Texas’ mental health care budget has nearly doubled in less than a decade—from $1.9 billion in 2012-13 to $4 billion for 2018-19 in the state’s budget that passed in May. However, the lack of state funding for mental health remains a challenge for Harris County as it tries to provide care to all of those in need.

“The good news is, in a world that has become very partisan and very uncivil in terms of politics, everybody agrees mental health is an issue we can all work on,” Harris County Judge Ed Emmett said.

Even with the increase of focus and funding in recent years, years of neglecting the issue means the county needs even further increases, said Emmett, who believes Harris County is still woefully underfunded and lacks the resources to provide adequate mental health services to its growing population.

“I think we should be doing a lot more, but at least everybody is saying the right thing and we’re moving in the right direction,” Emmett said. “We just aren’t moving fast enough.”

Funding challenges

Bill Schnapp, Harris County’s mental health policy adviser, said the county receives around $100 million from the state for mental health services each year. This funding supports mental health services such as counseling, crisis intervention, pharmacological management and hospital care, Emmett said.

Schnapp said to adequately address all mental health concerns, the county would need $500 million.

“We have taken a lot of time to estimate this in different ways,” he said. “We keep coming back to the fact that we appear to be meeting 20 percent of the need.”

Emmett said Texas is ranked 48 out of all 50 states in per capita funding for mental health, and the lack of funding affects how well the county can treat patients.

“If you just think about the Harris County Psychiatric Center, the fact that Harris County has more people than 25 states, and we have a 225-bed facility—that’s not enough,” Emmett said.

Besides the Harris County Psychiatric Center, the other county-run mental health providers are the Harris Center for Mental Health and Intellectual Development Disorders—which has clinics throughout the Greater Houston area—and the psychiatric ward at Ben Taub Hospital.

While these resources are available to all Harris County residents, they are concentrated in Houston, which presents a problem for people in unincorporated areas, such as Cy-Fair.

Emmett said it has been difficult to open clinics in the suburbs, because the assumption was that more people in the city needed access. However, almost as many people live in unincorporated Harris County today as in the city of Houston.

Throughout Harris County, private hospitals—including Houston Methodist Willowbrook Hospital in the Cy-Fair area—also provide mental health services. However, Theresa Fawvor, the associate vice president for Memorial Hermann Behavioral Services, said these facilities are often affected by the limited number of psychiatrists in the field.

“It is one of the lowest reimbursed specialties for physicians,” Fawvor said. “Access—that’s the significant problem because of the limited number of specialists in the community providing ongoing outpatient treatment.”

Fawvor said this access problem affects everybody. Even patients with great insurance coverage often have to wait weeks after scheduling an appointment before they are able to see a psychiatrist.

Jail diversion

Alongside the lack of funding, Emmett said the biggest challenge Harris County faces is the number of people with mental health issues who end up in jail.

“[Harris County Jail] is the largest mental health facility in the state of Texas, and that is not something to be proud of,” Emmett said. “But with the way our criminal justice and mental health system works, if you are picked up on a minor crime, you go to jail, when in fact the real issue is mental health.”

In 2013, Harris County secured funding from the state to start a jail diversion program designed to address this problem. The state provided $5 million for the first year of the program and continues to provide funding every year to help the county—including $3.6 million in cash in 2016 and $2.3 million in goods and services.

Emmett said the program identifies people with mental health disorders who have been arrested repeatedly and diverts them to the Harris County Psychiatric Center—or another facility where they can receive help—the next time they are arrested.

Emmett said the program has produced encouraging results. However, it is limited by its lack of resources. He believes a change of ideology at the state level is necessary for the program to become more effective.

“On any given night, the Harris County Jail probably has 3,000 people who are either on some kind of psychotropic drug or need to be on one, and we can only deal with maybe 500 people as part of the jail diversion project,” Emmett said.

For its part, local law enforcement departments like Harris County Precinct 4 constable’s office, do make an effort to ensure the people it encounters with mental health issues receive a proper diagnosis after being detained. Constable Mark Herman said the department often takes suspects to the Harris County Psychiatric Center or another facility.

“Anytime we deal with folks with mental health issues, we have no problem getting them into a facility or getting them looked at,” Herman said.

Helping the homeless

Penny Bahr, outreach coordinator for Cy-Fair Helping Hands—a nonprofit that helps homeless people get off the streets in the Cy-Fair area—said more than 90 percent of the clients her organization works with suffer from some sort of mental illness.

Bahr said for her nonprofit to get individuals to a treatment facility, they first must be stabilized on medication and go through a mental health evaluation. This task involves transporting them to a mental health facility that treats uninsured patients—either the Harris County Psychiatric Center or Ben Taub.

“There are no facilities in our area that we can take them to,” Bahr said. “We also don’t have a bus system, so they don’t have any means of getting down there outside of someone in our organization taking them.”

Bahr said individuals with mental health problems can have short windows during which they can be evaluated, and many miss that window because of the lack of local facilities.

“If they’re in a manic state and there’s no immediate way to get them to [be evaluated], we might miss that window,” she said. “By the time we can arrange the transportation, they might be back off that manic state and things are good again.”

Bahr said she would like more county services to cater to the northwest Harris County area, including a facility to provide drug and alcohol rehab, mental health evaluations and a place where people can get medication after evaluations.

Emmett said he thinks expanding mental health services may help stem homelessness, but the county lacks the resources to solve the problem completely.

Long-term solutions

Emmett said he believes addressing the problem requires changing the county’s view of mental health as a separate issue from general health care. Combining the two would allow various governmental agencies to work together more efficiently.

In the past this was difficult because of a fear of violating privacy laws. However, he said various departments are starting to work together to share pertinent information without violating patients’ privacy.

As the county is focused on operating more efficiently, Schnapp said he is optimistic about a more permanent solution. Increased awareness from elected officials and the general public has led to more money being poured into neurology research, which Schnapp said is key in addressing mental health concerns.

A major problem is that the causes for many mental disorders—such as depression, schizophrenia and bipolar disorder—are unknown. Available treatments fix the symptoms of the disorder, not the disorder itself. If treatments were available to address the disorders, Schnapp said he believes the state would be more inclined to provide funding, because the funds would be going toward a permanent fix rather than a temporary one.

“When we give those medications, we are treating the symptoms, we are not treating the cause,” Schnapp said. “And once people figure out what the cause is, generally a treatment that is cheaper to administer and easy to administer comes about.”