Efforts to expand mental health services in Harris County have been ongoing since the close of the 2013 legislative session when $332 million was restored to mental health services in Texas.

With additional funds, mental health facilities in Harris County have carried out significant service expansions and are continuing to improve treatment options to meet an ever-increasing demand for care.

"The biggest line item was the $48 million that went to eliminating the waiting lists," said Bill Kelly, director of policy and government relations for Mental Health America of Greater Houston. "Credit goes to the Legislature for funding it and the Mental Health and Mental Retardation Authority of Harris County for taking on those patients. That's a good first step, but we have a long way to go for real progress on mental health services."

Expanding services

Across the state, an estimated 894,000 residents have a severe mental illness, such as schizophrenia, major depression or bipolar disorder, said Steven Schnee, executive director of MHMRA. Of that amount, 163,724 adults in Harris County—one of the state's fastest growing areas—are believed to have a severe mental illness, he said.

"We have less than 10 percent treating capacity on an ongoing basis of what the need is," Schnee said. "Every day, every week and every month, there are young people between ages 16 and 24 who are beginning to manifest symptoms that could be indicative of a major mental illness. It is not a static population."

Through the restoration of millions of dollars in funding, MHMRA was able to hire new employees and plans to continue increasing staff levels in 2015, Schnee said. The facility has also increased its monthly patient base by 1,600 to reach 9,800 individuals in the past year and anticipates the capacity to treat 11,000 adults in the near future, he said.

Prior to 2013, MHMRA maintained an external waiting list of an estimated 1,800 people who were screened and determined eligible for treatment by the Department of State and Health Services. Schnee said the facility was able to expand its outpatient services to eliminate the external waiting list entirely and address the need for five new treatment teams to serve 2,500 patients with psychiatrists, nurses, caseworkers and rehabilitation staff.

"We're in the process of building out the capacity for five new treatment teams," Schnee said. "Three of those teams are fully staffed and in place, and the other two are nearing completion of their staffing pattern. We're very pleased we've been able to accomplish that in a fairly short period of time."

MHMRA has also been able to increase its treatment capacity for individuals who qualify for a more intensive service package.

"Prior to these [financial] resources coming online in fiscal year 2014, we had approximately 880 adults who qualified for a more intensive service package than we had the capacity of achieve," Schnee said. "With these additional resources, we've been able to offer and expand services to people who qualify based on clinical assessments."

Schnee said the new resources have enabled MHMRA to better match individuals and the severity of their conditions with clinical services and support.

Jail diversion program

Following the 2013 legislative session, Senate Bill 1185 was signed into law creating the Harris County Mental Health Jail Diversion program to address a population of mentally ill inmates who keep cycling through the jail system.

Prior to the legislation, the Harris County Office of Criminal Justice Coordination began studying subpopulations inside the Harris County jail and noticed a high frequency of individuals with a mental illness were cycling in and out of the jail, Program Director Regenia Hicks said.

During the first year, the program is responsible for serving a minimum of 200 people and will probably be up to 500 people by the 2015–16 fiscal year. Participants will enter into one of three community components after they are released from jail, including the clinic-based team, critical time intervention team or permanent supportive housing team.

"People have to want to participate, and no one can be sentenced or mandated into the program," Hicks said. "That's important because part of the success of this will be bringing individuals in who have a level of motivation to make changes in their life. The program is structured around providing people resources and information to make active changes to keep them from cycling back through the jail."

If the program is successful in Harris County, it could be duplicated across the state, Hicks said, since the issue of mentally ill inmates cycling through the jail is not unique to Harris County.

"This program is the perfect example of people reading from the same book and coming together to make the system better," Kelly said. "It didn't matter the [political] party, the bottom line was that we need to get people help."

Private clinic funding challenges

As a privately funded clinic, Lone Star Behavioral Health in Cy-Fair and Tomball does not receive any state funding and has encountered its own set of challenges regarding funding.

Catering to adults with mental illness or substance use disorders, Lone Star Behavioral Health opened a 24-bed inpatient hospital in Cy-Fair in 2011 and has operated a 167-acre outpatient facility for several years in Tomball. The facility accepts out-of-pocket payment or insurance coverage for services.

The outpatient facility hosts two programs for patients—partial hospitalization involves four group sessions per day and intensive outpatient therapy consists of two sessions per day. The facility serves patients in the Greater Houston area as far north as Huntsville.

Erin Rollins, administrator at Lone Star Behavioral Health, said each patient is housed at the inpatient hospital for an average of seven days before discharge. The facility has encountered issues with insurance companies, such as Blue Cross and Blue Shield, not covering the full cost of care for some patients, Rollins said.

With the implementation of the Affordable Care Act, Texas opted out of the Medicaid expansion that was proposed to expand coverage for millions of uninsured residents. For patients who use Medicare and Medicaid at the facility, reimbursement rates are much lower than other insurance policies, meaning the clinic receives less funding, she said.

"Our facility is one of the only [private] facilities that has been able to be open for the past two years with the [President] Obama cuts," Rollins said. "[Medicare and Medicaid] reimbursement rates were cut by 33 percent each year for the past two years. It's really sad."

Legislative outlook

Looking ahead to the upcoming 84th Legislature, Schnee said he is hopeful state representatives will continue to restore funding to mental health facilities. There is a growing need for more resources and housing options to support individuals who have severe mental illness, he said.

"While we took an important step last session, we don't have sufficient resources to treat even the most severely impaired, let alone broader range of conditions," Schnee said. "Hopefully the Legislature will see the wisdom of taking step two and building up the capacity of our outpatient system. It's difficult for individuals with any serious chronic medical condition to achieve stability and maintain it over time, but [especially so for] people who have a severe mental illness."

Ultimately, increasing mental health funding is not a one-session solution.

"We look forward to that continued investment to catch Texas up and build up our infrastructure," he said.