Texas' failure to fund mental health treatment leaves hundreds stranded in jails around the state

Of course, the crisis shouldn't have been news to state lawmakers. In 2005, the Texas Commission on Jail Standards and the Texas Correctional Office on Offenders with Medical or Mental Illness (TCOOMMI) reported to the Lege that at least 17 percent of adult offenders inside the state's county jails had previous contact with state's mental health care system, though anecdotal evidence suggested the number of mentally ill inmates could actually be much higher. Mental illness floods the criminal justice system largely because communities lack comprehensive treatment options, the report found. Many in the jails, the report speculates, could be unidentified, undiagnosed, and without the legal assistance to even push for needed competency hearings. And while there has been change since those findings were published, it's been small and inadequate, according to advocates. In 2009, legislators allocated some $10 million for 20 additional state hospital beds in Harris County. They shuffled $30 million toward an extra 100 beds in Montgomery County, all the while drafting five new pilot programs for outpatient mental health treatment — including one in Bexar County.

The National Alliance for Mental Illness' national report gauging mental health services in all 50 states released in late 2011 shows how far Texas has yet to go, ranking the state dead last when it comes to funding mental health care services. That is: Even though the state kept program funding relatively flat over the past three years, it still spends less per-capita on mental health care than any other state, according to NAMI — $38.38 compared to a national average of $122.90. And NAMI worries mental health treatment centers across the state were forced to tighten after June when federal stimulus cash that boosted the federal match for Medicaid expired. Texas, the group says, could see its share of the costs rise to the tune of $851 million due to the reduced federal match. "We have a rationed system here," said Robin Peyson, executive director of NAMI Texas. "We're at the lowest, we're at the very bottom. … And I can't think of a single other illness that we are so inured to, so callous to."

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Family members of those with so-called forensic commitments say getting placement is a battle. State hospital beds in Texas have declined gradually since the mid '90s after a push to de-institutionalize those battling mental illness. Back then, the state had some 400 more beds available than it does today. "They started shutting down beds with the promise that the money would follow people into the community for treatment," said Leon Evans, CEO of Center for Health Care Services, Bexar County's main channel for mental health care for low-income and indigent patients. "Of course, that money never came."

Now the number of beds can't keep up with the number of patients needing, or ordered into, state hospital treatment. As community mental health care providers juggle the high demand — one 2011 report out of Bexar County warns that demand for local mental health care already far outweighs available services – Evans says he and others on the community-treatment side fear the Texas system bounces individuals with mental illness in and out of jails and hospitals. "Over half of all our state hospital resources here (in Bexar County) are taken up with the people that come through the criminal justice system," Evans said. "We don't have money on either side of the ledger, so the only door that's open to a lot of these folks is jail. … With our funding system, that's the road, the fate they're left with."

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