By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
Advocates and mental health consumers were delighted that the new medications would soon be widely available. David Clark says that unlike the older drugs, the new antipsychotics don't give patients a permanent case of the shakes or cause saliva so thick it leads to tooth decay. With the new medications, the mentally ill are "indistinguishable from other people," he says. "They can suddenly blend in."
As the September deadline approached, however, it was clear MHMRA would fail to meet its state-mandated target: Only 626 eligible patients -- 31 percent of the agency's target -- had received the medications, a failure that caught the attention of those who had advocated loudly for state funding for the drugs.
Joe Lovelace, former president of the Texas Alliance for the Mentally Ill, came down particularly hard on MHMRA in a series of e-mails to advocates and providers across the state. Angry over what he called MHMRA's "sorry" performance, Lovelace rattled cages at the state mental health department, which sent Heather Hajovsky, interim director of community programs, to meet with Schnee.
In an August 7 letter to Hajovsky on the eve of her visit, Schnee outlined a number of "considerations" that hampered MHMRA's efforts, including:
" Caseloads as high as 450 patients per physician, which limited how often patients on the new drugs could be monitored
" Psychiatrists at HCPC, who were reluctant to prescribe the medications because they didn't stabilize patients quickly enough
" A higher-than-expected number of patients who didn't like the new medications and who had refused to take them
Schnee conceded in the letter that MHMRA wouldn't reach its target by September 1, but protested any reduction in future funding to MHMRA for the new medications. However, Hajovsky wasn't impressed with Schnee's reasoning. In a letter written after her trip to Houston, she noted that every local agency in the state had the same problems Schnee described.
Indeed, the state's other large cities didn't appear to have any trouble delivering the drugs to their patients. In Dallas, 1,395 people, 96 percent of the target for that area, were prescribed the new medications. Austin-Travis County MHMR added 161 people, 92 percent of the target. In San Antonio, 562 new patients are receiving the drugs, 70 percent of that agency's target.
At a recent needs council meeting, Schnee shocked some advocates when he said MHMRA had attempted to return $2 million of the $7.6 million the agency had received for the new drugs rather than risk losing future funding. Schnee tried to calm the waters by insisting that he hadn't heard any complaints from patients who were unable to get the new drugs. But one woman, Cheryl Villareal, said her son received the drugs only after she appealed directly to the MHMRA board. Attorney Robert Hager reminded Schnee that two of his clients had been denied the new medication.
Maurice Seiden waited almost a year for his MHMRA psychiatrist to put him on the new antipsychotic medication. Seiden's medical records, which he agreed to share with the Houston Press, show that last year, while taking the old-style medication, Stelazine, he reported psychotic symptoms, including increased paranoia, to his MHMRA physician. According to the records, the physician increased Seiden's Stelazine dosage.
In January, Seiden was browsing in a bookstore when he suffered an attack of dystonias, a sudden cramping of the neck and arm muscles that is a common side effect of Stelazine. Seiden made it to his general practitioner, who gave him an injection of Benadryl and kept him under observation for four hours. Seiden reported the dystonias at his next appointment with MHMRA, but the physician merely reduced the Stelazine dosage. Seiden hasn't had another seizure, but he wasn't prescribed the new antipsychotics until late October when he asked his doctor for them. His doctor never raised the subject in all those months, Seiden says.
John Griffith, a psychiatrist on staff at HCPC, says he considered filing a complaint with the Texas Board of Medical Examiners after MHMRA refused to fill a prescription for a patient with tardive dyskinesia -- a serious side effect of the old medication and a condition that, if untreated, can cause permanent neurological damage. Griffith says MHMRA's failure to honor physician requests for the new drugs illustrates how the agency often makes administrative decisions that are not in the patient's best interest.
"I talk to them about patient needs," Griffith says, "and they respond, "Well, that's a medical model. We provide psychosocial services.' "
Callahan of Advocacy Inc. finds Schnee's claim that many patients refuse to take the new drugs incredible. "Hell, the clients don't know the difference," Callahan roars. "If it wasn't for the new-generation drugs, I'd still be where I was in 1987."
MHMRA has begun to work out the kinks in its new-drug delivery system, Schnee says. The agency has broadened its eligibility requirements and has agreed to share up to $100,000 of state funding for the antipsychotics with HCPC, which discharges 1,700 patients annually who are eligible for the new drugs. Schnee says HCPC psychiatrists have agreed to begin prescribing both the new- and old-style drugs "when appropriate."
But Schnee argues that the reduction in outpatient services for indigents means they will see their physician only every three months. He predicts that as many patients as remain on the medications between appointments will, for one reason or another, stop taking them.