Marginalized, the mentally ill can't get the help or the funding for services they need
| Mary Baird has several family members who struggle with mental illness. She opposes privatizing state hospitals. "The facilities are so under-funded. If they had what they needed, we would have better care. Let's face it: A corporation needs to make a profit. Where does it come from?" (Photo by Laura McKenzie)
Apparently homeless, apparently mentally ill, the woman is one of thousands of Texans who need psychiatric treatment. Due to a funding shortage for state hospitals and other mental-health services, mentally ill Texans don't always receive the help they need and wind up in flophouses, on the streets, or in jail.
As the woman left the courtyard, inside the church's parish hall the San Antonio chapter of the National Association for the Mentally Ill began its monthly meeting. Psychiatrists, administrators, health-care workers, caregivers, and those who at some point had been committed to state hospitals, discussed the state's financially imperiled system, its possible privatization, and the effect of public policy on not only the mentally ill, but on society as a whole.
"The problem starts with getting people's attention to the issue and putting money where it does the most good," said Mary Baird, whose mother, sister, and three of her five children suffer from mental illness. "Here's a pocket of help, there's a pocket of help. There's got to be a more coordinated effort."
According to the Austin American-Statesman, two years ago the legislature cut nearly $15 million from mental-health centers, a 5 percent decrease. In 2003, more than 125,000 Medicaid recipients lost their Medicaid benefits.
Texas ranks 48th in the nation in per capita expenditures on mental-health care. Nowhere is this deficiency more obvious than at state facilities, which treat the acutely ill but don't have the resources to address chronic mental illness. The average length of stay is 22 to 42 days, Kenny Dudley of the Department of State Health Services testified before the Senate Health and Human Services Committee.
Sometimes the stay is even shorter.
Debbie Scofield, who served on the NAMI panel, was committed to a crisis unit as recently as last November under orders from her doctor. She stayed 23 1/2 hours.
"I had to ask when it was time to eat because there were no meal times," she recalled. "The men and women weren't separated. The only privacy was in the bathroom.
"We need to get back to mental-health facilities that care about individuals; we need funding and care back to patients."
Several panelists at the NAMI meeting commented that as recently as 10 years ago, San Antonio State Hospital offered a wide array of services, with programs to integrate consumers into the community.
Now, NAMI board member Eliseo Smith said, "We have a mental-health system that is very fragmented and without empathy. There is a lack of coordination and a lack of leadership. It's hard to get services. The mentally ill are waiting three or four hours for a doctor's appointment."
| National Association for the Mentally Ill
Meets the second Tuesday of each month
Christ Episcopal Church
David Pan of Telecare, which provides supplemental services for the mentally ill through the Center for Health Care Services, criticized the lack of community help in caring for some of San Antonio's most vulnerable citizens. "Mental illness can be managed, but people need housing," he said. "If you don't know where your next meal is or where you're going to sleep, mental health doesn't mean much."
Moreover, state funding cuts have caused a staffing shortage, and consumers can't always receive one-on-one care.
Baird said that after her son, who suffers from schizoaffective disorder, a condition in which people can experience schizophrenia and mood disorders, is admitted to San Antonio State Hospital, his only therapy is "TV therapy."
"They tend to medicate them and that's about it. They need arts and crafts and other activities to stimulate their brains."
Yet, the public-policy problems with mental illness extend beyond state facilities, said Baird. Community resources, even private ones, are difficult to access.
Baird's son occasionally stays at Laurel Ridge, a private mental-health facility, but Medicaid won't pay for his care there, only for treatment in psychiatric wards at traditional hospitals. "But those are short-term stays. There is really nothing long-term. He needs to stay awhile and get behavioral therapy and counseling."
Baird's son lives in a Section 8 apartment and receives $599 in monthly Social Security disability benefits. She adds that the mentally ill would fare better living in a combination Section 8/assisted living facility that could monitor and administer medications to consumers (a term Medicaid uses to describe people receiving services) reluctant to take them.
"Keeping him independent is a time-consuming and expensive burden," Baird said. "Keeping him at home is impossible."
Several states are looking to privatization to cure their funding woes, including the Texas legislature, which entertained the idea of privatizing state facilities in 1993, 1994, 2003, and this session. In March, a consultant's report commissioned by the legislature concluded that no state hospitals or state schools should be closed.
Despite this report, state legislators introduced three bills aim to privatize state facilities. Arthur Valdez, who has worked at the San Antonio State Hospital since 1973, described the effort as lawmakers "looking to amputate the whole system."
Senate Bill 1610, authored by Steve Ogden, a Republican from Bryan, would transfer authority to close or consolidate state hospitals and schools from the legislature to the executive director of the Health and Human Services Commission. The bill was left pending in committee. With less than two weeks left in the session, it is unlikely to be resurrected.
SB 1760, authored by Mario Gallegos, a Democrat from Houston, and its companion bill HB 3089, authored by fellow Houston Democrat Harold Dutton, would allow the state to contract with a private provider to operate one or more hospitals if the private interest can show a 5 percent savings and offer the same level and quality of services. It allows the Department of State Health Services to enter into an agreement with a private group to finance, design, build, and operate a new facility to replace one or more state hospitals.
| The cost of mental health |
San Antonio State Hospital
Number of beds: 296
Cost per patient per day: $322
Cost of pharmaceuticals, including all general and psychiatric medications: $2.21 million
Source: Department of State Health Service. Figures are for the last full fiscal year.
While SB 1760 was left hanging in committee and HB 3089 died last week, these bills catered to the latest privatization overture from Atlantic Shores, which operates two former state hospitals in Florida. Atlantic Shores is owned by a corporation well-known to Texans: Wackenhut, a specialist in the private prison industry, which has taken on a more innocuous name, the GEO Group. The GEO Group operates more than 35 prisons and detention centers in the U.S., including 12 in Texas and one in San Antonio. It also has facilities in the United Kingdom, New Zealand, Australia, and South Africa.
On April 26, Gallegos told the Senate Health and Human Services Committee that the bill attempts to "replicate the Florida model, decreasing the number of incidents of restraint or seclusion, the length of stay, while improving the quality of care."
It's understandable why Gallegos and other bill authors might want to duplicate Florida's efforts. According to Texas Ethics Commission campaign finance documents, Gallegos received $1,000 in contributions from an Atlantic Shores lobbyist, Russell Kelley, who also gave $5,000 to Ogden. Dutton's campaign coffers benefited by $1,000 from Kelley and $1,000 from another Atlantic Shores lobbyist, Kent Hance.
The GEO Group didn't return calls from the Current seeking comment, but Atlantic Shores Vice President Dale Frick testified during the committee hearing that the company's forays into mental-health care in Florida had been successful. He said no state workers had lost their jobs during privatization, and that most job losses were due to attrition.
Former Florida State Senator Debbie Sanderson testified on Atlantic Shore's behalf saying, "It's a new approach and most cost-effective."
However, an opinion piece by Sue Tennant published in the Gainesville Sun in February 2004 cited an initial report from Florida's Office of Program Policy Analysis and Government Accountability that stated "Privatizing South Florida State Hospital has not resulted in cost savings or improved client outcomes."
Tennant pointed out that the private hospitals can choose whom to admit, adding that "compared to local state hospitals, it costs approximately $19,000 more per patient per year at the Atlantic Shores facility."
Kenny Dudley of the Department of State Health Services noted in his testimony that Florida, unlike Texas, had several non-accredited hospitals, high rates of seclusion and restraint, and a long waiting list because of its average length of stay - eight years.
With the Texas bills all but dead, mental-health advocates plan to continue lobbying lawmakers for more funding. At the NAMI panel, Bob Arizpe, superintendent of San Antonio State Hospital, said, "I'm mad, because professionals know what they're doing. Nobody gets into this field to get rich; we do the best we can with the resources available."
Mary Baird asked for support from not only legislators and policymakers, but the community at-large:
"I would like to plead with the people of the city and state to look at the people with this disease and no one to speak for them. Their illness makes them undesirable company. I'm asking for compassion." •
By Lisa Sorg