes that. But MHMRA's harshest critics contend that money isn't the agency's only problem. They believe the failure to deliver new drugs to patients or to manage a federal grant to keep 113 of them off the street reflects a public mental health system on the verge of collapse.
"It's the perfect opportunity to ask some probing questions," says Joe Lovelace, a former president of the Texas chapter of the National Alliance for the Mentally Ill, whose son suffers from schizophrenia. "Is this how we want to do business with finite resources? What model do we use to get this money, which we certainly hope to get more of, to the customer?"
One Friday in September, word came from MHMRA's executive offices that 28 of 29 case managers at the agency's six adult mental health clinics were being let go. One case manager remained at the Bayshore clinic. Two weeks later she was gone too.
Most of those workers have been reassigned within MHMRA. But more than 9,000 patients are now without a service they had used perhaps more than any other. Case managers help patients keep their appointments, arrange transportation to the clinic, track down leads on jobs and housing and, in general, navigate people with mental illness through MHMRA's daunting bureaucracy.
"They are much more important than any doctor or medication," says Kristi Huddleston, an MHMRA patient who was so overcome by the change that she wept openly at a September 11 meeting of the Adult Mental Health Planning Advisory Council. Huddleston says nurses are expected to handle some of the case management duties -- news that wasn't welcomed by at least one nurse who, according to Huddleston, left MHMRA after 20 years.
At the Bayshore clinic, the agency reassigned the only Spanish-speaking caseworker and gave translation duties to a bilingual clerk. But clerks aren't supposed to know anything about the patients' medical conditions or treatments, Huddleston says. In her view, patients would be better off if MHMRA had kept the caseworkers and cut administrative positions.
"Why not start with the people who do not serve the consumer?" she asks.
That's what Patricia Tamedy wants to know. A licensed psychologist at MHMRA's southwest Houston clinic, Tamedy says she was fired for openly criticizing the decision to eliminate case management services. She also protested the reduction of clinical teams from eight members to three: one physician, a so-called licensed professional of the healing arts (a therapist or social worker) and a clerk. The move was supposed to create more teams, thereby reducing each team's caseload from 450 patients a month to 350. The result, Tamedy says, has been "chaotic."