A mental-health safety net, frayed and torn

Back in Texas, which will cut its budget by $60 million in the next two years, professionals are just beginning to experience the problems going on elsewhere. Patients cut off from benefits in September are just now running out of medication - and often winding up in trouble.

Already, jails and psychiatric centers in Harris Country are feeling the effects. Houston's Ben Taub Psychiatric Emergency Center typically sees 450 to 500 patients a month, but since Sept. 1, those numbers have steadily climbed. Medical Director Edythe Harvey blames state cuts in outpatient care. "When patients don't have that follow-through, they return to the emergency room in crisis, get their medications refilled, and return when those run out," she says. "These are people who don't need to be in a hospital."

Already this year, the Mental Health Mental Retardation Authority of Harris County has closed three clinics and eliminated hundreds of staff jobs, disrupting care to several thousand patients.

"We encourage our patients to get into a routine and then the state does things to disrupt that routine," says Tom Mitchell, with the Harris County agency. "Things have gotten totally out of whack."

He tells the story of a man who lost outpatient services, went off medication, and was arrested for trespassing. He was given a two-day jail sentence - but it took the state six months to get him mentally fit enough to serve those two days.

"So we are spending thousands of dollars on this one guy for a misdemeanor," says Mr. Mitchell. "And all because the services weren't there for him."

Mitchell is director of the Mobile Crisis Outreach Team, a new $1.3 million program that's bucking the trend of cutbacks. It was started in February and is funded entirely by the Harris County Commissioners Court. It's designed to help those in the early stages of mental-health crises. A team of doctors, nurses, and social workers reach patients in the community - making old-fashioned house calls in vans.

They provide medications and food stamps, connect people with clinics and counseling, even drive them to appointments and find them winter jackets. Many of the new calls, says Mitchell, come from the three areas in the county where clinics have closed. Today, the first call is near downtown Houston.

Kathy (not her real name) is sitting on a stone bench outside a grocery store when Dr. Tracie Dejarnette-Holly and nurse Annabel Elsner pull up. She's been diagnosed with severe depression, but since starting a new medication, she's experiencing anxiety and mood swings - enough that the shelter she's staying at wants her to leave.

"I'm on a roller coaster. I don't understand my emotions," says Kathy, her hands shaking as she fingers the tiny cross around her neck. "I just want to be normal."

Psychiatrist Dejarnette-Holly listens for awhile and recommends a lower dose of her medication: She'll take just enough to keep the voices from returning. Before heading to another appointment, the doctor and nurse set a time to meet with Kathy in the next few days, promise to call the women's shelter and explain her situation, and agree to return with a winter coat.

They are proud of Kathy. She's been following through with appointments, taking her medication, and going to substance-abuse meetings. "You need to know that you're doing very well," says Ms. Elsner, hugging Kathy goodbye. "A lot of people would fall back on old behavior, but you are hanging in there."

"Thank you," says Kathy. "I needed to hear that."

Page: 1 | 2