By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
A dozen patients were being treated at the 16-bed clinic when the decision to close it was announced February 19 by the Mental Health & Mental Retardation Authority of Harris County, which operates the center, known as NPC. Those patients had all been discharged by early this week.
NPC's first-floor emergency room, which opened in October 1999, remains open, although it too is operating deep in the red. Losses at NPC are running about $300,000 a month, about a third of that generated by the second-floor inpatient clinic. Even without the expense of operating the 16 beds, MHMRA needs roughly $2.4 million in additional funds to cover the emergency room's costs for the next 12 months.
Steven Schnee, MHMRA's executive director, said the agency underestimated the number of uninsured patients who would seek care at NPC, as well as the impact of Medicaid managed-care practices on patients who are covered.
"There has been a significant change in the commitment to psychiatric coverage, and we had no real feel for what that would be," Schnee acknowledged. "The actual reimbursements are much less than we expected, and we can't cover our costs."
The sudden closure of the second-floor clinic, which opened last October, is an abrupt reversal of fortune for NPC. In late January MHMRA's nine-person board of trustees voted unanimously to keep the clinic open and gave Schnee 60 days to hustle up emergency funding from local charities and foundations (see "Upstairs Down -- and Out?" by Brian Wallstin, February 1).
But Schnee's fund-raising effort never got off the ground. First, the county Mental Health Needs Council, an advisory panel appointed by Commissioners Court, recommended that MHMRA close the inpatient clinic immediately. Then, on the afternoon of February 19, two committees of MHMRA trustees reached the same conclusion; a few hours later, Schnee told the staff at NPC to start sending inpatient admissions to the county's psychiatric center.
Alfred Forsten, chairman of the MHMRA board, said trustees realized that the prospect of additional funds for NPC was purely speculative, and in any event, funds would come too late.
"We had already lost another $200,000, and so it is unlikely that we could get funding from the community to support" NPC, Forsten said. "Our real concern now is we have to keep the first floor operating because that service doesn't exist" elsewhere.
Indeed, since it opened, NPC's emergency room has been treating more than 1,000 patients a month -- nearly twice the caseload MHMRA had anticipated. That's taken some of the strain off the only other public psychiatric emergency room, at Ben Taub Hospital. Patients who could not be stabilized at the NPC emergency room were treated for up to five days in the second-floor clinic. Some local mental health professionals and advocates have criticized MHMRA for ever opening that inpatient clinic, especially without the money to operate it. They point out that on any given day, the Harris County Psychiatric Center has as many as two dozen beds available for poor and uninsured patients.
"The problem with NPC is it duplicates the function of HCPC," says Steve Johnson, a lawyer and mental health advocate. "NPC has been bleeding money from the get-go, while HCPC has whole wards that are closed down."
MHMRA gives HCPC more than $20 million in state and county funds every year to operate 143 beds for the agency's patients. For now, at least, that's more than enough beds to handle the two patients per day NPC was admitting before it closed.
What's not known is where the money will come from should MHMRA need more than the 143 beds at HCPC. The agency has asked Harris County for another $1.7 million, which could be available March 1. But that money is earmarked to help offset the losses at NPC's emergency room; with the county money, the center would still have about $750,000 in annual deficits.
One financing possibility rests with a perennial state legislative bill that seeks to have HCPC funded by the University of Texas System rather than MHMRA. Supporters of that plan say it would insulate HCPC from the agency's dire financial situation and allow the psychiatric center to provide more beds for the poor and uninsured.
Most states spend more on mental health care than Texas, which doles out less than half the national average of $27 per resident. A statewide coalition of mental health advocates has launched an aggressive lobbying campaign in Austin to reverse that dismal record.
However, success at the state level seems more unlikely every day. Lawmakers are now trying to find $350 million to cover the state's health care costs for the next two years. Most of that, if not all of it, likely will be used to fund the Children's Health Insurance Program.
In the meantime, said Bill Schnapp, chair of the Mental Health Needs Council, Harris County's public mental health system advances ever closer to total collapse.
"We're underfunded at practically every type of service in Harris County," Schnapp said. "It's a horrible situation, and it seems to be getting worse."