We Don’t Need No Stinkin’ Mental Health Services

[Homebrew]

Texas joins the growing list of states that have cut funding or the availablity of mental health services. With passage and implementation of HB 2292 Texas is set to reorganize and “streamline” the delivery of health and human services in Texas. Let’s take a look at how that will be accomplished.

Currently, the Health and Human Services system consists of 11 agencies and the
Commission. HB 2292 reduces the number to 4 agencies plus the Commission.

HHSC New Agencies
I. Department of Aging and Disability Services
All powers and duties of the following entities shall be transferred to the Department of
Aging and Disability Services:
[ul]
[li] Texas Department of Human Services, related to providing long-term care[/li]services and community-based support and services.
[li] TDMHMR related to providing mental retardation services, including state[/li]school administration and services and community residential services.
[li] Texas Department on Aging.[/ul][/li]II. State Health Services
All powers and duties of the following entities shall be transferred to the Department
of State Health Services:
[ul]
[li] Texas Department of Health[/li][li] TDMHMR, relating to providing mental health services[/li][li] Texas Commission on Alcohol and Drug Abuse[/li][li] Texas Health Care Information Council[/ul][/li]III. Department of Assistance and Rehabilitation Services
All powers and duties of the following entities shall be transferred to the Department of
Assistance and Rehabilitation Services:
[ul][li] Texas Rehabilitation Commission[/li][li] Interagency Council on Early Childhood Intervention[/li][li] Texas Commission of the Blind[/li][li] Texas Commission for the Deaf and Hard of Hearing[/ul][/li]IV. Department of Family and Protective Services
[ul][li] Department of Protective and Regulatory Services[/ul][/li]Note: This is a name change only. There is no reallocation of other agencies.

Now some specifics on what, I think, are some of the more frightening parts of this Act. (red indicates previous text that was changed, normally a strikethrough, but I don’t know the code for that)

SECTION 2.201. (a) Section 31.032(d), Human Resources
Code, is amended to read as follows:
(d) In determining whether an applicant is eligible for
assistance, the department shall exclude from the applicant’s
available resources:
(1) $1,000 [$2,000] for the applicant’s household,
including a household in which there is [or $3,000 if there is] a
person with a disability or a person who is at least 60 years of age [in the applicant’s household]; and …

So qualification for services is made more difficult by excluding less of the household income.

(e) In assembling a network of service providers, a local mental health and mental retardation authority may serve as a provider of services only as a provider of last resort and only if the authority demonstrates to the department that:
(1) the authority has made every reasonable attempt to solicit the development of an available and appropriate provider base that is sufficient to meet the needs of consumers in its service area; and
(2) there is not a willing provider of the relevant services in the authority’s service area or in the county where the provision of the services is needed.

So we’re going to dismantle the existing network of state Mental Health/Mental Retardation Centers which have been performing this vital service for decades. The reasoning behind this is that the “Private Sector” can do a better job. Yeah, right. What Private Sector companies are extending Mental Health services to the poor? I have a job with good benefits. My insurance pays for me to receive Mental Health services. However, I doubt seriously that my shrink would keep seeing me if the check wasn’t coming in. Who’s going to provide these services for the poor and underinsured? Who’s going to provide counseling and manage the medication for people who are barely able to function as it is?

Every day at the local MHMR center, the Sheriff is called because someone gets out of hand. At least at the Center, staff are trained on how to deal with someone with mental problems until the Deputies can arrive. The Center also works closely with Deputies to monitor people who have the potential to snap.

When these established, long standing centers close, these MH clients are going to wander the streets without meds and without counseling. It’s a powder keg and the state is about to toss a lit match. When these potential problems explode in the public, instead of in a controlled situation like at the Center, there are going to be people hurt.

Fellow Texans, get ready for more Luby’s Cafeteria incidents. Yes, Wedgwood Baptist Church still happened with the existing structure. But how many have been avoided? We’re going to find out soon enough.

Another questionable change is that The “Commissioner” becomes the “Executive Commissioner” (EC) and the title “agency director” replaces the title “commissioner” at each of the 4 newly created agencies. The EC will appoint each agency director. The EC and the commission appointed by said EC will have the power to “adopt rules and policies for the operation of and provision of health and human services by the health and human services agencies”. So power is being concentrated in one governor-appointed position instead of in the various agency boards.

Furthermore, over in the Family and Protective Services Council – which becomes an advisory council rather than a policy making entity - the Act removes rules that once limited conflicts of interest by prohibiting appointments of people or the spouses of people under the following conditions:

(1) is a person who is employed by or participates in the management of a business entity or other organization regulated by the department or receiving funds from the department;
(2) owns or controls, directly or indirectly, more than a 10 percent interest in a business entity or other organization that is regulated by the department or that receives funds from the department;
(3) uses or receives a substantial amount of tangible goods, services, or money from the department, other than compensation or reimbursement authorized by law for board
membership, attendance, or expenses, or as a client or a parent or guardian of a client receiving services from the department; or
(4) is an employee, officer, or paid consultant of a trade association in a field under the jurisdiction of the department.

With the DOMA insult, the Coup Attempt - otherwise known as the attempted redistricting - and now this, the 78th Texas Legislative Session is going to go down in history. The question is, how will it be remembered?

[MsRobyn]

These people are getting shafted in two ways. The state isn’t going to pay for their care, and if they’re eligible for Medicaid, they’re going to have a difficult time finding a therapist who accepts that. (I assume that the “private sector” translates into “providers who accept Medicaid”.) Contrary to popular belief, providers of services do NOT have to accept Medicaid; it’s a completely optional program.

Robin

[j.c]

Hmmmm. I have a friend who has a sibling at a mental health home in Texas. Better call him and find out what this means for him.

[Homebrew]

More fuming:

“We have completely given up on our obligation to mental health… in this state, and we’re putting [people with mental illness] in prison instead.”
-State Representative Pat Haggerty, Chair, House Corrections Committee

“To a great extent, we are dumping our mental health problems (people with mental illness)… into our jails and prisons- there’s no question about that.”
-David Satcher, former US Surgeon General

Evidence that this is so (from NAMI Texas):

150,000 adults and children with serious mental illness are now seen and under treated in our public mental health systems. [Although I’m sure this number will decline with these changes.]

150,000 adults and juveniles, who were former patients in our public mental health system, are now in our prisons, jails, or on probation or parole. [I’m sure this number will increase dramatically.]

People with serious mental illness who do not receive Medicaid rehabilitative services are twice as likely to spend time in jail or prison, according to TDMHMR.

Prison and Jails are costly housing for offenders with mental illness:

$30,000 a year to house and treat an offender with mental illness in the Texas prison system as opposed to $10,000 a year for ACT (Assertive Community Treatment)

I can’t comprehend why Texans are so willing to foot the bill for prisons when providing adequate mental health services would be so much more cost effective. When adjusted for inflation, state spending on mental health services has declined by 6% since 1981.

Here’s some statistics on Texas prison spending (from The Center for Public Policy Priorities):

Between 1988-89 and 2000-01, state biennial (2-year) spending on prisons has risen an average of 23 percent each budget session. In comparison, all state spending rose an average 16.3 percent each session in that time span. Unadjusted for inflation, prison spending has more than tripled, from $1.3 billion in 1988-89 to $4.5 billion in 2000-01in general revenue spending.

As a share of all state general revenue spending, prisons have gone from 5.2 percent of the budget in 1988-89 to 7.3 percent in 2000-01.

Texas has spent $2.7 billion to build prisons since 1982. Operating costs in 1999 were 10 times higher than in 1982.

It’s stupid and short-sighted; but it’s “tough”. Far too often mental health advocacy is seen as a bleeding-heart liberal attitude. Yet economically it’s actually more sound, which is what conservatives purport to support. Why the logical disconnect? Why is being tough on criminals seen as better than dealing with underlying problem? Why is this state willing to execute mentally retarded people but neglects the mentally ill before they become “perps” when the problem can be avoided?

[Apos]

Simply put, prisons are far more profitable, and far easier, than providing mental health services. I’m not usually this cynical, but having worked on both homeless/mental health services and in corrections/probation, I don’t doubt that the profitability of prisons is what fuels many truly stupid policies where treatment and probationary treatment would be far more cost effective to taxpayers. It’s just that THOSE options don’t include any simple way to pass thru tons of pork to someone.