Beggars Can't Be Choosers

On October 27, a bunch of middle-aged and old people packed the conference room at the Mental Health and Mental Retardation Authority to beg.

It was about all they had left in their arsenal. They appealed to decency, to humanity, to old promises they said were made to them by the state of Texas that now are being discarded on the scrap pile of economic efficiencies.

Texas, which once again finds itself short on cash, believes it can free up money by closing some of its 11 state schools and ten state hospitals housing the mentally retarded and mentally ill. High on the targeted-for-oblivion list is the nearby Richmond State School and its $38 million annual operating budget.

And so now, these people whose children are in their forties, fifties and older, whose sons or daughters have lived 20, 30 or more years in a state institution, are faced with the possibility of trying to find a new home for them.

A private consulting firm has weighed numbers and is along for the ride on a brief state tour conducted by the new Texas Health and Human Services Commission. Findings will be handed over to the state by year's end. The Texas legislature will take up the matter in January.

Ninety-four-year-old Mary Rosenfield was at the meeting, accompanied by her daughters Ilene Robinson and Rita Sue Rosenfield, who lives at Richmond. From her wheelchair, Mary Rosenfield struggled to explain why even though she loves her daughter, she can't bring her home.

Rita Sue is profoundly retarded. She can be self-abusive, biting herself when upset; and she has a sleep disorder that means she can be up and about at any time of the night. Loud noises upset her; crowds scare her, causing her to drop to her knees in terror. She needs 24-hour-a-day care.

The 57-year-old has lived at the Richmond State School since 1970, two years after the place opened. Her mother was a volunteer who helped raised money to establish the school, which was funded primarily by the George Foundation. In fact, Rosenfield was honored just the other week, named to the Texas Women's Hall of Fame by Governor Rick Perry for her work in the mental health field. So what she says should carry some weight.

But it's not certain that anyone was listening -- at least not anyone with the consulting firm hired to research the "feasibility of closure or consolidation." Public Consulting Group, after all, has been paid $180,000 to find ways to cut costs in the Texas mental health system. And it's going to say no, keep everything open? That's not how it got contracts across the country promising "revenue maximization services."

As several speakers pointed out, the proceedings weren't being recorded. Rather than being a part of the official record, this meeting appeared to be nothing more than an item marked off on a to-do list.

The plan is to, in effect, rate the bottom line of the various state schools and close the least efficient. Patients would then be moved to other institutions farther from their families or told to join community-based programs.

Whether these people would thrive in less-structured community-based programs is one troubling question. Actually, it's one that may never be answered, interrupted by another reality:

Right now in Harris County there are already 3,536 people on the Home Community Services waiting list and 3,714 waiting for any type of mental retardation treatment, according to the Mental Health and Mental Retardation Authority of Harris County.

Dumping a few hundred more into the community-based system poses the question:

"If there are more than 3,500 people on the waiting list and they're not already on it, where does that person go?" asks MHMRA executive director Steven Schnee.

Children aren't brought to places like Richmond State School anymore, which is just as well. Built in another time to house as many as 1,500 residents, Richmond, like other mental institutions throughout the country, has lost population in recent years as more comprehensive community-based programs have opened. Now it has 525 people, but -- as many of its supporters point out -- the "easy ones" already have been moved out into the community.

The people left are, for the most part, those who have been in institutional care since they were young and who have severe mental, behavioral and emotional problems.

Several are wards of the state, with no family to speak of. Others have parents who have "aged out," which means they either can't care for their children anymore or they have died.

Schnee believes there are still people in the state schools who could be moved into the community and prosper there, given the right treatment. And he says the legislature has every right to look at the effectiveness of any state-funded system, as it is doing, thanks to Rider 55 of the General Appropriations Act.

There are also arguments, he acknowledges, that sometimes people living in institutions don't learn to take care of themselves. But even people who've lived long years in institutions can acquire skills to become more self-sufficient in a good community-based program, he says.

What needs to be balanced, he says, are the needs of the insured with the most cost-productive way of meeting those needs. And the recognition that not everyone is the same and that some people have more significantly intensive problems.