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Best of SA 2013: 4/24/2013
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Texas' failure to fund mental health treatment leaves hundreds stranded in jails around the state

Photo: Illustration by Chuck Kerr, License: N/A

Illustration by Chuck Kerr

Photo: Courtesy photo, License: N/A

Courtesy photo

Jeremy Weaver

Evans insists mental health care providers in Texas are essentially "forced to ration care" — something Bexar County got a glimpse of this summer. Medicaid rate cuts and inadequate state funding forced the Center in June to start accepting only those with full Medicaid coverage, bumping those on Medicare or some other combination insurance plan to a growing wait list. Funded by DSHS, the Center gets about $6.8 million each year to enroll nearly 4,000 adult clients into outpatient services such as medication, counseling, or some combination of the two moderated by case managers to help keep patients stable and out of psychiatric crisis. Evans says the Center regularly treats 1,000 to 2,000 patients beyond their funding level, and patients discharged from hospitals that can't find community treatment are bound for repeat stints in emergency rooms or jail, he warns.

Evans says the Center and other providers never really recovered from cuts the state delivered in 2003, when the Legislature slashed community mental health services in the name of reform and efficiency — the Center itself took a $6 million hit and was forced to cut nearly 150 positions. The impact was stark and immediate around the state, says Maurice Dutton, a Waco-based advocate with NAMI Texas who's worked closely with the Texas Correctional Office on Offenders with Medical or Mental Illness for years. "The indications are that after that, like six or so years ago, we reached parity in the worst possible sense. … It looked like we had as many seriously mentally ill people in the criminal justice system as we had recorded in the mental health care system."

Dutton routinely testifies before criminal justice sub-committees in the state House and Senate, insisting the current funding of mental health services in Texas is not only inhumane but financially irresponsible. "It's financially inconceivable to refuse to adequately fund the mental health system, and then you turn around and pay two to three to four times as much to incarcerate somebody instead. … Because that's the other option you're left with."

A ramp-up in jail diversion programming in Bexar County, for instance, saved over $15 million over a two-year period, officials say, keeping some 4,000 people with mental illness in treatment and out of jail. "We still have far too many mentally ill people spending far too much time in county jails across Texas," Dutton said.


By mid-December 2011, just over 250 defendants declared incompetent by judges sat in jails across Texas waiting for beds to open up in the state hospital system, according to numbers from DSHS. For the 200 ordered into treatment at the Vernon State Hospital, the state's only maximum-security treatment center, DSHS officials say they could endure waits of up to 9 months.

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