Reality Check

Houston is scrambling for psychiatric and emergency medical services. But hoping for better state funding is just another psychotic episode.

Jesus, Mary and Joseph would feel right at home in Houston these days.

The county's mental health agency is turning away new nonemergency patients. The NeuroPsychiatric Center has gone on drive-by status three times since May -- no matter how sick the patient trying to get in to receive its emergency services. And a shortage of specialized trauma beds in hospitals throughout the region means some critically injured patients aren't getting where they need to go in time to do them much good. It's life-threatening and already life-damaging, doctors say.

There's no room at the inn all over town. Our own little Bethlehem West.

Fishkind says the state can fund better mental health care and save money in the long term.
Margaret Downing
Fishkind says the state can fund better mental health care and save money in the long term.

Money, of course, is cited by various experts as the root of all this evil. Dr. Steven Schnee, head of the Mental Health and Mental Retardation Authority of Harris County, called a press conference on short notice last week to make it clear that this is a time of "crisis."

"Going on drive-by status puts the community and the consumers and the family members that count on NPC at risk," Schnee said to reporters at NPC. He noted that Ben Taub's emergency room, which has psychiatric services, has had to go on drive-by also. Patients who cannot get treatment, he said, can get "quite agitated." Some of this agitation may be coming not just from the emergency room shutdowns but from MHMRA's decision to not take new nonemergency cases on an outpatient basis as of July 1. Some people are becoming more ill before they receive care, he said.

Betsy Schwartz, executive director of the Mental Health Authority of Houston, a patients' advocacy group, rushed in to the meeting and declared: "This is really an outrage. All of us should be ashamed of a city of the size and wealth of Houston to allow a mental health crisis to exist." If NPC were properly funded by the state, she said, there would be no crisis.

Dr. Guy Clifton, chief of neurosurgery at Memorial Hermann and one of the founding members of Save Our ERs, has his own crusade going. Starting in 1999, hospitals in Houston began to have emergency room saturation, diverting patients away 12 percent of the time. Patients aren't getting the care they need riding around the city looking for a hospital or sitting in most emergency rooms, which are not equipped to undertake the intensive measures needed to save these people's lives.

The pleas are heartfelt, the points valid. It is barbaric that Texas comes in 43rd in the nation when it comes to per-capita spending on mental health. Houston is a financial center, but it can't handle the vast number of uninsured patients that are sinking its medical system. It is maddening that we have the expertise to save people and aren't. We might as well all be wearing T-shirts saying Welcome to Houston, the greatest third-world city on earth.

But the likelihood of Texas ponying up some dough -- the state comptroller has projected a $5 billion shortfall when the legislature meets in January -- is about zip. Legislators didn't parcel out more money for those services when they were flush with cash. Why would they do it now?

Tragedy, Schnee said. "Somebody will do something really tragic and involve other people." Clifton said the state may come through with more money for trauma care after some legislator's child dies needlessly. Maybe when something really, really horrible happens, then the state won't be able to look the other way about its commitments to mental and physical health care.

Of course, since most of the mentally ill are not dangerous to themselves or others, it is more likely that the vast majority of the untreated will just sink into quiet depression and wasted lives.

It's ancient times brought to life in Houston. A human being is going to have to be sacrificed, laid out on a rock, split open, his or her life's blood pouring out. Losing their life, losing their mind. It'll be splashy, it'll be tragic. People will say they didn't know.

And Betsy Schwartz, Steven Schnee and Guy Clifton will shout in anger, sigh in resignation or cry in frustration. But then maybe something will be done.

In the meantime, we need a plan B.

It's five o'clock in the afternoon and Dr. Avrim Fishkind, medical director at the NeuroPsychiatric Center, needs a lift. He's clutching a cup of coffee from the Starbucks on Montrose; it'll keep him awake. Last week he put in 84 hours on the job. At a certain point, people just run out of gas.

At first glance, it would be easy to dismiss Fishkind as some kind of outsider who doesn't understand how things work in Texas. He's a graduate of the University of Maryland who got his medical degree from Johns Hopkins University. Fishkind was chief of the Comprehensive Psychiatric Emergency Program in Washington, D.C., when he got a call from the Mental Health and Mental Retardation Authority of Harris County to head up its new psychiatric emergency hospital.

He knew exactly what he was getting into. He'd worked for the Austin-Travis County MHMRA and knew the state's strengths and weaknesses. Moreover, his wife was expecting twins and wanted to be closer to her family in Austin.

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