MHMRA allows Philip Grantham to get his pysch meds mostly for free.
MHMRA allows Philip Grantham to get his pysch meds mostly for free.
Austin Miller

Mental Cases

On a recent afternoon, Philip Grantham sat in a crowded but quiet waiting room at the Ripley Clinic, an outpatient center operated by the Mental Health and Mental Retardation Authority of Harris County, and told the story about the crime that sent him to prison.

It started with Grantham, now 48, fleeing Slidell, Louisiana, in the late 1990s with 37 warrants out for his arrest. He left the state with a burglar who shared Grantham's affinity for smoking and shooting cocaine, and a woman who frequented Grantham's crack house in Slidell.

By the time the group reached Memphis, the trio had gotten quite skilled at casing houses one day and making quick break-ins and stealing stuff during the middle of the next. But the drugs sometimes blurred their judgment, to the point that they robbed a house even after learning it was around the corner from a police substation.

It proved to be a poor decision. As Grantham struggled to get a large television set into the back seat of their getaway car, a mass of police officers showed up, yelling, with weapons drawn.

"They were telling me to get my ass on the ground and everything, and of course I did," Grantham said, speaking at a manic pace. "The professional burglar dude was still inside trying to get a shotgun — he really liked guns — and when he walked outside and saw all the cops, he threw down the shotgun and started running and everyone took off after him and he jumped the fence and..."

The story was cut short by Grantham's MHMRA psychiatrist calling him from the waiting room, but before he went in for treatment, Grantham said, "Those times held a certain amount of excitement, but it's something I could never do again. I wouldn't want to."

Grantham continued, "I don't have a problem with the way things ended up. It's actually the best thing that's ever happened to me. It's been a goal of mine since then to always make the best of my life."

During the three years Grantham has lived in Houston, he's been homeless twice, the second time starting about two weeks back. The lifestyle has landed him in jail three times — a couple times for sleeping in a public park, another for failing to pay a ticket he got for trying to ride the Metro rail for free — but considering Grantham's past rap sheet and lifelong struggle with alcohol and drugs, his time in Houston has been impressive.

In fact, he even feels successful in keeping his mantra: "At best, I want my life to add something to society, but I certainly don't want to make it worse."

The "linchpin," as he calls it, of Grantham's success in Houston is MHMRA. It's the first agency he found when he got here, via bus with about $60 to his name, and it wasn't long before Grantham, diagnosed with bipolar disorder and major depression, was regularly seeing a psychiatrist who could prescribe him the mood stabilizers and antidepressants that keep him out of crisis and, ultimately, jail.

"I didn't have anything like this in Louisiana. I didn't know it existed," Grantham says. "Now I'm very partial to my doctors, and even through this homelessness, I believe they're the difference of why my life has gone so well."

MHMRA has fought funding battles for years and has another big one ahead. In July, state officials announced a reduction of about $90 million to mental health funding, along with an additional $34 million in cuts to the state's mental health hospitals. According to Steven Schnee, MHMRA's executive director, about $9 million of those cuts would hit Harris County. While the agency doesn't know exactly which programs or services would suffer, Schnee estimates that MHMRA would serve about 1,500 fewer people each year.

The effects could be disastrous, because in a mental health system that's already spread incredibly thin, MHMRA has continued to provide some level of care. The agency has endured its own level of cutbacks (the number of caseworkers was drastically reduced a few years ago, for example), but in most instances it's been even worse for private hospitals that have closed down or cut the number of available beds for people in mental health crises, opting to treat patients for things that Medicaid will actually pay for.

Even places that specialize in mental health are struggling. This summer, for example, the Harris County Psychiatric Center, run by the University of Texas Health Science Center and one of the largest mental health providers in Houston, cut a contract with its outpatient services provider. Meaning, once the psychiatric center's patients are out of crisis and stabilized, they are basically on their own.

Schnee calls it "flawed public health policy." Grantham hopes what's left will be enough to help him keep his tenuous hold on a credible life.

About seven years ago, the Texas Legislature, caught up in another multibillion-dollar budget shortfall, directed its attention to the state's mental health funding. Words like "streamlining" and "consolidation" became the buzz, and the plan, formalized in House Bill 2292, made community agencies funded by state dollars, such as MHMRA, stop focusing on direct treatment and instead help manage privatized care.

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."

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."

Twenty years ago, of course, Grantham couldn't imagine living homeless.

He was born and grew up in Beverly Hills, California. His father, a World War II veteran, wanted to capitalize on money being poured into the GI Bill, so he started a small engineering college, the Grantham School of Electronics. By the time Philip was born, the school was focusing much of its efforts in the "distance learning" niche, offering education by mail and pulling in a nice revenue doing it.

Grantham first started dabbling in alcohol and drugs — mainly pot — in his early teens, and by the time he was 17, he says, he realized he was a full-blown addict and alcoholic. The drug use escalated, primarily centering around cocaine, and he spent his 21st birthday in rehab and much of his twenties bouncing in and out of chemical dependency facilities. But in 1990, when Grantham was 28, he vowed to clean up and stay sober.

"I lost so much because of drugs and alcohol. My family, my friends, my car, my home," Grantham says. "When someone goes that low, you can do two years sober standing on your head, and I hit bottom harder than ever before."

That same year, Grantham's father relocated the business, which would eventually be called Grantham University, to Slidell, Louisiana. Grantham, clean and sober for the first time in more than ten years, moved along to work for his father.

Two years later, Grantham slit his wrists. Diagnosed with clinical depression for the first time, despite seeing private psychiatrists since his early teens, Grantham was hospitalized, and during a period of three months was placed on 20 different psych drugs. Lithium ended up being the med that stuck, and while it wasn't perfect, Grantham says it was the first time in his adult life that his mind was stable without his using illicit drugs.

By the spring of 1995, Grantham had been promoted to vice president and director of Student Services at his father's college, and more important, was running on six years sober, a stretch he credits to his psych meds.

In fact, business was going so well that Grantham was nominated for the 1995 edition of Marquis Who's Who Among Rising Young Americans.

"Granted, there are a lot of 'who's who' lists, so I don't know how much it matters, and I didn't get in anyways," Grantham says. "But I was arrogant."

On a night in December of 1995, Grantham agreed to go have a few after-work drinks with a woman he liked, along with his secretary and her husband.

"I ended up doing cocaine," Grantham says.

During the next three years, Grantham, who left the job with his father, all but quit taking his psych meds, instead relying on a steady diet of Xanax, Valium, hydrocodone and coke, which he started shooting in his arm. He lived in different houses in Slidell, and about the only work he did was out of crack houses to support his own habits.

When Grantham talks about this period in his life, he tells the stories with a combination of embarrassment and nostalgia, and during the stories that seem to be his favorites, he can't contain his excitement.

Like during the "Fuck the Police" story. He prefaces that one by saying, "No matter the situation, if the thought going in is 'Fuck the police,' run. The guy thinking that can get out and do what he wants, but there's really no way it can end well."

The story centers around an area of Slidell known as The Hole, a cul-de-sac of dilapidated houses that served, more or less, as an open-air drug market. When Grantham and his friends showed up in The Hole to buy a night's supply, there was a dealer standing outside whom the men didn't recognize. They didn't buy, and, talking it over later, they decided there was probably some kind of police operation going down. But maybe not, and they really needed drugs, so with a "Fuck the police," the group set back out for The Hole.

All of a sudden, when Grantham pulled in front of the houses, an undercover police car darted out of the dark and headed straight for Grantham's car. For whatever reason, Grantham says, the cops turned away at the last second.

"God, who knows how long we'd have gone to jail if we got pulled over that night," Grantham says. "We all had crack pipes, beers between our legs, who knows how many warrants between us, guns in the car..."

When the words really start flowing, like they were in this telling, Grantham knows he's hanging on the edge of a manic episode. During his last visit at MHMRA, which came about a week after he became homeless, Grantham's psychiatrist recognized that and tweaked his meds and dosage. It took about three days — quicker than normal — for Grantham to stabilize.

Not long after the near-miss in The Hole, Grantham was arrested in Memphis and served just over three years in a Tennessee state prison. After getting out, he returned to Slidell and lived with his brother for a while, yet his father's health was all but gone, along with his position at Grantham University.

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.

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.

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.

"I need to find deputies who have the right level of mental health crisis intervention training, with a combination of patrol experience, and won't take a deputy away from critical patrol responses," Garcia says.

Even West Oaks Hospital, a privately funded mental health care clinic, has started a CCSI pilot program that works in an outpatient setting specifically with the clients who are on the police department's list.

But despite the fact that the program has shown great results and is relatively cheap — it would have cost about $300,000 for another year — the city failed to deliver the funds, and MHMRA had to throw in its own money to keep it from shutting down.

Grantham was homeless for his first 15 months in Houston, but during that time, he received treatment and medication from MHMRA that kept him stable enough to work on finding a place to live, along with staying out of trouble and out of jail. He's also continued his streak of 12 years clean and sober.

Grantham has gone into crisis just once since living in Houston, during the weeks following Hurricane Ike when he ran out of his meds. Grantham made it to the NeuroPsych Center, an emergency room at Ben Taub Hospital for mentally ill patients in crisis, just as he'd been instructed to do. Doctors there gave him enough meds to keep him level until he could get a regular MHMRA appointment.

"I really think some people there are eager to help anyone who wants and needs help," Grantham says. "From the first time I went there, I was helped."

But if the proposed cuts go through, indigent people arriving in Houston or already living on the street, or the thousands of people who are simply uninsured, won't have a place for care. The cuts are stacked in such a way that it will take several years to see and feel the full effects in the city, but all told, 15 percent of the state's mental health funding, already one of the lowest in the country, will be gone.

Meaning, state lawmaker Coleman says, "These cuts are even more severe than it looks."

And it doesn't take much examination beyond the 2003 cuts in Houston, realizing what happened in the jails, the police department and the sheriff's office, to see what the result could be.

During Grantham's last trip to MHMRA, along with getting his meds adjusted to ease him out of a manic episode, his doctor also took him off an expensive psych med that cost $150 a month, nearly a quarter of his disability check. It's taking awhile to get used to the new drug, Grantham says, but the money will go a long way in finding a new place to live.

Grantham was also scheduled to see a caseworker for a "financial review." The woman wasn't working that day, however, and now Grantham has about two weeks to reschedule an appointment with her and get to the clinic, or he risks losing his service. He'll do what it takes to make the appointment, though, because Grantham knows the side of life without MHMRA.

Christopher Patronella Jr. contributed to this story.


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