Mental Health and Mental Retardation Authority of Harris County
Michael E. DeBakey Veterans Affairs (VA) Medical Center
NAMI Metropolitan Houston
University of Houston
Graduate College of Social Work/NASW/Houston
University of Texas
Harris County Psychiatric Center
University of Texas Mental Sciences Institute
City of Houston
Mental Illness in Harris County is an assessment of the current status of public mental health services for children and adults in Harris County. Sections include the prevalence, issues of concern, and recommendations for service improvement.
This report clearly indicates that, although concerted efforts have been made, our public mental health service shystem is substantially inadequate to meet the needs of most citizens who have a mental illness. This is especially true of children and adults who are indigent.
Leadership and support from the Harris County Commissioners Court has been instrumental in all major improvements in the mental health service system; its continued leadership is vitally important. The Mental Health Needs Council strongly encourages the Commissioners Court and our legislators to seek increased funding for public mental health services, with particular attention to the needs of the uninsured.
The Mental Health Needs Council pledges to continue investigating problems, providing information, and making recommendations to assist in the improvement and expansion of Harris County’s public mental health services.
PREVALENCE OF MENTAL ILLNESS IN CHILDREN
* 83,525 of the 86,000 Harris County children with mental illness have a severe mental illness.
* 86,000 children needed services from the public mental health system.
* Approximately 75 percent (14,100) of these children did not receive treatment services.
* 4,450 of these children received services from the public mental health system. 1,600 are in treatment at any given time.
* More than 49 percent of the 16,000 children in the Harris County Juvenile Probation Department have a diagnosable mental illness.
* 55 percent have been diagnosed with a substance abuse and/or chemical dependence problem.
* Almost half (48 percent) have a history of trauma exposure, often having witnessed or experienced family or community violence.
* 153,000 of the 552,000 Harris County adults with mental illness have a severe mental illness (Depression, Bipolar Disorder, and Schizophrenia).* 96,200 of these 153,000 Harris County adults have no public (Medicaid or Medicare) or private health insurance and are totally dependent on the public mental health service system for treatment.
* In 2007, approximately 27,000 adults received services from the public mental health system; 18,200 of these were uninsured.* In 2007, approximately 79,200 adults with severe mental illness were unable to access treatment from the public or private mental health systems.* Approximately 24 percent of Harris County’s citizens who are in jails or prisons have a current or past mental illness.* An estimated one-third of Harris County’s homeless population has a severe mental illness.* 90,500 adults in Harris County with a severe mental illness also abuse substances.
ISSUES OF CONCERN
Consequencesof untreated mental illness are poor performance in school, juvenile and criminal justice involvement, decompensation, unemployment, homelessness, and suicide.
There are 236,525 children and adults with severe mental illness in Harris County. In 2007, 14,000 children and 79,300 adults could not access the public or private mental health service systems.
The decrease in Harris County mental health service capability, especially outpatient services, has resulted in a dependence on crisis services.
The Mental Health and Mental Retardation Authority (MHMRA) NeuroPsychiatric Center (NPC) currently serves a monthly average of 910 crisis episodes.
The Ben Taub Psychiatric Emergency Center (EC) serves a monthly average of 480 people.
Both NPC and the Ben Taub Psychiatric EC have been forced to periodically close due to overcrowing during the past year.
The number of mental illness-related calls received by the Houston Police Department Crisis Intervention Team grew from 900 per month in 2003 to 1,350 per month in 2006 to 2,000 per month in 2008.
In Fiscal Year 2007, 15.7 percent of the persons hospitalized in The University of Texas-Harris County Psychiatric Center (HCPC) were readmitted within one year.
An increasing number of new children and adults previously unknown to the public system of care are requesting services.
227 new children and 295 new adults seek MHMRA services each month.
91 children and 214 adults request readmission to MHMRA services each month.
The Mental Health Needs Council is especially concerned with the following issues:
* More children and adults with severe mental illness reside in Harris County than any other Texas county, but Harris County receives substantially less per capita state revenue dollars for outpatient services.
* This inequitable practice impacts all of the following issues of concern.
Declining Service Capacity
* Each month more children and adults enter the public mental health system than are discharged.
* Few services are available to people without third-party insurance, reducing overall clinical effectiveness.
Crisis Only System
* Children and adults who do not have insurance are provided with little or no service, forcing them to repeatedly decompensate into crisis.
* A larger, better funded, more responsive, and easily accessibly outpatient system would break this cycle.
* Increasing numbers of children and adults with mental illness, whose illnesses are not severe enough to warrant inpatient or crisis care, are forced to wait for services and placed on waiting lists until they are in crisis.
Michael E. DeBakey Veterans Administration (VA) Medical Center Mental Health Services
* VA services have been impacted from increased usage of mental health resources by returning OEF/OIF veterans and an aging veteran population who have limited access to sparse public mental health resources.
* Budgetary support from the VA Central Office has so far kept up with rising demand, although local funds have to be found for the necessary space and administrative components.
Loss of Access to State Hospital Beds
* Rusk State Hospital (RSH) is teh primary public long-term inpatient resource for Harris County
* State budget reductions decreased access to RSH for Harris County residents.
* Restricted access to RSH increases the strain on Harris County psychiatric inpatient resources.
* HCPC continues to be insufficiently funded to operate its 250 beds. Two entire units remain closed.
* Opening these beds would allow more people to receive timely inpatient care.
Less Access to Private Care
* At least 16 of Harris County’s private inpatient facilities have closed within the last 10 years, in part due to managed care practices (which unfairly restrict access to care for some insured patients) and failure to receive prompt and complete payment of insurance claims. Another major factor affecting the closure of private psychiatric beds and services is the increasing burden of indigent care on the private sector.
* Some children and adults with mental illness, who have psychiatric insurance benefits, have difficulty access needed services.
Inadequate Dual Diagnosis Services
* Many children and adults with severe mental illness abuse substances.
* Appropriate care requires coordinated treatment for those who have a mental illness and substance abuse problems.
Lack of Access to Residential Care
* Many people with severe mental illness lose their jobs, family ties, and homes.
* Approximately one-third of Harris County’s homeless population has a severe mental illness.
* At least 14,000 Harris County adults with a mental illness lack appropriate housing.
* Residential treatment services for children and adults with mental illness are in short supply; this is a vital component of the mental health service continuum.
Inappropriate Juvenile and Criminal Justice Involvement
* Mental health services can substantially reduce the number of children and adults with mental illness who are in detention facilities, jails, and prisons.
* Effective community mental health treatment minimizes many inappropriate, costly, counter-therapeutic arrests and incarceration.
* Harris County’s inadequately funded mental health system forces many children and adults into the juvenile and criminal justice systems.
Uninsured Indigent Persons
* Many indigent children and adults with severe mental illness are unable to quality for CHIP, Medicaid, and Medicare.
* Those without private insurance, CHIP, Medicaid, or Medicare usually receive fewer services than those who have insurance.
* Higher service priority is given to children and adults with CHIP, Medicaid, or Medicare due to legislative directives and Medicaid rule mandates.
* CHIP, Medicaid, and Medicare recipients have greater access and recieve a more effective array of services than their non-federally insured peers.
* Uninsured, indigent children and adults have the greatest need for publicly funded, state-supported mental health services, but have less access to care.
Non-Existent Mental Health Safety Net
* Since 2003, the number of uninsured mentally ill Harris County residents seeking services at crisis, public psychiatric hospital, and jail settings has steadily increased.
* Harris County does not receive sufficient state funds to adequately support its mental health system.
* Cost shifting policies give high priority to CHIP, Medicaid, and Medicare recipients and penalize children and adults who are inelegible for federal insurance programs.
* Harris County’s safety net is non-existent for many children and adults most in need.
In addition, the Mental Health Needs Council is especially concerned that the demand for intensive public mental health services by uninsured Harris County residents continues to increase.
The Governor of Texas, members of the Legislature, Harris County Commissioners Court, and the Health and Human Services commission should:Direct that all new additional mental health general revenue dollars for Harris County be dedicated specifically for a continuum of outpatient services for children and adults to minimize the need for crisis and inpatient care.Support a cost effective mental health service system by sufficiently funding community-based Resiliency and Disease Management services by:
Modifying the current service eligibility and priority population criteria to insure that those persons with severe functional impairments due to mental illness are served, regardless of diagnosis.
Sufficiently funding The University of Texas Harris County Psychiatric Center to operate at its full 250-bed capacity to locally treat Harris County citizens.
Sufficiently funding Harris County’s service efforts to divert people with mental illness from the juvenile and adult criminal justice systems.
Sufficiently funding housing services for people with mental illness in Harris County
Sufficiently funding mental health rehabilitation services for people with mental illnesses in Harris County.
Reduce economic barriers to accessing needed public and private mental health services by:
Ending discrimination in mental health and chemical dependency insurance coverage.
Establishing mechanisms and procedures that promote and expedite enrollment in CHIP and Medicaid programs.
Insuring prompt and adequate Managed Medicaid reimbursement for psychiatric hospitilization.
Insuring prompt and adequate Medicaid reimbursement for foster care services.
Fund higher education programs to increase the Texas workforce that treats people with mental illness by:
Sufficiently funding psychiatric residency training programs.
Sufficiently funding social work training programs.
Sufficiently funding psychology training programs.
Support legislation to enable publicly-funded entities to share client data to promote coordination of care and reduce duplication of services.
A FINAL NOTE
Adequate funding is essential to effectively implement behavioral health assessments and interventions for children and adults. Like other medical conditions, the treatment of mental illness and substance abuse has been shown to improve a person’s quality of life and reduce the severity of disability.
The disarray and failure of the behavioral healthcare system in Haris County has, in large part, been a predictable and inevitable consequence of years of inadequate funding. The behavioral treatment system can work, but for it to function properly, it needs to be supported as adequately as any other system.
Mental Health Needs Council, Inc.
P.O. Box 270205
Houston, Texas 77277-0205