Jimmy Bailey has taken so much lithium in his life that all his teeth, except a few that wouldn't give up, have rotted away, leaving him with a broken, gummy smile.
He's been alive for 34 years and is a big man, weighing a little less than 300 pounds. When he tightens his fists and pounds them into a table like sledgehammers, it's a scary sight, even if someone doesn't know anything about all the times he's hurt other people and himself. Just a couple months ago, he slammed his head into a brick wall in a fit of rage and ripped a chunk of flesh off his forehead. "I did it because I didn't want to hurt someone else and go to jail," Bailey says.
He's diagnosed with schizoaffective disorder and severe major depression and belongs to a mentally ill population in Houston that is worse than the worst, and as one worker from the Mental Health Mental Retardation Authority of Harris County puts it, "doesn't have any more chances to get better. They've already lost themselves once."
Houston's 30 most mentally ill
Bailey is also one of Houston's 30 craziest people.
That's according to the Houston Police Department, because in February of this year, the department's mental health unit put together a list of mentally ill people, the "chronic consumers," based on how many times the cops have responded to a call concerning a person — regardless if an arrest was made — and how many times a person has been hospitalized under emergency detention orders from police. The list was handed over to two caseworkers from MHMRA, who trimmed it down to 30 (see "Houston's Craziest: The 30 Worst"), kicking off a six-month pilot program called the Chronic Consumer Stabilization Initiative.
The closest thing to this program before was the Assertive Community Treatment Team, which had nothing to do with the police department and was run by the Department of State Health Services. Many of the people on the police department's list have been kicked off that program. (Certain names and places were omitted from this story when clients would not give the Houston Press consent to publish their information.)
"There's one that kept coming into contact with police," says Lieutenant Mike Lee, who runs the police department's mental health unit. "With this lady, it was nonstop: standing out naked in the middle of intersections, throwing bricks at cars, running naked through high school campuses; she's been tasered by the police, been shot with a 12-gauge shotgun and she was brought to the hospital constantly."
He continues, "Come to find out, she had been receiving services from the ACT team, but they kicked her off. They said she wasn't complying. I said she shouldn't have a choice not to comply. She's sick."
According to Lee, the chronic consumer program is the first of its kind at any police department in the country. It's also the first mental health program in the police department to receive funding from the city and not the state. The pilot program cost the City of Houston $185,153.
The caseworkers aren't bound by state guidelines regulating how the money can be used, so the workers are charged with tracking down the clients, finding out why past treatments haven't worked and coming up with something that does. One woman, for example, showed dramatic improvement after she was taken to open a bank account and to get her hair done, things she hadn't done in years. Another man just likes to go to Burger King.
"We've trained this population to run down to the hospital anytime anything goes wrong, so that's what they do instead of working through it," says Janice Maire, one of the two caseworkers assigned to the chronic consumer program. "That's wrong, and it's costing us a fortune."
The goal of the program is simple: Reduce contact between police officers and the most serious mentally ill people in the city.
"We don't like to respond to these people in crisis situations, because sometimes things go bad. It's not ideal to have someone who is extremely psychotic and out of control confronted by a person who's armed," Lee says.
Police responded once — one of many times — to Bailey after he was involved in a bloody fight with the owner of a group home where he was staying. Bailey didn't have an identification card, so he relied on the owner to cash his monthly social security check and dole out his allowance. The fight started one day after Bailey asked for money that the owner didn't have, and when punches were thrown, a staff worker cracked Bailey across the head with a baseball bat.
A lot of Bailey's problems start at group homes, and he's stayed at about 30 different places in the last decade. He slammed the owner of one place through a wooden bedroom door, and, according to Bailey, he was raped by a staff worker at another. His longest stay in jail was 72 days for making a terroristic threat, and the Department of Homeland Security won't allow him in the social security office because he's considered dangerous. He's not allowed inside the MHMRA center on Caroline Street because he punched a doctor, and he's even banned from Houston's NeuroPsychiatric Center in the old Ben Taub Hospital.
"I can't go back there because of all the aggression I had toward others," Bailey says.
But since February, Bailey's hospitalizations and contact with police officers have dropped to a total of three encounters. During the six months before the program started, he had 12 offense reports with the police department and six emergency detention orders, according to numbers from the police. Back then, Bailey says, his life was "[moving] from house to house to house to house to house, hospitalization after hospitalization after hospitalization, suicide attempt, suicide attempt, suicide attempt, suicide attempt, suicide attempt."
"We've had our battles, and I've told him if he does something wrong, he'll go to jail," Maire says. "But he knows I don't want him to go to jail. We're working on his aggression, because I believe Jimmy can recover. He can hold a steady job."
The pilot phase of the program officially ended in August, and while it hasn't received a final approval, or funding, it has enough money to run until July, but nothing is certain after that. Lee plans to go before City Council and ask for more money, presenting the six-month results as evidence that the program has worked.
And he has the evidence. For instance, hospitalizations have decreased by 76 percent for people on the program, and police contact has decreased by 77 percent. More than half the clients aren't going to the Harris County Psychiatric Center as much.
"Something like this has never been attempted. We have a small portion of chronic mentally ill people who are creating the vast majority of the crisis calls for police," Lee says. "We would prefer these people have a caseworker to call when they're in crisis and in need of services, whatever it is that would have them calling the police instead. It's almost like babysitting, because some of them just need someone there and that's fine. Whatever magic works."
But things aren't looking too good for the program. Police Chief Harold Hurtt, according to Lee, supported most mental health programs, but he has resigned, effective at year's end. Mayor-elect Annise Parker has made it clear that it will be difficult for the police department to get any new programs funded.
"It's tougher for us, to convince the naysayers," Lee says of the mental health unit. "But if people will just think about it, and the money this will actually save, I don't see how they could say no."
On a sunny afternoon in November, Bailey stood in the living room of a crumbling house in south Houston not far from downtown. He hadn't lived there long, but caseworker Maire wanted him to move. The owner of this house, who charged Bailey most of his monthly income to live there, didn't lock up patients' medications, and beds were nearly stacked on top of each other. Residents used a garden hose attached to the faucet in the bathtub to shower.
Bailey, who had already all but run away from the house, returned with Maire to pack up his things and move, but he couldn't find his best pair of pants, slacks he had bought on his own, and a backpack he used to carry around his medications and a few personal belongings. He rifled through drawers and piles of clothes, not far from the elderly man with one leg who was sleeping in Bailey's bed. He couldn't find his pants or backpack, and he yelled at the house's owner.
"They're not here, not here, not here,not here," Bailey told her.
"Jimmy, you're always losing things," the owner told him. "You lost your pants."
Bailey looked like he was about to explode in rage. He stood in the living room, arms crossed in a tight grip, swaying back and forth.
"Jimmy, come on, we can buy you a new pair of pants," Maire said, walking toward the door.
"Yes ma'am," Bailey said and followed her out.
The audio from the 911 call is grainy.
"This man's got a knife up here and going to cut me and I'm his momma and I want him to go to jail," the woman tells the dispatcher. "I want him to go. Please come get him before he kills me."
"Is that your husband or your boyfriend?" the dispatcher asks.
"That's my son."
"And how old is your son?"
"He's 30 years old. Thirty-one, he's 31," the woman says.
"And he has a knife?"
"And he's still there?" the dispatcher asks.
"He's probably in the trash."
"Is he black, white, Hispanic or Asian?" It's the dispatcher's last question.
"Please just send the law here, please just hurry up!"
The call is from July 21, 2007, in south Houston, not far from Bailey's group home. Steven Guillory, 31, diagnosed as a paranoid schizophrenic, was inside his mother's house, threatening her with a butcher knife when she made the 911 call. According to police, officers arrived to find Guillory in the front yard with a steel pipe, which he then used to bash police cars.
"He was very chronic, had been in contact with HPD a number of times," Lee says. "He had just gotten out of [the Harris County Psychiatric Center], and that weekend, Mom had gone back and tried to get him in again, but they just told her that if the situation got bad enough, she should call 911, which she did."
By the time more police cars arrived at the scene, Guillory had broken his pipe on a cruiser, and threw the pieces at officers. Guillory was shot with a taser but didn't go down. He did, however, run at officers, causing one cop to fire his pistol, hitting another officer and Guillory. Guillory died from the gunshot wounds.
It was the second death of a mentally ill person at the hands of Houston police officers in several months, because in May of that year, a 42-year-old woman named Marnell Villarreal walked into police headquarters downtown with a knife, stabbing herself in the head, asking officers to shoot her because, "I want to end this."
When she charged officers, one of them shot Villarreal with a taser, and another shot her with a pistol and she died.
"She came into HPD all the time making claims that laser beams were being shot through her head and her food was poisoned," Lee says. "She had already been given a warning not to come back to headquarters, because not too long before that incident occurred, she came in and had a gun on her."
Lee continues, "She was an example of someone that was obviously very sick and was somehow slipping through the cracks."
It was a tough stretch for the Houston Police Department's mental health unit, which prides itself as being the largest and one of the most progressive mental health divisions in the country.
The unit was founded in 1999, starting with another pilot program that required Houston police officers to receive eight hours of training in dealing with mentally ill people. The mental health unit grew, and today, cadets are required to get 40 hours of "crisis intervention training" before graduating from police academy.
One of the most celebrated programs in the unit, implemented in 2008, is the Crisis Intervention Response Teams, which pair patrol officers and clinicians from MHMRA. That program became permanent, receiving full funding, in February of 2009. Lee has talked about mental health and law enforcement in front of the state Senate's Finance Committee and in Denver at the International Association of Chiefs of Police conference.
After the shooting deaths of Guillory and Villarreal, a mental health task force was formed. Members included Houston City Council member Adrian Garcia, now the Harris County sheriff; George Parnham, the attorney who represented Andrea Yates; Dr. Steven Schnee, the executive director of MHMRA; and Steve Williams, director of Houston's Health and Human Services. One result of the task force was the Chronic Consumer Stabilization Initiative.
The Houston Police Department, in its reports, describes the chronic consumer population this way: "Oftentimes, these individuals would be in a mental health crisis because they were not taking their medications or they would find themselves involved in a disturbance where they would call the police or someone else would call on their behalf. Officers usually found no real solution other than making an arrest or committing them for an emergency evaluation."
The report continues, "Then, within weeks or even days, the same chronic consumers would be back out on the streets or at their homes reverting back to their crisis modes. This 'revolving door' process has always been a perpetual cycle with no viable alternatives or methods to disrupt these patterns. There has never been a strategy developed to evaluate and research the root causes for all of these chronic consumers making persistent calls to the police department."
"Instead of just having a better reaction to these people, we want to start working on prevention," Lee says. "Most of these folks have been in the mental health system for years, but their services have expired or they just don't cooperate, and there are so many people that need services that if folks don't cooperate, they tend to get dropped. These people are so sick now, because of their illness, they're living under the bridge and eating pigeons in the zoo. We have to realize that there is a certain population that is so sick that they can't take care of themselves. We wouldn't let mentally retarded people wander downtown and live under the bridge. Society wouldn't accept it."
The first problem with the chronic consumer program was finding caseworkers crazy enough to take the job. Lee, along with Ann Macleod, who runs the program for MHMRA, tried to find two caseworkers with master's degrees already working for Harris County.
"We found that people with advanced education who worked their way up to a desk job don't really like to leave the desk," Lee says. "Especially not to deal with people like this. We need to send them to some bad locations, places we don't send our officers to a lot."
The department had to look for alternative choices. The first person to hire on was Maire, a 55-year-old woman who'd worked as a probation officer and spent most of her life working as a caseworker and investigator for Child Protective Services in Galveston County. In the early months of the job, Maire did a lot of random knocking on doors trying to find people without working phone numbers or solid addresses.
The woman behind one apartment door — it had the Ten Commandments scrawled on it — threatened Maire with a pistol after the caseworker wouldn't leave.
Maire retreated that day, but kept coming back, and eventually she discovered her client lived in a home that didn't have running water or electricity. Maire is working to find her a new place to live.
As a result, Maire says the client "is doing well and stabilized at this time. I have seen a drastic improvement in her attitude and her disposition since we have shown an interest in her recently."
Bailey has become somewhat of a favorite to Maire; since her involvement, he has made progress, greatly reducing his hospitalizations and contact with police. It didn't take some new medication or new type of therapy for Bailey to get stable, but just more personal attention.
"Everyone wants to blame the patient when they go into crisis, when they act like that," Maire says. "But a lot of times, they're just not being treated right."
In an assessment of Bailey, Maire complains, "He has case management services through [a health care provider]; however, they have not provided him with any services for some time. They have promised him a trip to his hometown, and informed him he would get this after one month of no hospital stays. They did not follow through, but stated that it would be two months before they reward him for staying out of the hospital. Needless to say, it appears they are not consistent with their methods of reinforcement."
"He wants to go fishing."
Bailey grew up in Center, an East Texas oil town about 120 miles north of Beaumont where the population has never been much more than 5,000 and the median income isn't much higher than $20,000.
"I had a wonderful mother. She walked me down to the road every morning so my ride could pick me up, because there wasn't a turnaround by our house for the van, and every night she'd be waiting for me," Bailey says. "But my father would beat me with anything he could get his hands on."
The physical scar that has lasted longest from the abuse Bailey took from his father is a knot that looks like a fist pushing out from the back of Bailey's head, the result of a beating with a piece of firewood. Bailey says he also saw his father beat his mother, sister and elderly uncle.
His first psychotic episode happened when he was 18 and a senior in high school. He disappeared, and says he was abducted by drug dealers at gunpoint and locked in a room for a couple weeks. That resulted in a stay in Rusk State Hospital, and he was later sent to Houston — his godmother didn't think mental health services in Center were good enough — and he bounced between here and East Texas for about ten years before permanently moving to Houston after his mother died in 2007.
"There's nothing like losing your momma," Bailey says. "You won't be ready to deal with that one."
Bailey hasn't found a group home in Houston where he can stay out of fights, and finding a good place for him to live has been one of Maire's biggest goals.
She wanted to get him into Lufkin State School, but he tested for only mild mental retardation, so he doesn't qualify for placement. Maire moved Bailey from several other group homes that she didn't think were right — Bailey's friend died of an overdose at one of the homes and Maire thought the owner of another place stole money from him — but he lives in a home now, in far south Houston, that Maire thinks is working.
"Miss Janice was able to track me down and find me," Bailey says. "That's when my stabilization started."
Then the program hired 33-year-old Chris Alas.
He started working in the mental health field while he was in college at Southwest Texas State University in San Marcos and desperately needed a job. A friend told him that a nearby psychiatric clinic didn't ask for a drug test or have much of any requirement to get hired. He got the job and loved working at the hospital, in that field, so much that when graduate school didn't work out in tiny Alpine, Texas, a few years later, Alas moved back to Austin and opened several group homes for mentally retarded people.
He owned and operated the homes for several years before the stress became too much and he sold them, eventually moving back to his hometown of Houston after hearing about the job with MHMRA. Lee says that Alas, who sports tattoos on both arms and wears his hair jet black and spiked, has been a perfect fit.
The first time Alas showed up at 37-year-old Tashonya Williams's apartment, he says he was approached by a man who asked if he would like to buy crack cocaine. Alas said no and knocked on the door.
Williams had five children from different fathers, and after losing custody of her kids in 2004, she has stayed unemployed without benefits and relied, for the most part, on her grandmother for money. Williams often went for days without food in her apartment, Alas says.
Williams had been in MHMRA's system since her early twenties, but she rarely went to treatment or took her medication, if she had any. Since losing her children, Williams had become increasingly delusional, believing that neighbors were performing voodoo on her or that a family member was trying to kill her.
"It was the people in the TV that were talking to me," Williams says. "I don't even know what they would say, but I just knew that someone was out there [to hurt me]."
Other times, when she had a psychotic episode, Williams would become "sexually hyperactive," opening her front door and lying in her living room naked, or she would walk naked down the street.
Shortly after the program started, Williams was discharged from a two-week stay in HCPC, and she said she was ready for psychiatric treatment. She's been to the hospital just once since the chronic consumer program started, and since she's become stable, Alas helped get her social security benefits for the first time in almost a decade. He also helped her open her first bank account that she can remember.
"I go and check up on her some nights," Alas says. "Because I know she'll start feeling good and stop taking her medication. One time I knew she wasn't taking her medication, so I went over there and said, 'If you don't take it now, I'm going to come back.' I went back at 8 o'clock that night and I brought my dog, because I knew I might sleep there if she didn't take it. It took about 30 minutes, but she took it."
"Me going over there and making her take her medication, that saved the city thousands of dollars," Alas says. "Because they didn't have to go and intervene, take her to [the NeuroPsychiatric Center] and wait to do whatever paperwork they'd have. It took me 30 minutes, boom, bam, end of the day."
In other cases, he hasn't been so successful. The one client on the list of 30 who died during the program was supposed to be helped by Alas. She was a 42-year-old refugee from Cuba who got assistance for room and board from the Harris County Guardianship program, a last resort of court-appointed guardians.
Alas first found the woman behind a gas station on the city's east side, in a wooded lot where there was a couch. "[The client] had not been attending day programs and was leaving the home at all hours of the day and night, for days at a time, and roaming the streets panhandling or hanging out in abandoned lots with transients under the influence of crack," Alas wrote in a case assessment. "Though [the patient] was med compliant, she was manipulative and drug seeking. [She] would bolt from her home for days at a time when she would partake in all types of criminal behavior, including prostitution and drugs."
The woman, because of the way she spent her time, would often find herself in confrontations with police. When that happened, she would simply "verbalize her mental illness and her willingness to hurt [herself]. She was well known at [the NeuroPsychiatric Center]..."
Alas got her into a drug rehabilitation program that treated people with chemical dependencies and mental illness, known as dual diagnosis, and the owner of the group home where she lived helped out by promising to keep her on lockdown. Days before the woman was scheduled to check into rehab, Alas says, the woman developed a rash on her stomach and when the intake worker at the rehab center asked her about it, the client said she burned herself, causing a self-inflicted wound. She couldn't get in.
Days later, she disappeared from her group home, and after a couple weeks passed, Alas received a call that the client had gotten a spot at another rehab. The next day, however, he found out the woman had been found dead.
"That was tough, because she had a chance," Alas says. "But she was going to do what she wanted to do."
Like many people on the list of 30, one man is scary. He has hepatitis C and is HIV-positive. And, Lee says, "He has this issue where he'll be walking through downtown, and he'll just coldcock you. You could just be standing at a bus stop, minding your own business, and he'll punch you. That's his conduct."
One morning this summer, that man was walking through downtown and decided to deck another man who happened to be the brother of state Representative Garnet Coleman. Police were called and the man was arrested. Trouble was, the next day, Coleman's brother was walking to work downtown and saw the same man who had punched him the day before. The brother called Coleman, who in turn called the police department.
"I told the rep's office it's a problem and we need some help. We've put [that client] in the hospital so many times, and he's out in a day or two. We'll put him in jail, and that's usually the quickest. He's out in 24 hours," Lee says. "It's not that I'm happy that happened, but they experienced a little taste of what we've been telling them."
Coleman's office has not responded to the Press's request for comment.
The chronic consumer program, according to Lee, would need about $350,000 a year to become a permanent program and hire two new caseworkers and a full-time officer who would be a liaison between the department and MHMRA. To put that money in perspective, the city approved a $135,000 contract to hire a consultant — for not even half a year — to evaluate the city's troubled Bureau of Animal Regulation and Care, and another $250,000 was approved for one year to pay a California-based consultant to oversee construction of two new light rail lines.
Still, Lee is concerned this program might not be funded. It's in the "proposal phase" right now, and the mental health unit has prepared a 26-page final report, which it plans to present to Mayor-elect Parker and the city council.
Parker hasn't exactly offered an open checkbook to the police department. She was quoted by KPRC-TV Channel 2 as saying, "I want to change the way we do policing in the city of Houston. We're going to have to do a better job with the amount of money we're putting into the Houston Police Department, and that's going to take a lot of input." Parker's office has not responded to the Press's request for comment.
Lee has the support of at least one council member, Ed Gonzalez, who ran Adrian Garcia's campaign when he was elected sheriff of Harris County.
"When you have chronic consumers that really place a toll on the system, it's important to try to address the root issues that are going on," Gonzalez says. "We can hone in and provide the necessary help, and we can eliminate a lot of those repeat calls. We would eliminate our first responders from a situation where they need to make a split-second decision and have some type of violent encounter with someone in crisis."
Still, Gonzalez recognizes that there isn't much money available for everything, and mental health services could get pushed to the bottom of the pile.
"But you could make the case with the costs associated with constantly responding to a certain person or location, the cost of transport and everything else; it's not like it's not costing us anything anyway," Gonzalez says. "I would definitely be an advocate if it's something the city could afford to do."
During the Thanksgiving holiday, Bailey got his wish to go back to his hometown in East Texas. His mother and father died a couple years ago, and his grandparents have passed away, too. Other extended family members — a few cousins and aunts — are still around but refuse to see him.
He still has a godmother that he's close with, but it was a risky trip for Bailey, who had been stable. He says most of his rage starts after he thinks about things that happened to him growing up. "I have these flashbacks," he says.
The day before Thanksgiving, Maire drove up to East Texas to check on Bailey, make sure he was taking his medication and doing well. He was. His godmother had even gone to get another birth certificate for Bailey, because he never was good at keeping up with it. He wants to visit again soon.
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"I did real good, and it was a wonderful trip," Bailey says.
"Policing has always been the traditional response; just take care of it at the time and move on," says Sergeant Patrick Plourde, an officer in the mental health unit. "There's never been a program to identify these people, to find out what the root causes are that drive them to constant crisis mode. That's what we've done."
Lee adds, "Even with the success we've seen, we all know that it has much more potential. Just with our little experiment, we know we can make a difference in keeping people out of jail. And ultimately keeping someone from getting killed."