While lawmakers locally and statewide are working to allocate more money toward mental health services, Denton County-area officials and health care providers say funding is still not enough to keep up with the growing population. A lack of mental health care providers is a direct correlation to the increase of inmates in the Denton County Jail with mental health illnesses, according to Sonia Redwine, director of health and mental initiatives for United Way of Denton County. “We are definitely an underserved community,” Redwine said. “When you look at our health ranking overall we are No. 1 in the state, but if you dive deeper into the mental health piece you see the ratio of providers to population, and for every one provider the population would be over 1,000. Those counties that scored well in that area had a 1-to-300 ratio, so you can see we have a huge gap in qualified mental health providers.”

Law enforcement involvement

Redwine said the Denton County Jail is the largest mental health provider in the county. “The county jail is where people go when they don’t have access to care, support and resources,” she said. “And unfortunately, we call 911 when we see someone acting erratically or not what we perceive as normal.” Doug Sanders, Denton County Correctional Health administrator, said as of July 16 there were 230 inmates—nearly 29 percent of the jail population—who needed routine therapeutic mental health services or medication. In addition he said on the same date the jail had 18 inmates on full suicide precautions and 83 on suicide watch. Suicide watch means the inmate has a possible risk of self-harm, and inmates on full suicide precautions are considered an imminent risk. “We are hiring two qualified mental health professionals immediately and we have a third one in the near future and possibly a fourth one to help with the workload,” he said. “The inmate population has really grown over the last 18 months.” Sanders said there is more mental health clinical care in jails and prisons than in hospitals. “Resources are just so limited,” he said. “Your jails and prisons have just become your primary care for mental health patients and [jails and prisons] are the least prepared for this.”

Lacking funds

Redwine said Texas spending on mental health per capita is one of the lowest in the country, and Denton County is reflective of that. Redwine said Denton County’s local mental health authority, or LMHA, Denton County Mental Health and Mental Retardation, receives less money per capita than most other LMHAs. LMHAs are community mental health centers serving the state’s medically indigent mental health patients. The Texas Health and Human Services Commission contracts with LMHAs to plan, coordinate and provide mental health services. In fiscal year 2015—the latest numbers available—the funding rate for Denton County MHMR was set at $12.94 per capita, 25th among all 38 Texas LMHAs. DCMHMR Executive Director Pam Gutierrez said more funding is needed in order for the nonprofit to keep up with the county’s growing population. “There is no possibility that we will be able to continue to keep up with the demand that we have coming in our door without more additional funding,” she said.

Funding at work

The county jail and MHMR have received some additional funds through state grants and waivers. Gutierrez said MHMR was able to create three programs through a waiver, which is used to create programs aimed at providing help to people suffering from mental illness and intellectual development disabilities who might otherwise end up in the jail system. The money has funded a 24-hour triage program; a residential facility where people can go in a crisis or wanting to learn rehab skills; and an integrated clinic that provides services to individuals with co-morbid diseases such as diabetes and bi-polar disorder. Gutierrez said her main focus right now is trying to find funding to keep the programs going once the waiver funds are up a year and half from now. “They’ve been very successful, so we want to keep them,” she said. Gutierrez added the nonprofit has recently started to reach out to local municipalities for funding. “The county is absolutely wonderful, and the commissioners support us and they give us funding as well,” she said. “And for the first time ever we have asked Lewisville for funding, and they gave it to us. It was a small amount, but we got our foot in the door.” In January the Texas Health and Human Services Commission announced it was awarding up to $27.5 million in grant funds to support mental health services and projects. The commission selected 12 LMHAs and one local behavioral health authority to award grant funds. Denton County MHMR was one of those. “That affords us the opportunity to help people who need to go into the hospital,” Gutierrez said. “Our nearest state hospital is North Texas State Hospital, and it is full 98 percent of the time and what that means is they don’t have a bed for those who are in crisis a lot of the times. So we contract with local hospitals, which really is awesome for the person because they get to stay in their community.” DCMHMR will also be receiving grant funds from HHSC through Senate Bill 292, which Gutierrez said will be used to work with inmates released from jail to reduce recidivism and incarceration of individuals with mental illness. “We wanted to collaborate with the jail and give [released inmates] a place to come in to, which is our crisis residential facility,” she said.

Mental health legislation

In June, State Sen. Jane Nelson, R-Flower Mound, announced her plans to strengthen the state’s mental health system. She proposed a bill that will help coordinate state mental health initiatives across Texas’ health-related institutions of higher education. “By coordinating our mental health initiatives across the state, I believe we will both strengthen our mental health system and help connect individuals to the care they need,” Nelson said. “Additionally, this initiative will fill a workforce gap and improve access to services.” Redwine said the bill would help build collaboration among medical schools, especially psychiatry programs, so that physicians can reach out to get more information on how to better serve patients.