Texas’ mental health care budget has more than doubled in less than a decade—from $1.9 billion in 2012-13 to $4 billion in the state’s proposed 2018-19 budget that, as of June 5, was waiting for Gov. Greg Abbott’s signature. Despite this increase, the lack of state funding for mental health remains a challenge for Harris County as it tries to provide care to 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 recent increase of focus and funding, years of neglecting the issue mean the state has a lot of ground to make up and a need for even further increases, Emmett said. He said Harris County in particular is still woefully underfunded and lacks the resources to provide adequate mental health services to all the individuals who need care.

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

Large Need, Little Aid

Bill Schnapp, Harris County’s mental health policy adviser, said the state provides the county around $100 million a year for mental health services. However, to address all mental health concerns adequately, the county would need $500 million a year.

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

Emmett said Texas is ranked 48 out of all 50 states in per capita funding for mental health, and the lack of funds affects how well Harris 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 Spring and Klein. Emmett said it has been difficult to open clinics in the suburbs, because the assumption was that more people in the city needed access to clinics. However, almost as many people live in unincorporated Harris County today as the city of Houston.

Throughout Harris County, private hospitals—including Cypress Creek Hospital and Intracare North Hospital in Spring and Klein—also provide mental health treatment. However, Theresa Fawvor, the associate vice president for Memorial Hermann Behavioral Health Services, said private facilities are often affected by the limited number of psychiatrists working 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 who have thorough insurance coverage often have to wait weeks after they schedule an appointment before they are able to see a psychiatrist.

Jail diversion

Alongside the lack of funding, Emmett said the most significant mental health 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 aimed at addressing this problem. The state provided $5 million for the first year of the program and continues to provide funds every year to help the county—including $3.6 million in cash and $2.3 million in goods and services in 2016, county officials said.

Emmett said the program identifies people who have 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.

The jail diversion program has produced encouraging results, he said, but 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. “It’s going to take a whole sea change at the state level to start focusing on mental health rather than criminal justice.”

For their part, local law enforcement departments, such as Harris County Precinct 4 constable’s office, make an effort to ensure that the individuals they encounter who have mental health issues receive a proper diagnosis after they are 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

Kristyn Stillwell, founder of H.O.P.E. Haven—a nonprofit that helps homeless people in the Spring and Klein area get off the streets—said about 90 percent of the clients her organization works with suffer from some sort of mental illness.

“The mental health services we use are the kind that people with no insurance could use,” Stillwell said. “So we’re very limited in what is out there.”

Stillwell said many of her clients use drugs, but helping them requires more than taking them to rehab. She often finds her clients are using drugs as a way to self-treat a mental illness for which they are not receiving treatment. To rectify this, H.O.P.E. Haven takes clients to behavioral health service clinics, where they receive free mental health assessments. If they have been previously diagnosed with mental health disorders—but are currently not taking their medications—the doctors fill out prescriptions, which H.O.P.E. Haven pays for.

However, if Stillwell has a client who has not been previously diagnosed but is showing signs of a mental illness, H.O.P.E. Haven takes the client to a psychiatric hospital to get evaluated.

Stillwell said she sees a direct link between the lack of mental health resources and the homeless population in Harris County and believes that, if more services were available for the poor, then those services could help get the homeless off the streets.

Emmett said he agrees the two issues are connected, but the county does not have the resources to solve the problem completely.

“The local government, all we have is a property tax, so we can’t build enough facilities to mainstream [patients back into society], Emmett said. “Because that’s what you want.”

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.

This type of collaboration has been difficult to achieve in the past because of the fear of violating privacy laws. However, Emmett said various departments are now beginning to work together to share pertinent information without violating patients’ privacy.

As the county focuses on operating more efficiently, Schnapp said he is optimistic it will achieve a more permanent solution. Increased awareness among 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.

“There is much more research in neurology than there was 20 years ago, and the machines we have to study it are much more sophisticated,” Schnapp said.

A major hurdle is that the causes for many mental disorders—such as depression and schizophrenia—are unknown. Available treatments fix the symptoms of the disorder, not the disorder itself. However, if a treatment for the disorders were available, Schnapp said he believes the state would be more inclined to provide the necessary funding, because the money would be going toward a permanent solution 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.”