Mental Cases

Philip Grantham counts on his meds and his MHMRA doctor to stay straight. Too bad Texas is slashing funding.

Along with cutting millions from the budget, HB 2292 also identified the three mental illnesses the state would treat: bipolar disorder, severe major depression and schizophrenia. Things like panic disorder and obsessive-compulsive disorder would have to be handled by the private system.

Perhaps the most damning change cut almost all mental health benefits out of Medicaid, leaving more than 100,000 Texans who needed mental health treatment — long-term, outpatient care — unable to pay for it.

A report from MHMRA summed up the problem: "With realignment of funds, continuing increases in the Harris County population and demands for public service, MHMRA needed to restrict access through the front door to uninsured individuals who were not in crisis."

MHMRA allows Philip Grantham to get his pysch meds mostly for free.
Austin Miller
MHMRA allows Philip Grantham to get his pysch meds mostly for free.
Harris County Sheriff Adrian Garcia took over a jail in 2008 that was already the largest provider of mental health services in the state.
Austin Miller
Harris County Sheriff Adrian Garcia took over a jail in 2008 that was already the largest provider of mental health services in the state.

The treatment picture in Houston and Harris County became dismal. Doctors began to resign from MHMRA and the agency didn't have money to recruit new ones, creating immediate "concern about an adverse impact of the quality of care" at MHMRA clinics. The Bayshore and Northeast centers, which had long provided outpatient services, were shut down and clients were "transitioned" to remaining MHMRA clinics.

Today, MHMRA directly serves about 8,800 patients, down from 25,000 before HB 2292, and even among the population still eligible for MHMRA care, there is a waiting list of about 400 to 500 people. Worst of all, the 2003 cuts may have actually cost the state more money, because the system still, often by default, has to treat patients in crisis.

Schnee puts it this way: "The system is set up so that, basically, we have to have treatment failures to take people in."

A study by the group Mental Health America estimated that it costs about $10,000 a year to treat a person with mental illness at an outpatient clinic, and not treating the same client costs more than five times that much. That's because people in mental health crisis aren't often treated by MHMRA or private mental health centers, but in more expensive emergency rooms.

The Houston-Galveston Area EMS/Trauma Policy Council and the Harris County Healthcare Alliance found that between 2004 and 2006, ER visits by patients needing only mental health treatment increased from about 79,000 to 107,000. It's an upward trend that has continued and, according to the study, "constitutes a significant and increasing burden of care."

In the worst-case scenarios, which occur quite frequently, people in crisis are treated by police officers, sheriff's deputies and, ultimately, the jails and prison system. Since the 2003 cuts, there's a lengthy list of mentally ill people killed by officers on the street or while in custody.

In 2003, for example, a 47-year-old welding instructor at San Jacinto College was shot to death by a sheriff's deputy after the man, who suffered from mental illness, reportedly threatened to kill himself and his wife.

Two years later, constable's deputies were serving a mental health warrant for a 52-year-old man, and after he resisted, the man was restrained and tasered multiple times, all while protesting, "I'm your friend!" A bone in the man's neck was broken during the struggle, and he suffocated to death while in custody in front of his house.

One of the most publicized deaths in recent years came during the summer of 2007, when Houston police officers shot and killed 31-year-old Steven Guillory. (The Houston Press wrote about Guillory's death in its December 31, 2009 cover story, "Houston's Craziest.") Guillory had been discharged from the Harris County Psychiatric Center days before he was killed.

The Harris County jail, meanwhile, unexpectedly became the largest provider of mental health services in the state, housing an estimated 2,400 people each day who need psychotropic meds. The boom in the mentally ill population led to a string of death-in-custody cases, and the jail has since spent countless taxpayer dollars as part of an investigation by the United States Department of Justice.

In its August 21, 2008, issue, the Press wrote about Alexander Hatcher, a sometimes-homeless man who had been diagnosed as bipolar and schizophrenic and had a long history with MHMRA and state mental hospitals. After being arrested on a misdemeanor charge in 2006, Hatcher entered the Harris County jail and couldn't get his meds. His mental state quickly deteriorated, and Hatcher got in fights with jail guards and was charged with several counts of assault of a public servant. Hatcher is currently serving a 54-year sentence in state prison on those charges, costing Texas taxpayers tens of thousands of dollars each year.

"It's fairly obvious that the [2003] cuts did more damage than good," Schnee says. "I don't want to think about what we'll look like with more."

Philip Grantham lives near the public library downtown. He barely slept his first night on the street — he takes meds for a sleep disorder related to depression — because, he says, a concrete incline near his spot made him worried about falling.

It got better the next night, and even though the street isn't nearly as nice as being "homed," Grantham had been depressed for weeks and being homeless has been a surprisingly positive change.

"I'm already looking for another place as soon as I can save enough money, but damn that's hard," Grantham says. "And I'm actually very happy about it. It can be uncomfortable, but I see it as a step toward a better life."

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