Admission Impossible

The wait to get into one of Texas' 10 state mental hospitals — already long — may be about to get longer.

Last month, as part of its attempt to comply with Gov. Rick Perry’s request that each state agency reduce its budget by 5 percent, the Department of State Health Services proposed eliminating 50 beds from four of the state's 10 mental hospitals: San Antonio, Rusk, Terrell and North Texas Wichita. 

The state's mental hospitals are already almost at full capacity, with 2,461 patients — both self-admitted patients and allegedly criminal patients awaiting treatment so they can stand trial. Wait lists, sometimes nearly 100 names long per hospital, range from a few weeks to several months. Mental health advocates foresee that patients awaiting admission will languish in county jails and emergency rooms, both of which are already overcrowded and ill-equipped to treat complex mental illnesses. “If those [beds] get cut, you’re looking at more very sick people in communities around the state who are unable to access the treatment that they need,” says Lynn Lasky Clark, president and CEO of Mental Health America of Texas. 

If the cuts are approved by the Legislative Budget Board in mid-April, the system would serve 207 fewer patients in fiscal year 2010 and 1,240 fewer in 2011, saving the department $27 million over the 2010-11 biennium. The overall two-year budget for DSHS is about $5.9 billion. The bed-elimination option, just one of the agency's proposed cuts, accounts to a quarter of the department's anticipated savings. 

Carrie Williams, a DSHS spokeswoman, says eliminating beds was last on the department's priority list but that the money had to come from somewhere. The beds "make up a large part of our budget, and it is nearly impossible not to include them as an option,” she wrote in an e-mail.

The number of beds at Texas’ state mental hospitals has gradually declined since 1996, when 2,800 were available to patients. As the number of beds gets smaller, the waiting lists get longer. “In previous years, [the state] would reduce the number of beds because people would move back to the community, and they wouldn’t need that many beds online anymore,” says Beth Mitchell, an attorney for Advocacy, Inc, an organization that represents the disabled. “Now the number of beds can barely keep up with the number of patients.” 

In 2006, Texas ranked 48th in mental health spending per capita: just $34.57, compared to the national average of $103.53, according to the Kaiser Family Foundation’s state health facts. That same year, DSHS requested $41.6 million for the 2006-07 biennium to add 240 beds at state hospitals. The state contributed almost $34 million to that project.

"Funding those additional beds has certainly helped," Clark says. "But we would like to see continued increases in funding so that more people are helped."

During the 2009 legislative session, lawmakers provided $7.5 million for a new private facility to be built in Montgomery County near Houston, an option industry experts and advocates said they were unaware of at the time. They later questioned the investment in a private company instead of improving the state's existing services.

Outpatient services have begun receiving some state money, shifting the focus from state hospitals to community-based services and outpatient treatment. But not enough, advocates say, to address the growing need for in-patient care. Right now, the state serves 27 percent of the population’s mental health needs, and the average cost to maintain a single bed ranges from $320 to $420 per bed, according to DSHS. “You can’t go much further down than what we’re already spending,” Mitchell says. “The most vulnerable citizens usually end up getting hurt the most.”

The proposed cuts come as the state and mental health advocates battle in court over funding to house mentally ill alleged criminals. In 2006, Mitchell sued the state to force officials to reduce the amount of time mentally ill criminals spend waiting in jail to get treatment so they can stand trial. Her clients — two of whom were defendants in criminal cases in Dallas County and one in Travis County — were deemed incompetent for trial and court-ordered to state mental hospitals to receive treatment but waited months in county jails.

Texas passed a bill in 2007 that made the treatment process more efficient and lenient for mentally ill or mentally retarded inmates, but Mitchell says that wasn't enough, and the legal battle continues even as officials weigh whether or not to reduce the number of beds. The suit demands waiting periods for alleged offenders be limited to three days at most, and the state would need more beds to fulfill that need.

“Just because you cut out the beds doesn’t mean that they’re not going to need somewhere else to go,” she says. 

Mitchell predicts a decision won’t be made regarding the case until late 2010 or early 2011. DSHS declined to comment on the pending lawsuit.