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.

Schwartz is generally well liked and appreciated for her commitment to the cause of mental illness. She declined to discuss Stohr's employment at the association, but defended her advocacy efforts, saying any criticism is coming from "a vocal few." Confrontation isn't her style, Schwartz says, nor is it very effective. "We're quiet, behind the scenes."

Schnee and MHMRA also have lost credibility over the agency's failure to vigorously pursue Medicaid and social security benefits for uninsured patients. MHMRA has increased its reimbursements from the federal programs from $333,000 in 1990 to an estimated $12 million in 2000. But that likely reflects only a fraction of the patients who are eligible for the benefits.

Between September 1, 1999, and May 1, MHMRA's consumer benefits office received more than 1,360 referrals, most of them from clinics. Almost a quarter of them never followed through with the application process, either by choice or because MHMRA lost track of their whereabouts. Of the rest, only 101 were certified to receive Medicaid or federal disability insurance; another 360 cases are pending.

Betty  Chesser still misses her son, Steve.
Deron Neblett
Betty Chesser still misses her son, Steve.

Attorney Hager, who argues claims disputes for several mentally ill clients, says most of the MHMRA's patients are eligible for subsidized benefits. The problem, he says, is that MHMRA's patient charts don't include the information government reviewers need to approve eligibility.

How government reviewers "evaluate mental disorders requires information that is not in the normal medical record," Hager says. "Doctors don't put down a lot of information about functional limitations, about how you can or can't take care of yourself. But for social security, that's the bottom line."

Hager says he has tried for five years to get Schnee to urge his physicians to include more pertinent information on patient charts, as well as to increase the staff in MHMRA's benefits office. Schnee was unreceptive, Hager says, until late last year. That's when a study by the Rand Corporation, a public advocacy group, showed that only about 50 of 212 severely mentally ill people in MHMRA's supportive housing program were on social security. More telling, perhaps, are the results of a recent analysis by MHMRA: Only 46 of the agency's 326 most acute cases had ever been referred to the benefits office by MHMRA clinicians.

Schnee acknowledges he has no choice but to get more consumers qualified for government benefits. To balance this year's budget, MHMRA needs $22 million in revenues from third-party payers. The upshot is that in order to reap those revenues, MHMRA has had to cut services to those who don't already have some type of insurance and realign the agency's staff and resources to serve those who do.

That's not supposed to be how it works, says Schnapp, chair of the Mental Health Needs Council. Agencies like MHMRA were created to care for the "sickest of the sick, the poorest of the poor," he says. Now, they are being told, in essence, to turn their backs on those who cannot pay.

"Who's going to take care of the non-Medicaid patient who is seriously ill?" Schnapp wonders. "Nobody. Nobody."

It's hard to miss the urgency in Schnee's voice when he talks about the upcoming legislative session; or the frustration when he talks about the ever-weakening safety net. MHMRA's critics are "shooting the messenger," Schnee says, and are ignoring the state's unwillingness to provide decent care for one of its most vulnerable populations.

"Texas is very conservative in the way it approaches health and human services," he says. "We make choices. We fund our prisons well. We probably have one of the best road systems in the world.

"All we can do -- what we are trying to do -- is paint the picture for people to understand, to hear and to listen, and try to influence the policy makers on the significance of putting resources into this."

Steve Chesser was new to the mental health system, but other members of his family weren't. One of six children, Steve told the staff at the NeuroPsychiatric Center that he had a sister with bipolar disease who had just been released from a state hospital. Steve's mother, Betty, says her father had mental problems, and her husband's mother received electroshock therapy in the 1940s and 1950s.

Over the years, Steve drifted from one low-paying job to another. His favorite gig, Betty says, was as a plant security guard. He worked four days on and four days off, which gave him plenty of time to check up on Maria. Steve and Maria tried marriage counseling early, Betty says, but it didn't work. Maria left him, came back, then talked him into a trial separation. The marriage wasn't all bad, Betty says. Despite his problems, Steve could be a kind and thoughtful man.

"He would go for three months and just be so good to everybody," Betty recalls. "Then something insignificant would set him off."

On those occasions, Steve would sometimes beat Maria, Betty says, or threaten his daughters in bizarre ways, like announcing he planned to hire someone to rape them. Steve had just started seeing a private psychiatrist, Betty says, but neither she nor her son thought to call him after Steve bound his wife in duct tape and threatened to shoot her. Instead, they wanted a place that would hospitalize Steve, keeping him safe from himself and others.

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