Reality Check

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

Fishkind said the change will come "when people begin to understand the lost productivity and costs of not treating mental illness. When fiscal factors hit enough people in a broad enough scale."

But waiting for the legislature to act is no solution.

"I think everybody has got to learn to live with less," said Konigsberg, pointing to the example of the Harris County Hospital District. The district has taken on a lot more of the indigent, particularly with HIV and AIDS, and done a good job without additional funding, she said.

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.

"You have to look at what you have and be creative," Fishkind said. If all else fails, people use churches, Fishkind said. "They use spiritual systems, and there's a lot of evidence that can be just as effective." He also said that even putting off people on their appointments -- as long as you give them an appointment -- doesn't do that much damage. "As long as people have hope for an intervention, that gives them a resource."

Groups also need to generate additional money through other funding sources, Konigsberg said. Of course, competition for stray dollars may put a damper on cooperation among agencies. Just as the need for trauma beds competes with the needs for other kinds of beds in facilities.

"The only way to solve the problem is to have an open, honest dialogue clean of politics," Konigsberg said.

While and until all this gets sorted out, emergency rooms will continue shifting critically injured patients around the region, hoping to get the worst ones to the few trauma centers in time.

And the Mental Health and Mental Retardation Authority of Harris County, as Steven Schnee himself has said, will be rationing care. Is someone a little bit crazy? A lot? A new crazy, an old one already on the books? Dangerous? How dangerous?

And everybody has got to guess right every time.

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