Mental Cases

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

He did, however, get back on a small regimen of psych meds, keeping the sobriety he had gained in prison. Grantham bounced from job to job for a few years, got engaged to a woman and unengaged, and finally moved in with a friend. After he simply stopped showing up for his job in the produce section of a grocery store — one of the only times in his life, he says, that he simply gave up — he and his roommate decided Grantham needed a change.

His plan, because he enjoys gambling, was to make it to Las Vegas, but his friend only had enough money to buy him a bus ticket to Houston. He accepted.
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A few weeks after Grantham arrived in Houston, the 2008 election season was kicking off, and in the Houston area, one of the most anticipated races was for Harris County sheriff. Mental health issues had become one of the key issues for City Councilman Adrian Garcia, who was trying to unseat longtime sheriff Tommy Thomas.

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.

Garcia's ammunition grew that summer when officials from the Justice Department started showing up and investigating the high number of inmate deaths, and the jail had already been the target of another investigation and lawsuit, spurred by reports concerning mentally ill inmates who couldn't get their meds, from Advocacy, Inc., a statewide advocacy group for the disabled and mentally ill.

When a judge granted investigators access to the jail, they found it in disarray, and that mentally ill inmates were being placed in solitary cells for extended periods without visits from psych doctors, despite a contract with MHMRA to provide care.

The investigation forced changes in the jail's mental health unit, and during Garcia's campaign for sheriff, jail guards were fired for lying to cover up an inmate's death. It was a couldn't-miss issue for Garcia.

"We have seen too many cases where interactions between law enforcement and the mentally ill results in a tragedy," Garcia told the Press during an interview in the summer of 2008, a few months before the election. "We cannot allow ourselves to be paralyzed by the issue and do nothing."

But since winning the election and taking office, the changes that Garcia promised haven't materialized. He's been unable to get a Crisis Intervention Response Team started for the sheriff's office, and while Harris County commissioners have promised funding for a facility to help mentally ill inmates transition from the jail to the free world, to keep them from simply cycling back to the jail weeks or even days later, that funding is far from secure.

With the sheriff's office in a hiring freeze, already operating with a patrol and staff shortage, spending money on mental health programs has slipped from the front lines.

"The economy caught up with all the ideas that I had," Garcia says. "Pulling people away from critical operations has been difficult to do, so we're still figuring out ways to accomplish that."

Trouble is, all signs point to the jail system becoming the landing place for the untreated population of mentally ill people, if the proposed budget cuts come down.

"These cuts are dealing with indigent care, and when people are diverted from care, they usually end up in jail," says State Representative Garnet Coleman, who has been one of the biggest advocates of mental health issues in the legislature. "That's become the fact."

Conditions at the jail have improved since Garcia took over — inmate deaths have dropped and the jail passed its most recent state inspection — but the place is far from perfect.

Last month, for example, Randel Theobald, a 39-year-old mentally ill man who was in the jail for killing a woman in a hit-and-run at Meyerland Plaza, was found dead in his jail cell after somehow overdosing on his psych medications.

"Grits for Breakfast," a statewide criminal justice blog, has continually written about mental illness at the Harris County jail, and in a post concerning the proposed cuts, blogger Scott Henson wrote: "Indeed, county jails are already packed with mentally ill inmates due to lack of community based services... For those concerned that state budget cuts next year might harm public safety, don't worry about closing prisons. Worry about the consequences of reduced access to mental health treatment."

And in the August issue of Texas Monthly, in a "Letter to Houston" column, writer Patricia Kilday Hart asked, "Wouldn't the fiscally prudent — and humane — option be to support treatment programs that keep as many mentally ill Texans as possible from ending up in the county jail in the first place?"

When it comes to mental health funding, of course, that is much easier said than done. The Houston Police Department's Chronic Consumer Stabilization Initiative, for example, has been a comparably inexpensive program that has kept mentally ill people out of jail. The program assigns caseworkers to mentally ill people in the city who are constantly in contact with HPD officers.

The results have been so good that Garcia, who helped get the CCSI pilot started while on City Council, says he'd like the sheriff's department to do a similar program. Mona Lisa Jiles, who runs MHMRA's jail operations, has identified a list of inmates who would be good candidates for the sheriff's plan, and Garcia estimates it would cost about $350,000.

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