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Analysis: Pay for Mental Health or Pay the Jailer

Once again, the state's care for mental health patients is under legislative scrutiny, and county sheriffs and other local officials are hoping the state will fix a problem that has spilled into their domains.

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The sheriff of the state’s largest county is peeved with the Texas Department of State Health Services, the agency that runs the state’s mental health hospitals.

The agency is not offering the care that it is required to provide, the Harris County sheriff, Adrian Garcia, said. Given proper treatment, the sheriff argues, some patients would not be committing the crimes of which they are accused. Instead, they end up in Harris County’s jails, where they are a health care and financial burden to the county.

Sheriff Garcia has allies, and might even get some help. The state agency is being reviewed by the Legislature’s Sunset Advisory Commission, which will hold hearings later this month on a report from its staff that calls the system a mess. “Resolving the current crisis in the state mental health hospital system requires action, starting now,” the first recommendation states.

The report is remarkably clear, as these things go, detailing changes in organization and programs that would reboot the agency. It has floundered since undergoing a reorganization ordered by lawmakers who were trying to create “a truly integrated health services organization” in 2003.

“The state mental health hospital system is dealing with enormous pressure from increased commitments from the courts, and the review found that a lack of communication and collaboration between DSHS and the judiciary only exacerbates the problem,” the staff analysts wrote. They added that out-of-date facilities, “critical shortages” of clinical staff and the agency’s struggles with organization and new legislative initiatives have added to the troubles. The agency did not offer much resistance in its formal response, saying the report “captures the challenges we face” and that agency officials “understand and support the intent and direction of the recommendations.”

In other words, the system is not working. The recommendations include increasing staff for the hospitals and expanding capacity by contracting with local providers whenever possible.

That is not revolutionary thinking. “Several of the recommendations in this report simply reflect a need for the agency to simply do its job better,” the analysts wrote.

Harris County has a list of about 900 people — frequent fliers, they call them — who were in and out of jail at least five times in 2011 and 2012. Some had 30 or more visits, the sheriff said.

From that list, 538 had been diagnosed with mental health issues that required treatment, according to the sheriff. He points out a couple of issues.

First, they are more expensive to jail. He contends that they get the care they need while locked up that is as good as or better than what they receive in state programs that are supposed to care for them. But it is expensive. The average jail inmate costs taxpayers less than $70 a day, Garcia said. The average inmate in need of mental health treatment costs $300 per day.

Second, the jails are not the best place for this care. It is less costly to treat these patients — those who commit crimes and those who do not — in the state mental hospitals that, unlike jails, were built for the job.

On any given day, Harris County has 9,000 people in its custody, Garcia said. “A third of them are receiving some degree of psychotropic medication,” he said. “Imagine the care they could be otherwise getting outside the jail. If they got that treatment, if they had access to that treatment, they would in all likelihood not come to me to begin with.”

Last year, lawmakers approved a pilot program — proposed in legislation from state Sen. Joan Huffman, R-Houston, and a former state district judge — intended to get treatment for inmates as they check out of Harris County’s detention centers. The hope is that the treatment will effectively turn unintentional criminals — people whose crimes are tied to their mental illnesses — into non-criminals.

“I firmly believe that the majority of people who are in my custody who are in this mental illness category are coming here largely because of their illness and not necessarily because of their actions,” Garcia said.

“Here is an agency that has the money and can’t do it,” he added. “I cannot explain why, with all those calls for action, why they are unable to get it right.”

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