The restoration of $332 million in funding for mental health and substance-use disorders by the Texas Legislature will have far-reaching effects in Harris County, where 500,000 adults and 150,000 children are affected by a mental illness.
Waiting lists for public providers such as the Mental Health and Mental Retardation Authority of Harris County have been chock full—until this year. The additional funding will have one of the largest impacts on the state's waiting list, with $46 million earmarked for eliminating it statewide, said Andrea Yusonga, director of policy and government relations for Mental Health America of Greater Houston.
"It will have a huge impact on Harris County, because at the beginning of this year we had 1,600 people waiting to receive mental health services," she said.
MHMRA is in the process of expanding its treatment teams by 2,500 outpatient slots each month and intends to zero-out the organization's waiting list and keep it from re-occurring because of funding it received in the 2013 legislative session.
"Through the combination of the state and federal funds, we're expecting to do some remarkable things for adults in Harris County who have been underserved or not served," said Steven Schnee, executive director for MHMRA of Harris County.
Recognizing the issue
The state legislature's move to restore mental health dollars, according to officials, comes from a confluence of factors, ranging from national mass shootings in which mental health is believed to have been a factor to recognition that mental illness is a serious issue that needs to be addressed.
"I don't doubt that Newtown weighed heavily on the minds of legislators, but there were others who were talking about the issue earlier in 2012 and studies being done during the interim," Yusonga said. "I think legislators were also coming to grips with the fact that they have underfunded the system for far too long."
Harris County Judge Ed Emmett said mental health has become an issue that crosses political party and philosophical lines.
"The state and people here locally recognize mental health as an issue that we need to deal with," he said. "If you have a diseased kidney, there is no issue with talking about it, so the fact that you have a diseased brain should be the same way—it's part of health care."
Mental illness occurs regardless of factors such as race, education and socioeconomic status, and it tends to affect the population uniformly at about 6 percent. As the general population in Harris County continues to grow, new cases of mental illness manifest as well, but there are not enough resources to treat them, Schnee said.
"We have a problem when we treat these diagnoses as an acute condition as opposed to designing service systems that would go across years of the patient's life to attain and maintain stability as functioning members of our community," he said.
One of the biggest issues in serving the mentally ill in Harris County is the lack of enough community services to help those in need, especially for the one-third of county residents who are uninsured.
"If people have insurance, they can seek out private providers," Yusonga said. "There are also community agencies that provide services. If they don't have insurance, the MHMRA is the largest public provider of mental health services."
MHMRA of Harris County serves about 15,000 individuals each month, primarily those who show signs of the three major mental illnesses—bipolar disorder, schizophrenia and major depression. Because of the restoration of state dollars from the legislature and federal dollars from the 1115 Medicaid waiver, MHMRA has embarked on several initiatives to improve and expand services throughout Harris County.
"The additional funding that is being provided is enabling [the Mental Health and Mental Retardation Authority of Harris County] to expand our outpatient services capacity," Schnee said. "The intent over this year will be to, if at all possible, zero out the waiting list and try to keep it from reoccurring."
MHMRA is also in the process of expanding its treatment teams by 2,500 outpatient slots each month, which will expand the outpatient services from 8,500 adults to nearly 11,000 as the expansion rolls out.
"We're also adding 30 licensed chemical dependency counselors who will be treating people who have not only mental illness, but very often are abusing street drugs and alcohol, or both," Schnee said.
A new program
Harris County has the state's largest mentally ill population because of sheer size of its population—more than 4 million residents—which puts a strain on the county's facilities.
"As a community expands and the population grows, the community is used to adding police, fire and ambulance services because there are needs that have to be responded to," Schnee said. "We have not done that with regard to people who have serious mental illness or intellectual and developmental disorders."
Nearly 2,500 of the Harris County jail's 9,000 inmates are mentally ill, making the facility the largest mental health facility in the state, Emmett said.
"On any given night, more people there are receiving prescription drugs than anywhere else and it's fundamentally wrong on many levels," he said. "It's also a really bad deal for the taxpayers, because dealing with someone in the criminal justice system costs more money than if they were in the provider system."
State Sen. Joan Huffman, R-Houston, passed Senate Bill 1185 through the legislature this year to create a pilot program to divert mentally ill inmates from the county jail to a provider program to stop them from cycling through multiple times. The program will first be implemented in Harris County and could then be used across the state in the future.
"It will focus on people with mental illness leaving the Harris County jail and trying to provide them with case management and other needed services that will keep them from returning to the criminal justice system," Yusonga said. "There are individuals who have been cycling through the jail for decades, so if they can craft a solid program, it will keep some of those folks on the outside."