Another View: Texas’s broken mental health system reaches Amarillo
I recently attended a NAMI Texas Panhandle affiliate meeting, and the honorable Judge Nancy Tanner was the guest speaker. Judge Tanner was touting the possibility of a State Hospital being constructed in the Panhandle region. The fact is we are the only region in Texas that does not have a Mental Health State Hospital that provides long-term care for people suffering psychological crises.
The meeting evolved into a think tank as mental health stakeholders discussed pros and cons of a State hospital, gaps in the local mental health system, and how psychiatric service provision could be improved. Some consistent themes materialized such as remedies for staff shortages, incentives for mental health professionals, and a culture change that emphasizes health and existential purpose.
All those ideas have merit and deserve investigation, but as my grandma used to say, “you get what you pay for”. SAMSHA ranks Texas 49th out of 50 states in mental health spending per individual (per capita). It’s important to note that the Meadow’s Mental Health Policy Institute disputes this claim stating that the SAMSHA research did not include Medicaid expenditures in the Texas ranking. However, the Meadow’s website fails to inform their readers that Medicaid expenditures were not included in the data set for the other states as well. We can split hairs, but the truth is Texas is, arguably, on the lower end of the totem pole when it comes to mental health spending. It’s been that way for years, and denialism is a sedative that makes one drowsy with indifference.
I often hear, “How can the problems of the mental health system, which are by nature multi-layered and complex, be distilled down to funding?” I believe there are multiple causal factors that are creating gaps in our local community and abroad, but I also believe inadequate state funding is the main driver of the problems we are currently experiencing. It deserves the lion’s share of attention.
Imagine a tree structure diagram. Mental health legislature appropriations are at the top, and then it branches out to several domains (outpatient services, inpatient services, the criminal justice system etc.). If the funding is scant at the top, each lower branch is compromised. With that said, I want us to investigate the criminal justice branch in our local community.
Debbie, a parent desperately seeking advocacy, reached out to me about her daughter’s incarceration at Potter County Detention Center. Debbie’s daughter has schizophrenia and was charged with 4 crimes. Two crimes were dismissed, but two charges remain pending, and the jail roster denotes her as, “found incompetent to stand trial”; meaning the mitigating factor of the crime could be her mental health symptoms. Debbie’s daughter was incarcerated on September 2021, and according to her daughter’s records, she had a psychological evaluation on October 26, 2021. As a result of the assessment, Debbie’s daughter was referred to a Forensic State Hospital for mental health treatment. In a streamlined system, her daughter would have been admitted to a hospital shortly after the commitment, but Debbie’s daughter has been languishing in jail for 15 months after the commitment was ordered.
Apparently, Debbie’s daughter is not alone. To understand the depth of the problem, I spoke to a Potter County Detention Lieutenant, and he told me he’s personally witnessed others like her psychologically decaying while waiting for a State hospital bed. For some, the wait could be 3 months, it could be a year, or in Debbie’s daughter’s case, 15 months. I won’t elaborate on how incarceration is a contraindicated treatment for mental illness, but inadvertently, the treatment model for some folks in Amarillo, Texas is incarceration. This is why you hear the all too common refrain that “the largest mental health hospitals in Texas are the local county jails.”
From 1955 to the present, the state of Texas reduced the number of state hospital beds from 16,445 to 2,241; an 86% reduction. This was driven by deinstitutionalization; a social reform policy that closed large-scale institutions and moved people with mental illness out of the hospitals and into their local communities. From 2019 to 2022, the waiting list for forensic mental health patients has increased from 883 to 2400 individuals. Texas Health & Human Services Semi-Annual Reporting of Waiting Lists (2022-2023) revealed that waiting list times are anywhere from 6 months to 10 months depending on the type of State hospital one is admitted to. Currently, Texas Health and Human Services has reported that more than 700 hospital beds are not being used because of staffing issues.
When mental health staff vacancies were brought up at the NAMI Texas Panhandle meeting, some individuals made the blanket assertion that “people don’t want to work these days”. It’s a common trope that is bandied about in the Panhandle, however, the problem with generalizations is that reality is often far more complicated and nuanced.
When mental health funding is low, mental health job creation is low. State hospitals can’t afford to pay for additional personnel. Worker incentives are low because the State hospitals cannot pay competitive wages and give raises to people who have the expertise and credentialing. Maybe there’s a kernel of truth that some people don’t want to work in mental health, but there is also a recruitment and retention problem.
Through email correspondence with Judge Tanner, I was told that the inpatient hospitals in Amarillo, Texas are not treating forensic patients. It staggers the imagination why a forensic unit has not been created in our local inpatient hospitals for people like Debbie’s daughter. She could have been receiving critical mental health services months ago and on the road to recovery. Why doesn’t Ocean’s Behavioral Hospital and Northwest Texas Health Care System Behavioral Health (formerly the Pavilion) assist with individuals “too incompetent to stand trial” ?
Ocean’s Behavioral Hospital and Northwest Texas Health Care System (Behavioral Health) could be transitional facilities until a State bed opens up, or until the person returns to competency to stand trial. Maybe the inpatient hospitals in Amarillo will respond to our community as to why this is not happening. Is it staff shortages or lack of funding? Do private hospitals get to make their own rules?
Incarcerating people with mental illness is not only morally bankrupt and inefficient, but from a taxpayer point of view, it costs 11 times more to warehouse individuals with mental illness in jail than it does to provide community treatment according to the Houston Chronicle. I’ve had to regurgitate this to our representatives and others for the past two decades. We tout that we are fiscal conservatives in the state of Texas, but there is nothing conservative about asking the taxpayers to spend 11-fold more to incarcerate individuals with mental illness.
Another reality is the logjam this creates in the criminal justice system. Paraphrasing defense attorney, Keith Hampton, “When a person is deemed incompetent, their case cannot proceed, nor can they have any meaningful conversation with their attorneys. Criminal cases languish and can fall apart. The entire system stops and is frozen in time, including resolution for the defendant, witnesses, victims and survivors of victims. All these people are told nothing will be done for months or years because the state hospital doesn’t have a bed available. And there is no emergency plan.”
Somehow, we have wound back the clock to the days of Dorothea Dix. In the latter 19th century, Dorothea Dix taught Sunday school in her local prison and noticed that people with mental illness were salad mixed with hardened criminals. She thought to herself, why are the psychologically afflicted confined with criminals? Individuals with mental illness were underfed, barely clothed, and surrounded by the stench of their own waste. Dorothea Dix became a champion for change in the criminal justice system which led to the building of large-scale psychiatric institutions and humane alternatives to prison. Let us not unravel the progress of the champions of mental health that came before us.
According to the Meadow’s Mental Health Policy Institute, Texas has increased its overall mental health spending by 34% since 2015. This is an improvement, but according to Mental Health America’s annual research, Texas still ranks 51st out of all states and the District Columbia in the area of mental health care accessibility. I want that to sink in. We are “dead last” in helping people get access to mental health care. Texas also ranks 41st out of 50 with the highest prevalence of youth mental illness with lower rates of access to care.
On January 2023, Texas Health and Human services made a public statement that State hospital personnel will receive pay bumps on March 1, 2023. This is a start in the right direction, but it does not erase the decades of suffering that have been inflicted on people due to the Texas state legislature’s “dipping their toe in the pond” approach to mental health spending. Mental health care should always be an issue where one dives in all the way.
Debbie’s daughter and the thousands waiting for hospital beds are clear indicators that we are reaping the harvest of the “dipping their toe in the pond” spending paradigm.
Let’s be clear, Texas has a broken mental health system, and its tentacles have reached Amarillo.
Folks like Debbie’s daughter will continue to languish in jail and have no other viable option for treatment if we kick this can down the road. The staff shortage will persist because credentialed individuals will have no way of making a living wage for their families. There will be no creation of jobs because there is no money for it. And most importantly, individuals with mental illness will be cheated out of services because there are not enough staff to cover the demand. These souls will have to elbow out their psychological demons on their own.
I honestly don’t believe we need mental health hospitals on every corner similar to pre-deinstitutionalization, but we do need to strike a balance between outpatient and inpatient services on the fulcrum of mental health care. Currently, Representative Four Price has authored House Bill 2099 (link below).
https://capitol.texas.gov/BillLookup/History.aspx?LegSess=88R&Bill=HB2099
The bill is a requirement that Texas Health and Human Services Commission establish and operate a State Hospital in a county located in the Panhandle region. This would be the first State Hospital constructed in our territory for people who need long-term care. The bill sits in committee as I write this. Sometimes, the wheels of legislature turn slowly, but this is an issue where we don’t have a lot of time.
Tony Foster received his Master’s in Educational Counseling at Sul Ross State University in 2002. Tony has been involved with mental health service provision for 14 years. Tony joined the staff of Amarillo Area Mental Health Consumers in 2006 as a peer group facilitator, and he became the Executive Director in 2010. Tony is a mental health advocate and has written articles on recovery and stigma that have been published in psychology journals such as Europe’s Journal of Psychology and Schizophrenia magazine.
This article originally appeared on Amarillo Globe-News: Another View: Texas’s broken mental health system reaches Amarillo
