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"We try to see them more frequently, but with physician vacancies and resource deficiencies, it has implications," Schnee says. "If I start you on a medication, I don't know exactly what dosage you need to make it work. I've gotta adjust it, readjust it. And if I can't see you with some frequency, I have to proceed cautiously."
Joe Lovelace has come to view MHMRA's failure with new medications as symptomatic of the agency's inability to carry out its mission. The state legislature dug deep for $50 million to pay for the new drugs because they work, he says. Other local agencies have managed to spend their share. There's no good reason why MHMRA couldn't do the same.
"They argue that they're underfunded, and that's why a lot of problems exist," Lovelace says. "It's a convenient scapegoat, but I don't think it works. I think this shows that if the medication was free, they couldn't get it to me."
On the evening of October 4, Steve Schnee and his staff held their customary public forum to unveil the agency's annual budget at the MHMRA clinic on West Dallas.
Schnee, in shirtsleeves and loosened tie, looked worn out. Earlier that day, at a particularly feisty meeting of the Mental Health Needs Council, he had bickered with David Clark and Robert Hager, whose criticism of Schnee and MHMRA has become increasingly confrontational. At one point during the council meeting, Clark interrupted Schnee's summary of MHMRA's funding woes to crack, "One way to get more money is to spend the money you get well." That evening Clark and Hager were back at Schnee for an explanation of why 113 mentally ill people might lose their rent subsidies.
At issue is a series of five-year housing grants totaling $5.4 million, awarded by the federal government between 1993 and 1996. Every February a committee representing local social-service agencies does a "gaps analysis" to determine where housing assistance is most needed and how to deliver it. In 1997 the committee discovered that MHMRA had spent only $500,000 of $2.6 million in grant funds the agency received in 1993 and 1994.
Apparently no one at MHMRA had noticed the grants weren't being spent until the committee brought it to the agency's attention. According to deputy director Rose Childs, an internal investigation turned up "a flaw in the program design" that has since been corrected. Childs also blamed the agency employees, since departed, who monitored the grants.
Earlier this year, MHMRA applied for a renewal of the $1.7 million grant the agency received in 1993. In large part because of the amount of unspent funds, the proposal was ranked dead last out of 31 applicants. The feds haven't rejected MHMRA's renewal application yet, but Childs isn't optimistic. MHMRA also could have trouble renewing the other housing grants. The agency has spent less than half of the $3 million received in 1998 and 1999.
The housing debacle infuriates MHMRA consumers and their advocates -- for good reason. A shortage of decent, affordable housing is perhaps the biggest crisis facing the adult mentally ill, many of whom end up homeless or living in cramped, unregulated halfway houses. Housing programs like those funded by the federal government do more than provide shelter; they also teach consumers how to budget their money, shop for groceries, even socialize.
"A lot of mentally ill people have no work history and no family," explains Bruce Stohr, a former MHMRA client with bipolar disease. "Medication just isn't going to clear out all the wreckage."
A few years ago Schnee pulled together a coalition that included many MHMRA consumers to convince county commissioners to fund the $5 million NeuroPsychiatric Center. It's difficult to imagine Schnee gathering the same support today. The agency's problems, including the substantial reduction in supportive services, have bred "consumer alienation," says advocate Steve Johnson. Consumers have neither the opportunity for significant input nor an effective outlet for their grievances, Johnson says.
The state requires local mental health agencies to form planning advisory councils, with at least half the memberships set aside for consumers or their family members. But Johnson says the council's resolutions are rarely considered by MHMRA's board. "The resolutions don't even go to the board, but to a committee, which sometimes doesn't even forward it to the full board," he says.
Nor are some consumers pleased with the local groups that are supposed to protect their interests. In 1995 Bruce Stohr was hired by the Mental Health Association, the oldest and most prominent advocacy group in town, to organize a consumer advocacy council. Stohr embraced the job and soon began bringing complaints to the association's executive director, Betsy Schwartz. She invariably sided with Schnee against consumers, Stohr says, and she expected him to do the same.
"I didn't realize I was really working for MHMRA under a different name," Stohr says, half joking. "She wanted Uncle Toms, and I'm no Uncle Tom."
Stohr says Schwartz fired him after less than a year for being "angry" and "uncooperative." He wasn't replaced, although Stohr's consumer advisory council, which included David Clark, evolved into Houston Area Mental Health Consumers. After several years of ad hoc existence, the group recently got nonprofit status and a telephone.