With more than 500,000 Texans suffering from serious and persistent mental illness and 1 in 5 Texans experiencing a mental health condition each year, behavioral health continues to be a problem with no long-term solution in sight.
While lawmakers locally and statewide are working to allocate more money toward mental health services, health care providers and Greater Houston area officials say funding is still not enough to keep up with the growing population and provide services needed to keep individuals with behavioral health problems off the streets and out of jail.
“The way our criminal justice and mental health system works, if you’re picked up on a minor crime, you go to jail, when in fact the real issue is a mental issue,” Harris County Judge Ed Emmett said.
Senate Bill 1—the Senate’s proposed state budget for the 2018-19 biennium—allocates $3.4 billion for behavioral health services, including counseling, crisis intervention services, pharmacological management and hospital care services, according to the bill. As of press time, the bill had not yet been adopted.
The amount of funding has increased over the past decade, up from $1.9 billion in 2012-13, according to the House Research Organization.
“The Texas Legislature, the last few sessions, has increased funding for mental health services, but we’re still running close to dead last nationally in funding of behavioral and mental health infrastructure for our citizenry,” said Theresa Fawvor, associate vice president for Memorial Hermann Behavioral Health Services.
As the state’s population grows exponentially each year, there is not enough funding in the state budget to adequately serve its residents’ mental health needs, Fawvor said. This often leaves counties and health care organizations having to bridge the gap locally.
County officials said they are hopeful as state lawmakers continue to allocate more money for behavioral health services, but resources remain limited.
“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.”
LAW ENFORCEMENT INVOLVEMENT
He said the county implemented a jail diversion program funded through the state in 2013. As part of the program, the county works with law enforcement to identify individuals with multiple arrests who have potential behavioral health issues.
“The next time they get picked up, rather than putting them in jail [and] going through the criminal justice system, we divert them to—if not the Harris Center [for Mental Health]—then some of the nonprofit organizations in town,” Emmett said.
In Montgomery County, officials have also been working to keep individuals with behavioral health issues out of jail. In fall 2016, the county launched a mental health court designed to address the population of people with crime offenses associated with mental illnesses.
The court has about 15 cases in the system as of late May, with a capacity for 60 said Gloria Kessler, director of the Montgomery County Mental Health Court.
She said the court has helped to cut down on repeat offenders who suffer from a mental illness, but the program excludes violent offenders and some with more serious illnesses.
“We only take the ones that are able to care for themselves,” Kessler said. “In this court, they have to have some wherewithal to know they have to go to court once a month.”
Local law enforcement and health care officials said individuals with behavioral issues are better off when they are in treatment and out of jail. However, finding a doctor for basic and emergency mental health services is a challenge in the Greater Houston area.
The state ranks 46th in mental health care accessibility, according to national nonprofit organization Mental Health America.
For individuals who do not receive ongoing care for mental illnesses, such as depression or psychosis, symptoms can become a crisis, resulting in a trip to the emergency room for medications or intervention, Fawvor said.
“If you’re depressed or suicidal or psychotic—and you have great insurance—it’s still six to eight weeks out before you can get an appointment,” Fawvor said.
To help combat behavioral health patients ending up in ERs and jails, Favwor said Memorial Hermann Health System is working with primary care physicians in a pilot program—already taking place in the Kingwood area—to reach patients before a disorder becomes unmanageable.
The hospital system already operates three mental health crisis clinics in Houston, including a location at Memorial Hermann Northeast Hospital in Humble, that accept patients regardless of insurance or appointments.
“What we’re trying to do with our behavior health continuum is try to move it from a crisis stage to more of a prevention stage,” she said.