Getting Out

Too scared to leave her house, Sandy has one last chance: a county crisis team that will come to her

He's been off and on meds for schizophrenia and off and on marijuana dipped in formaldehyde. Mostly on. It's known as wet, fry and amp, and it's a common drug among schizophrenics. Collins says it's called fry because that's what it does to your brain.

She asks to see his meds, and he produces from his blue jeans pocket a bottle of mismatched pills. Collins lifts her glasses and squints at the washed-out label. What he's been popping for the last month is anyone's guess. This is a common problem. Clients who can't get to the clinic or miss appointments with their social workers can wind up without medication. In Charles's case, he's illiterate and can't remember the names of his meds, so if he can't get in to see his regular doctor or nurse practitioner, he might wind up with someone new who prescribes a different type of medicine.

But now, Collins continues through her standard list of intake questions.

Sandy and Jennifer were made to eat on the floor like 
Sandy and Jennifer were made to eat on the floor like dogs.
Without consistent care, clients lose track of their 
Without consistent care, clients lose track of their meds.

"Who loves you and cares about you?" she asks.

He says his real mom and dad love him. He communicates with his dad telepathically through what he calls a sensor. The sensor also allows him to talk to his old prison buddies.

When Collins asks about his real mother, Charles become agitated. He's told the impostor story a million times, and all he wants is for someone to call the FBI and have that woman arrested.

Collins speaks calmly, as if to a child, but Charles becomes more frustrated. Harris quietly gets out of his chair and leaves the room. He says later that he was bothered by the way Collins kept asking about Charles's mom. He says he would've left it alone.

But Collins carries on.

She asks: What's the best thing that's ever happened to you?

Getting out of the pen, he says.

She asks: Do you ever get messages from the television?

"No," he says. "I'm not crazy."

Four years ago, the MHMRA lured Dr. Avrim Fishkind from Washington, D.C., where he basically overhauled the district's emergency psychiatric program. Tall, heavy-set, with a bushy gray goatee, Fishkind is the president-elect for the American Association for Emergency Psychiatry.

MCOT is his baby. After seeing how mobile units worked elsewhere, he was eager to build one in Houston.

Mobile crisis teams have historically worked closely with law enforcement, whose hands are tied unless individuals with mental illness present immediate threats to themselves or others. Instead of having to wait until a person reaches their breaking point, officers can call upon mobile crisis units to assess the individual. Such is the relationship between Houston law enforcement and the new crisis team, Fishkind says.

Mobile crisis units are also one of the only ways to reach an otherwise hidden population.

"One of the great unidentified mental health populations are people who are just quietly mentally ill," Fishkind says. "They predominantly stay in their homes…they may come out just to do simple shopping. [They] are often grossly delusional, often disorganized, but…never rise to the level of dangerousness, so never come to anyone's attention."

Without realizing it, he's just described Sandy. And he says there are thousands in Harris County.

But, like Mitchell and others tied to the new team, Fishkind is prepared to make a financial argument in favor of the program in case compassion fails.

"Let's say somebody says, 'I don't want any of my tax dollars to go to taking care of that homeless mentally ill [man] on the corner…but I want you to get rid of him,' " he says. "Well, let's look at what that means."

A homeless mentally ill person is typically hospitalized 40 days a year, Fishkind says. At $500 a day, that's $20,000 just for a bed. That doesn't include emergency room care, medication or outpatient care. It doesn't include the cost of the usual police or EMS calls. And it doesn't even account for how many days that person might have spent in jail.

"So if you think you're doing nothing for a homeless chronically mentally ill person -- you're not spending a penny and you're not gonna -- that's absurd," he says.

According to Fishkind, some states have figured out that they can house, clothe, feed and medically treat a chronically mentally ill person at a starting cost of about $28,000. In succeeding years -- as that person stabilizes -- the cost declines.

"In a lot of places they've figured out that actually doing something actually saves the taxpayers money," he says. "Doing nothing costs the taxpayers a lot of money."

Harris County Commissioners Court agreed.

When presented with Fishkind's funding proposal, the court was eager to accommodate, says County Judge Robert Eckels. Besides funding the new team, Commissioners Court also funded MHMRA's new 18-bed respite center on Caroline Street, gave additional funding to the emergency room and has added six beds to the ten-bed voluntary stabilization unit at NPC.

"We looked at this as a way to diffuse a mental health crisis," Eckels says of MCOT. "It's a smart use of tax dollars, and it's a service that's desperately needed in the community."

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