All the Money in the World can’t fix the mental health problem in Texas.
July 10, 2022
Dallas County’s average wait time for a state psychiatric hospital bed is longer than any other urban county in Texas, with some waiting more than 800 days for hospital admittance, according to state data.
Dallas Morning News July 10, 2022
“They may or may not have gotten case management or medication they need.” he continued.
The mentally ill are People. Have we forgotten? Are they forgotten?
THE COUNTY BLAMES THE STATE FOR THE DELAY IN GETTING MENTALLY DISTRESSED DEFENDANTS INTO STATE HOSPITAL BEDS FOR TREATMENT. Such defendants are required to receive treatment, usually in state care, before they can be declared mentally competent by a judge to then stand trial.
There are several resources for a person who grew up in a household where schizophrenia was present. This website is a good resource, but I will share others.
Jeff White knows what can happen when 911 dispatchers receive a call about someone who feels despondent or agitated. He experienced it repeatedly: The 911 operators dispatched police, who often took him to a hospital or jail. “They don’t know how to handle people like me,” said White, who struggles with depression and schizophrenia. “They just don’t. They’re just guessing.” In most of those instances, he said, what he really needed was someone to help him calm down and find follow-up care. That’s now an option, thanks to a crisis response team serving his area. Instead of calling 911, he can contact a state-run hotline and request a visit from mental health professionals. The teams are dispatched by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received assistance from the crisis team several times in recent years, even after heart problems forced him to move into a nursing home. The service costs him nothing. The team’s goal is to stabilize people at home, instead of admitting them to a crowded psychiatric unit or jailing them for behaviors stemming from mental illness. For years, many cities have sent social workers, medics, trained outreach workers, or mental health professionals to calls that previously were handled by police officers. And the approach gained traction amid concerns about police brutality cases. Proponents say such programs save money and lives. But crisis response teams have been slower to catch on in rural areas even though mental illness is just as prevalent there. That’s partly because those areas are bigger and have fewer mental health professionals than cities do, said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. “It certainly has been a harder hill to climb,” she said. Melissa Reuland, a University of Chicago Health Lab researcher who studies the intersection of law enforcement and mental health, said that solid statistics are not available but that small police departments and sheriffs’ offices seem increasingly open to finding alternatives to a standard law enforcement response. Those can include training officers to handle crises better or seeking assistance from mental health professionals, she said. The shortage of mental health services will continue to be a hurdle in rural areas, she said: “If it was easy, people would have fixed it.” Still, the crisis response approach is making inroads, program by program. White has lived most of his life in small Iowa cities surrounded by rural areas. He’s glad to see mental health care efforts strengthened beyond urban areas. “We out here get forgotten — and out here is where we need help the most,” he said. Some crisis teams, like the one that helps White, can respond on their own, while others are paired with police officers or sheriffs’ deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. The officers can use the tablets to set up video chats between people in crisis and counselors from a telehealth company. That isn’t ideal, Wesolowski said, but it’s better than having police officers or sheriffs’ deputies try to handle such situations on their own. The counselors help people in mental health crises calm down and then discuss what they need. If it’s safe for them to remain at home, the counselor calls a mental health center, which later contacts the people to see whether they’re interested in treatment. But sometimes the counselors determine people are a danger to themselves or others. If so, the counselors recommend that officers take them to an emergency room or jail for evaluation. In the past, sheriffs’ deputies had to make that decision on their own. They tended to be cautious, temporarily removing people from their homes to ensure they were safe, said Zach Angerhofer, a deputy in South Dakota’s Roberts County, which has about 10,000 residents. Detaining people can be traumatic for them and expensive for authorities. Deputies often must spend hours filling out paperwork and shuttling people between the ER, jail, and psychiatric hospitals. That can be particularly burdensome during hours when a rural county has few deputies on duty. The Virtual Crisis Care program helps avoid that situation. Nearly 80% of people who complete its video assessment wind up staying at home, according to a recent state study. Angerhofer said no one has declined to use the telehealth program when he has offered it. Unless he sees an immediate safety concern, he offers people privacy by leaving them alone in their home or letting them sit by themselves in his squad car while they speak to a counselor. “From what I’ve seen, they are a totally different person after the tablet has been deployed,” he said, noting that participants appear relieved afterward. The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received startup money and design help from the Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also contributes to KHN.) In Iowa, the program that helps White always has six pairs of mental health workers on call, said Monica Van Horn, who helps run the state-funded program through the Eyerly Ball mental health nonprofit. They are dispatched via the statewide crisis line or the new national 988 mental health crisis line. In most cases, the Eyerly Ball crisis teams respond in their own cars, without police. The low-key approach can benefit clients, especially if they live in small towns where everyone seems to know each other, Van Horn said. “You don’t necessarily want everyone knowing your business — and if a police car shows up in front of your house, everybody and their dog is going to know about it within an hour,” she said. Van Horn said the program averages between 90 and 100 calls per month. The callers’ problems often include anxiety or depression, and they are sometimes suicidal. Other people call because children or family members need help. Alex Leffler is a mobile crisis responder in the Eyerly Ball program. She previously worked as a “behavior interventionist” in schools, went back to college, and is close to earning a master’s degree in mental health counseling. She said that as a crisis responder, she has met people in homes, workplaces, and even at a grocery store. “We respond to just about any place,” she said. “You just can make a better connection in person.” Thomas Dee, a Stanford University economist and education professor, said such programs can garner support from across the political spectrum. “Whether someone is ‘defund the police’ or ‘back the blue,’ they can find something to like in these types of first-responder reforms,” he said. Critics of police have called for more use of unarmed mental health experts to defuse tense situations before they turn deadly, while law enforcement leaders who support such programs say they can give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and jail stays. Dee studied the Denver Support Team Assisted Response program, which lets 911 dispatchers send medics and behavioral health experts instead of police to certain calls. He found the program saved money, reduced low-level crime, and did not lead to more serious crimes. Dr. Margie Balfour is an associate professor of psychiatry at the University of Arizona and an administrator for Connections Health Solutions, an Arizona agency that provides crisis services. She said now is a good time for rural areas to start or improve such services. The federal government has been offering more money for the efforts, including through pandemic response funding, she said. It also recently launched the 988 crisis line, whose operators can help coordinate such services, she noted. Balfour said the current national focus on the criminal justice system has brought more attention to how it responds to people with mental health needs. “There’s a lot of things to disagree on still with police reform,” she said. “But one thing that everybody agrees on is that law enforcement doesn’t need to be the default first responder for mental health.” Arizona has crisis response teams available throughout the state, including in very rural regions, because settlement of a 1980s class-action lawsuit required better options for people with mental illnesses, Balfour said. Such programs can be done outside cities with creativity and flexibility, she said. Crisis response teams should be considered just as vital as ambulance services, Balfour said, noting that no one expects police to respond in other medical emergencies, such as when someone has a heart attack or stroke. “People with mental health concerns deserve a health response,” she said. “It’s worth it to try to figure out how to get that to the population.” This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
In 2016, nearly 400,000 inmates in US jails and prisons were estimated to have a mental health condition. Of those inmates, an estimated 90,000 were defendants who had been arrested and jailed but had not come to trial because they were too disordered to understand the charges on which they were detained. All but three states authorize evaluating the mental competency of such offenders within the jails or in the community, and some states authorize treatment to restore competency outside a hospital.
Yet, America’s state hospitals remain the default option for providing pretrial mental health services to criminal defendants.
There is no fast or easy fix for the mental health system failures that have taken half a century to develop. In an ideal world, individuals with acute or chronic psychiatric distress should not have to worry about wait times in jail for mental health beds because they would receive timely and effective treatment when they needed it and jail diversion when their symptoms led to criminal justice involvement. Under current less-than-ideal circumstances, reducing inmate bed waits and ED boarding will require implementing a combination of strategies that reduce forensic bed demand, increase bed supplies or both. Computer modeling offers policymakers and mental health officials a mathematical tool for developing evidence-based policy and practice to break the logjam of inmates with mental illness who are unable to come to trial because they are too sick. Although it would not address the hospitalization needs of the other populations, this step alone could moderate the nation’s bed shortage, reduce mass incarceration of people with mental illness and make existing beds available to more patients.
Just to type those two words, “Electroshock Therapy” makes my heart beat faster and causes my anxiety to rise. To remember that my mother had electroshock therapy in the 50s and 60s both satisfies me and frightens me.
If you have found your way to my blog on my mother’s schizophrenia, please do not be alarmed. Electroshock therapy is not always a bad thing. It’s administered very differently than it was during my mother’s lifetime.
There is much talk about how bad the mental hospitals were in the 50s an 60s. Equally horrifying to some is the idea of electroshock therapy. I can only tell you as an eyewitness to my mother’s condition, she came out of the hospital a more sane person than when she went in. She was not a zombie. We could actually talk to each other after her treatment. I did not see the mummified person that is depicted in the movies.
Thorazine is another word that might scare people. I can only, once again, tell you from my eye witness account of my mother’s emotional state when she was off the thorazine, things were not pretty, which is putting it mildly. Most of us who were around my mother could tell when she was off her medication. The paranoia haunted her. The cries in the night, the “dialogue” with people through the printed word of the newspaper were horrid. Horrid.
Imagine your worst frightful memory and multiply it by 10,000.
When you see the deranged man in the street that is alone and cold, remember that his brain may be experiencing delusions, hallucinations and paranoia. Simply put, we give people a coat, which is admirable, but what they REALLY need is their medication. Society presumes to know what they need when they are not even aware of their illness. We try to tell them about religion, which is not a bad thing, but what they often need is a warm bed and family who is estranged from them because they will not accept treatment. Texas is toward the bottom of all the states in our country in how it treats the mentally ill. Jails and prisons are becoming the new asylum.
Long before I knew that anosognosia was a word, I knew it existed. Even after multiple hospital stays and numerous attempted suicides, delusions, hallucinations, and paranoia, my mother NEVER admitted she had any mental health condition. Finally, there is a word for it, “Anosognosia”. Frankly, I have trouble pronouncing the word, but it’s good to know it exists. Imagine how hard it is to get help for a loved one when you call to make an appointment at your local MHMR and hear the words, “They must call.” WHAT?!!
How and why would my mentally ill mother make a phone call for something she never acknowledged?! You think it might be difficult to get people help?!!
Many decades ago, I was part of a carpool that left San Marcos, Texas and arrived in Austin for jobs we had with the State of Texas. We were not a talkative group, and I was new to the area.
I sat next to a gentleman who helped change my family’s life. He happened to be a member of the Scheib family, which initially did not mean a great deal to me. I must have brought up the need for mental health services, and he told me about the Scheib Center in San Marcos. It was a godsend.
I’m not sure if my father thought my mother’s mental illness would magically go away when we moved near her parents, or if he just felt like he needed to focus on food and shelter for us. It was clear to me that after decades of dealing with her schizophrenia, which included delusions, hallucinations, attempted suicides, multiple traumatic events, multiple stays in Big Springs State Hospital, my mother’s schizophrenia had to be dealt with.
My father retired from teaching in El Paso in 1979. What are the odds that I would end up in a carpool with a member of the Scheib family? I knew very few people in the area. All my friends were back in El Paso where I grew up.
“The Scheib Center was started as a nonprofit 501(c)(3) corporation in 1971 with money bequeathed by Dr. and Mrs. Scheib for the purpose of providing services to the developmentally disabled and emotionally disturbed individuals in the San Marcos/Hays County area. The service programs were in partnership with the Texas Department of MHMR. The Scheib Center provided the buildings and the Texas Department of MHMR provided the money and staff.”
I learned quickly that Scheib Center (https://www.scheibcenter.org) offered several services to not only their clients or patients but also to their family members. Once my father heard it from me, he quickly went into action. My mother’s medications were lined up. We had a social worker. I still remember her first name. She spent time talking with me over the phone, and helped navigate my family through very difficult waters.
It is the first and only place where I talked with my mother’s psychiatrist. “Is it nature or nurture?” I asked him. He laughed a bit and said, “if we knew that we could be of much more help to people. It says in your mother’s notes that without medication, she would need…..”
And with that I close. It was clear to everyone in our family that Mother had to have her medication. Without it, her life would spin totally out of control. In turn, it would affect her entire family.
While the holidays are filled with warm fuzzies for many folks, those who suffer from mental illness are sometimes overwhelmed with it all. If you know someone in crisis, please reach out to your community. If there is not a Scheib type center, maybe you could help start one.
Thank you, Katy. Thank you, Buck. Thank you Dr. ___ but most of all, thank you Scheib Center for being there for the community. We need more places like yours.
As you pray for the flood victims, please say a special prayer for the mentally ill. I suspect there are some that have lost their medication and will have difficulty getting back on it. This can be a game changer for them and their loved ones. It can also be a game changer in the shelters if they have numerous mentally ill patients in desperate need of seeing a psychiatrist for anxiety, depression, hallucinations, trauma…. There is a shortage of psychiatrists in our country. I just hope some of them will be available at the shelters to write prescriptions that have been lost in the flood. If not, the situation will become worse. My prayer and hope is that the government officials are considering this piece of the puzzle as they try to put communities and people back together again.
It is not a topic that you’ll see on the news, yet it is the first thing I think of when I hear about the flood that has taken so many things from people.
It won’t be pretty if it is not addressed. Mental illness is not a respecter of persons. It can affect the rich and the poor, your neighbor and even your family.
Running Toward Happy 
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