Catch Us If You Can

Steve Chesser went to MHMRA for help. Sent home from its emergency clinic without medicine or therapy, he shot his and killed himself. Diagnosis: A mental health care system in free fall.

Inspectors gave Cresthaven two weeks to comply with state health and safety standards. The facility failed two inspections and was denied state certification until August 1994, after which Schnee immediately laid off the additional staff from Nursefinders, claiming the need to cut costs. Eventually Cresthaven was taken over by state health officials, who appointed trustees to assume operations.

At the time, Schnee complained that investigators' findings were taken out of context and pointed out that Cresthaven's patients were severely retarded, some bedridden and incontinent. He blamed the state's failure to increase Medicaid payments that would have funded improvements. "This facility has always been held to be an example of high quality," Schnee told the Houston Chronicle at the time. "That doesn't mean it was perfect."

At least one local advocate called for an inquiry by the MHMRA board of trustees into Schnee's dual role as head of the agency and operator of a private nursing home for the mentally retarded. Schnee denied any impropriety, saying he had never referred an MHMRA patient to Cresthaven and that, in fact, he had no control over who was treated there. Apparently that was enough for trustees, who declined even to discuss the matter. In a prepared statement, the board said that because "the issue concerns a private non-profit facility in Austin not part of Harris County MHMRA," it would be "inappropriate" to comment.

Barbara Dawson is head administrator at NPC, which targets paying patients for its second-floor beds.J
Deron Neblett
Barbara Dawson is head administrator at NPC, which targets paying patients for its second-floor beds.J
Joe Lovelace faults MHMRA for not getting more of the new antipsychotic medicines to patients.
Joe Lovelace faults MHMRA for not getting more of the new antipsychotic medicines to patients.

Six years later it's clear that the current MHMRA board -- and for that matter just about everyone else in the local mental health community -- continues to faithfully defer to Steve Schnee. Schnee dominates the monthly meeting of trustees, explaining state regulations, fielding questions about service delivery and, especially, pointing out the consequences of inadequate state funding.

Schnee is also the controlling force of the Mental Health Needs Council, whose members are appointed by commissioners court. Unlike the MHMRA board, which is a mixture of professionals and laypersons, the needs council consists of representatives from organizations that work with the mentally ill, including Baylor College of Medicine, the hospital district and, of course, MHMRA. Advocacy groups such as the Mental Health Association of Greater Houston and the local chapter of the National Alliance for the Mentally Ill are also represented.

The role of the needs council has been a matter of considerable debate lately. Advocates such as Robert Hager and David Clark say council members should be watchdogs who protect the interests of MHMRA's patients. Council chairman Bill Schnapp calls the council "an information-sharing group not an advocacy group."

These competing views have led to a few tense moments. In August, Hager and Clark asked the needs council to look into MHMRA's failure to spend federal housing grants. Hager and Clark say Schnapp agreed to create a task force. But the following month Schnapp turned the housing issue over to the Mental Health Association. Steve Johnson, a lawyer and consumer advocate, says Schnapp was shielding MHMRA from scrutiny when he reneged on his promise of a task force.

"David Clark demanded accountability, and it just shocked the hell out of everybody," says Johnson. "The minutes of that meeting were so sanitized that you couldn't even tell it was the same meeting. They have become almost paranoid about protecting MHMRA."

Johnson says that because MHMRA's policies affect how everyone else does business -- and they all do publicly funded business with MHMRA -- the agency is "like a bull in the china closet."

"When commissioners court has a question dealing with the MHMRA of Harris County and refers it to the needs council, basically what they get back is a reflection of what MHMRA of Harris County wants to have reflected," says Johnson.

Jack Callahan of Advocacy Inc. of Houston says the needs council is "a providers council" and that as the largest source of state funds, MHMRA has managed to "co-opt" most advocates of the mentally ill into becoming apologists for the agency. "Dr. Schnee is a very friendly and personable person," says Callahan, a former trial lawyer with bipolar disease. "The advocates want to be invited to sit at his table."

Schnapp argues that as the chief provider of mental health services, MHMRA naturally dominates the needs council's agenda. However, he insists, that doesn't mean Schnee or MHMRA's policies are immune to criticism. If it seems that way, it's because Schnee "is very good at working with other agencies," Schnapp says. "He works very hard and very diligently to work out continuity-of-care issues."

Despite all his defense of MHMRA and its chief administrator, Schnapp acknowledges concern over the agency's inability to deliver new-generation medications to indigent patients, a complex issue he has begun looking into independently. "I'm clear on all the problems," he says. "I just haven't been able to add them all up."

In 1999, after heavy lobbying by a statewide coalition of patients, physicians and advocates -- including Representative Garnet Coleman of Houston, who has bipolar disease -- Texas lawmakers earmarked $50 million over two years for the new drugs, which are more effective and have fewer debilitating side effects than old standbys like Haldol and Thorazine.

The legislative mandate was to the point: In Harris County's case, MHMRA had one year, until September 1, 2000, to put 2,043 indigent and uninsured patients on the new antipsychotics. Failure to do so could lead to forfeiture of unspent monies, as well as a possible reduction in future funding for the drugs.

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