The Way Back
Bruce Stohr didn't know it at the time, but his mental illness first came on when he was in high school. Even for a hormonal teenager, Stohr was emotionally unpredictable and unusually antisocial. He didn't hang out, play sports or date. At his worst moments, Stohr thought about suicide.
"I went to class, got passing grades and stayed out of trouble," he says. "So no one knew anything was wrong."
Stohr joined the Marine Corps in 1970 and began drinking and taking drugs. "Self-medicating," he calls it. After three years, four months and 11 days in the corps, his erratic behavior led to an early discharge.
But it wasn't until four years later that Stohr learned what had been haunting him since his early youth: He was mentally ill. He discovered it when he had his first psychotic breakdown in 1977. Diagnosed with bipolar disease, he spent the next decade in and out of the VA hospital. He managed to join Alcoholics Anonymous and quit drinking, but his mental health was so fragile most of the time that he was unable to hold a job.
Relief finally came in 1987, when an MHMRA physician gave Stohr a prescription for a new medication. Stohr felt as good as he had in years, but with no real employment history since the Marines, his prospects were dim. He worked temporary jobs when he could find them and lived with his parents.
In 1991, at age 39, Stohr enrolled in a patient-education program that taught MHMRA consumers how to be case managers. For nine months he attended class six hours a day, five days a week at Houston Community College to learn basic social-worker skills, as well as the ins and outs of the MHMRA system. Stohr was the valedictorian of his 25-student class. After graduation, he took a job with MHMRA as a case management aide, helping clients who were very much like he once was: broke, without skills and stigmatized by a frightening and misunderstood illness.
Today Stohr is a licensed chemical-dependency counselor. While he credits medication for opening new doors in his life, the case management aide program gave him the wherewithal to walk through them. "I've been paying taxes for ten years now," he says, "all because of the start I got at MHMRA." Such sentiments are rare at MHMRA now. Not long after Stohr left the agency in 1995, MHMRA dismantled the case management aide program, which each year had given two dozen mentally ill people the opportunity for a career. Other education and employment services, such as Fairweather Lodge, a job-training program, have been gutted to almost nothing.
According to the Texas Mental Health Code, local mental health agencies like MHMRA must "consider the feasibility" of finding job opportunities within the agency for patients "that may lead to competitive employment." Each year, the agencies are supposed to file a report showing how they complied with that directive. State records show MHMRA hasn't filed such a document in at least three years.
"The opportunities I had when I started in 1991 aren't there anymore," says Stohr. He says Steve Schnee, MHMRA's executive director, closed them out. "His vision is to give medications to stabilize consumers, give them crisis care when they need it, and, if you need anything more, you go to the state hospital."
Schnee agrees that supportive education and training programs are important components of good mental health care, but inadequate state funding has forced MHMRA to reduce or, in some cases, eliminate those programs. To address that problem, state mental health officials have organized a task force, of which Schnee is a member, to come up with a specific package of services for the uninsured and what it would cost. The idea, Schnee says, is that patients will know exactly what to expect, and providers will know exactly what it will cost.
"If the state is going to say, publicly, that the only benefit package for the uninsured is emergency services and pharmacological services, that's all we're going to provide," Schnee says. "If the state says there should be caseworkers' services, counseling, rehab services, they have to create a cost package, then say to the legislature, "This is how much it costs to serve a life for a year. You give us this amount of money, we'll serve this number of people.' "
Schnee says any change in how the state funds mental health services is several years away. In the meantime, the erosion of services for the poor and uninsured continues. Funding for MHMRA's adult mental health services has increased from roughly $44 million four years ago to an estimated $77 million this year. During that same period, services for MHMRA's neediest consumers have been cut drastically. In 1997 MHMRA spent more than $7,400 per person to provide supportive employment and housing services to the indigent; after cutting this year's budget for those programs by $1.5 million, MHMRA will spend less than $4,200 per person, a decrease of 43 percent.
The long-term impact of such a reduction in spending can't be overstated, says Brenda Lyles, who ran MHMRA's supportive employment programs until 1995, when she left to become district program manager for the Florida Department of Children and Families. Lyles says she ran a program that allowed MHMRA consumers to rebuild laser toner cartridges on a contract basis for local government agencies. Then there was the Fairweather Lodge, which trained groups of consumers to work as janitorial crews.
"Our focus was on not having people see themselves as not able," Lyles says. "It made it possible for people who had mental illness to work and be gainfully employed. I'm talking about salaries that allowed people to go back to school or get involved in different kinds of training programs so they could get the education necessary to become employed."
All of these programs were in place when she left MHMRA, Lyles says. In her view, they were probably the most important services the agency could provide. The more self-sufficient the mentally ill are -- and most of them can be -- the more cost-effective it is for everyone.
"How you look at it is, this is what happens when you don't provide these services," she says. "You're going to pay for it one way or the other, through homeless dollars, people being put in jail because they're out on the street, getting arrested for trespassing."
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