Mental Math

Sheriff Pat Burnett is fed up, and he’s not going to do it anymore. He’s not going to put two of his deputies on the road for 12 hours each way from Van Zandt County in East Texas to El Paso — paying hundreds of dollars for overtime, gas, lodging and food — just to find a free bed for a mentally ill inmate.

“We now refuse to do that,” Burnett says. “It’s not only bad for the patient. It’s also bad for the taxpayer.”

Like Burnett, sheriffs across Texas are increasingly frustrated and worried about the ever-decreasing amount of bed space available at state mental hospitals. Too often, when mentally ill offenders come to their jails, sheriffs who are required to provide appropriate care for their inmates say they are forced to either drive hundreds of miles, wait for days in hospital emergency rooms guarding patients or try to make do in their local jails until a mental health bed becomes available. The looming budget shortfall that legislators will be grappling with in 2011 has sheriffs concerned that the problem will mutate into a crisis. “We’ve cut way too far, and it’s just not working,” Burnett says.

The number of beds at Texas’ state mental hospitals has gradually declined from 2,800 in 1996 to about 2,400 now. As the number of beds shrinks, treatment waiting lists expand. That means treatment delays for both law-abiding Texans and criminal offenders with mental illness.

In the decade since he was elected sheriff in Van Zandt County, Burnett says he’s had to transport a handful of patients, including at least one teenager, to the state psychiatric hospital in El Paso because that was the closest available mental health bed. It’s a 700-mile drive each way. Not only is it expensive, he says, it also means two fewer deputies patrolling his county for at least two days. So Burnett says he won’t take patients to El Paso anymore. If no bed is available for a mentally ill inmate, the person has to either stay in the jail or in the hospital emergency room, neither of which are prepared to adequately treat mental illness. And either way, the Van Zandt County taxpayer winds up footing the bill. “Every time you cut a state agency such as mental health, it’s going to trickle down to the county,” Burnett says.

Limestone County Sheriff Dennis Wilson in Central Texas says he’s had to put his deputies on the road for hours with mentally ill offenders, too. And they’ve spent countless hours in the local emergency room, guarding patients until a state mental hospital bed becomes available. “We have seen the availability of mental health beds continue to dry up,” says Wilson, who is also on the board of the Limestone County Mental Health Mental Retardation Center. It sometimes takes months, he says, for a mentally ill inmate to receive a competency evaluation before trial. “To say we’re going to continue to cut, I don’t know how much more on the bottom we can get,” Wilson says.

Sheriffs in rural counties aren’t alone in dealing with the troubles of a growing mentally ill population. Harris County Sheriff Adrian Garcia says that on any given day, about 25 percent of his 10,000 inmates are on some type of psychotropic drugs. Similarly, in El Paso County, the sheriff reports that about 40 percent of inmates need those medications. “I’m running a mental health institution inside the Harris County Jail,” Garcia says. It costs the county about $27 million just for mental health treatment inside the jail, he says. And that doesn’t account for the costs of responding to hundreds of calls that result from mental health issues in the community or training his officers to deal with those situations. He’s also worried about veterans of the Iraq and Afghanistan wars who are returning from battle with post-traumatic stress disorder and winding up in conflicts with law enforcement. “We’re concerned that our veterans may not be getting the level of treatment they may need,” Garcia says.

The Texas Department of State Health Services, which operates the state’s mental hospitals, at the request of lawmakers, has proposed a budget for the next biennium that is 10 percent less than its current budget. One of the options the agency proposed is eliminating even more beds — more than 190 of them — from five of the state’s 10 mental hospitals. “Fewer beds could have a potential ripple effect on other hospitals and on community mental health centers,” says State Health Services spokeswoman Carrie Williams. “Any reduction would be done gradually, systematically taking beds offline as patients are discharged.” Cutting the beds is far from a done deal, but because of the size of the budget reduction the agency needs to make and the large cost of operating the mental hospitals, Williams says, leaving the facilities untouched in their proposal wasn’t an option. “We’ll continue to give the very best care possible to our patients,” she says, “even if our numbers are fewer.”

But cutting mental health beds to save money in the state budget could actually be more expensive in the long run, says Polly Ross Hughes, spokeswoman for Mental Health America of Texas. Without appropriate treatment, mentally ill Texans often land in a costly cycle of hospitalization, homelessness and incarceration. A 2009 report from economist Ray Perryman, president of an economic research and analysis firm based in Waco, showed that if Texas spent what other state’s do on mental health care — $100 per capita was the national average in 2005, compared to $36 in Texas — the spending would stimulate enough economic activity to produce $23 for every $1 spent. “The problem is if a person has a really serious mental illness that’s going untreated, the illness doesn’t go away,” Ross Hughes says.

Texas sheriffs say they understand the dire financial straits the state will be in when lawmakers convene in January to start working on the 2012-2013 budget, and Garcia says they’re not asking for more mental health funding. They’re just pleading with lawmakers to shield them from more cuts. “We’re just saying please don’t take away what we’ve got,” he says.