Other Voices

Texas must face need to treat the mentally ill — and not in our jails

One of the hold cells in the processing section of the Tarrant County jail.
One of the hold cells in the processing section of the Tarrant County jail. pmoseley@star-telegram.com

We are failing people with mental illness and the Texas taxpayers who contribute to their care.

We can change that.

Incarceration and punishment don’t treat mental illness any more than they treat diabetes or cancer, yet jails in Texas are serving as our largest mental health institutions.

JPS Health Network is Tarrant County’s publicly supported healthcare system. We operate our community’s only psychiatric emergency center, as well as inpatient and outpatient behavioral health services.

We experience about 8,200 behavioral health patient encounters every month, with about 1,500 of those in the emergency center.

This is not just a Texas issue.

A 2015 study by Mental Health America revealed people with mental illness account for more than half of county jail populations across the country.

In Texas, that’s 38,000 people who suffer from mental illness and repeatedly end up in jail.

Many are accused of nonviolent offenses, yet law enforcement often has to arrest them because no viable treatment options are available.

Texas spends $650 million annually in local justice system costs for only 38,000 people whose mental illness and substance use disorders are inadequately treated, according to the Meadows Mental Health Policy Institute.

At the Tarrant County jail, MHMR of Tarrant County provides mental health screening and treatment — for $2.3 million a year.

The Mental Health Unit of the Harris County jail, where more than a quarter of the 9,000 or so inmates take medication for mental illness, can treat almost 250 inmates a day.

Such services aren’t available for many counties and are often nonexistent for municipal jails.

Broader, more proactive strategies are required to divert those entering the criminal justice system with mental illness to treatment programs.

However, diversion is not a practical solution when inpatient and community-based care options are inadequate.

Those evaluated as not competent to stand trial stay in jail until a state hospital bed is available for competency restoration.

As many as 400 of these patients remain jailed rather than receiving restorative care today due to the lack of a state hospital bed and no funding for local competency restoration options.

The picture is equally bleak for those who need access to state hospital beds from a civil commitment.

In 2014, the number of state hospital beds occupied by patients from the criminal justice system who have been evaluated as not competent to stand trial surpassed those used by civilly committed patients.

With lengths of stays 4-5 times longer for these criminal justice system patients, this trend will all but eliminate access to state hospital beds for those committed through the civil process.

The state’s 2015 study found an unmet state need for 570 hospital beds, with an additional 607 beds needed to keep up with population growth over the next decade.

Despite the state funding 28 beds in Tarrant County, on any given day eight to 10 people in our community are waiting for a bed at the state hospital.

And there’s more. Unless we address our state’s inadequate behavioral health workforce our efforts for facilities will continue to be thwarted.

According to analysis reported in the Hogg Foundation’s Mental Health Workforce in Texas Policy Brief, 185 out of 254 Texas counties were without a single psychiatrist in 2015, leaving more than 3 million Texans in counties without access to a psychiatrist.

The Meadows Mental Health Policy Institute identified Texas as having only 76 psychiatrists per million residents, compared to the national average of 129 psychiatrists per million residents.

Recent bills in the Texas Legislature to create medical education loan repayment programs for psychiatric residents are a great start, but they aren’t enough.

We must fund additional psychiatry residency slots, enhance the ability to use technology to deliver care, create reciprocity for psychiatrists licensed in other states, and find incentives to persuade those who complete medical school and/or a residency in our great state to set up their practices here.

Texas needs to stop spending tax dollars on incarceration and start investing where those dollars can make a real difference — jail diversion programs, inpatient beds and expanded psychiatric residency programs.

Robert Earley is president and CEO of JPS Health Network, Tarrant County’s publicly supported healthcare system. A former state legislator, he serves on the board of Meadows Mental Health Policy Institute.