Tuesday, April 03, 2012

Reality check on mental health funding lacking at lege hearing

Dr. Floyd Jennings, who is special resource counsel to the Mental Health Division of the Harris County Public Defender, posted an account on Karen Franklin's In the News blog of his first experience giving invited testimony to the House Criminal Jurisprudence Committee last month. Grits happened to be in the room when Dr. Jennings gave his testimony, and at the time I didn't have a chance to comment on an odd and telling discussion he referenced in his account:
I learned that the lucidity of the argument may have little consequence. I was upbraided for failing to provide the legislature with specific means of cost savings through transfer of mental health services to the "private sector", although there is no private sector entity with the duty to provide mental health services to the chronically mentally ill on a statewide basis. And even if existing, no private sector entity has the resources to provide such. The tone of questions made it plain that legislators would prefer to have government provide all the goods and services that governments rightly provide, but at no cost, or with private sector funding.
Rep. Wayne Christian was the main legislator pushing Jennings for a "private sector" solution for mentally ill defendants in the justice system. It was at times an almost abusrdist discussion: Around the room, looks of befuddlement flashed across most faces in the audience as the same questions ran through everyone's mind: What "private sector" services is Christian talking about? Does he understand Jennings is discussing mentally ill homeless people cycling in and out of the jail? Who believes there is a "private sector" solution for that? The private sector needs customers to be economically viable, and the only customer in sight who might pay for treatment of indigent, mentally ill defendants is government. I can understand Dr. Jennings frustration; the exchange was flat out surreal.

I get that Rep. Christian doesn't want to spend more money, but that particular discussion needed a serious reality check. Since he and others on the committee at times didn't seem to grasp Jennings' key points, I'll close by reiterating them here in his own words:
the charge of the committee was to address whether alternative sentencing for mentally ill persons would be desirable. I argued simply that no changes in sentencing were needed -- because it would be difficult to craft, impossible to implement as it would trade on definitions of applicability, and moreover, courts already have the option of considering a defendant's state of mind as either mitigating or exculpating.

On the other hand, diversion strategies for the lower-level misdemeanor offender could have enormous cost benefits and not compromise public safety. As well, pre-trial jail psychiatric services could be provided at modest direct cost through the use of physician extenders, and provide just that opportunity for stabilization necessary to enable rapid disposition of the matter, shortening any period of confinement. Finally, I argued that opportunities for post-disposition placement tiered to the acuity of the person would dramatically reduce recidivism.
Jennings was sensibly suggesting counties and the Lege spend pennies to save dollars. Christian, by contrast, would have the state save pennies today, even if it means the dollars required tomorrow are compounded. Ironically, Jennings' is actually the more fiscally conservative view.

10 comments:

DeathBreath said...

Where is the leadership in this state? I truly don't know. But, under the reign of Pretty Boy Perry, mental health treatment has suffered, immeasurably.

Who am I kidding? Texas elected politicians who pandered to a group of ignorant individuals who demanded, "no new taxes."

Logic and critical thinking tends to escape these buffoons. Some, still believe in miracles. These people seem to approach the budgetary needs of this state like the story of Christ multiplying loaves and fishes.

Evangelical fundamentalists still believe in creationism over evolution. They even believe that the earth is around 6,000 years old.

So, tell me, how do you expect to solve this problem? I know, let's have a prayer orgy. That will work. It worked for the drought.

Oh, and it you pray hard enough, these mentally ill patients will miraculously disappear, won't they?

Some Evangelical fundamentalists still believe that mental illness is caused by demon possession.

Please, tell me, why are you still scratching your head in disbelief?

Anonymous said...

Don't know that the religious overtones are helping clarify the issues with Mental Health?

BUT, PLEASE PLEASE don't be another idiot to suggest more money for Mental Health. How about overhauling mental health and then making the folks employed by MHMR get off their oxygen wasting asses and work like everyobody else is expected to work. Quit paying a deadbeat agency for nothing more than griping about being underpaid and overworked!

Gritsforbreakfast said...

1:56, two things: First, re-read what Jennings actually suggested. He's discussing the criminal justice system, mostly in the jail, and MHMR only tangentially. What do you think of what he actually suggested (as opposed to what you reflexively rail about)?

Second, besides "making the folks employed by MHMR ... work like everyobody else," how would you suggest reforming the mental health system? You seem to have strong opinions so please, be more specific.

DeathBreath said...

For the buffoon who questioned my experience & wisdom, after over 30 years in the field, here are some of my recommendations. First of all, "raise taxes." If you don't, you will pay for it down the road. Also, don't privatize! Profits & mental health treatment don't mix. Finally, trash the faith-based initiatives because some are self-serving in that they try to get patients to stop taking their medication to avoid overhead. When I think of all the GOPigs stripped away, over the years, it will be a very long time before the support systems can be restored. But, it takes money, not blind faith! Treating only disease-based psychopathology in outpatient centers is no solution! It is modeling the behavior of an ostrich. When patients in TDCJ-ID are paroled without their 10-day supply of psychoactive (cost savings for UTMB-CMC) & told they won't be seen within 30 days after release, there is an increased likelihood they will self-medicate. Please, sit down at the table of reality and let's talk. I have intimate knowledge of the system!

DeathBreath said...

You're comments about increasing funding for mental health treatment are simplistic & misinformed. In essence, you're comments reminded me of this saying, "shallow brooks are noisy."

Since you clearly don't know what you're talking about, mental health treatment, I would suggest silence.

I see where you are mouthing the words of the Tea Party which are grounded in stupidity.

So, let's get on our knees & pray. That will work, won't it? Anonymous, you are a coward & troglodyte who emits stupidity like a dyenteric cur!

If you follow the patient through the system, you will clearly see where budget reductions have failed all. Now, you're holding the bag of flaming feces.

"Oh, Lord Jesus, I know you are so great & powerful. Please, make these mentally ill people go away so that I don't have to pay more taxes. Please, let me continue to have my cake & eat it too. Oh, and please bring some of those Easter Eggs so that I can be a better Christian. Please, continue to feed the Catholic Church priests with young lives! I know you are Super Jesus."

Anonymous, you might want to consider auto-lethality.

DeathBreath said...

Correction: "dysenteric cur."

Anonymous said...

Before you have your opinion about something, do a little research - don't just throw stones without examining the entire picture.

Not all christians are pharisees. I am one my self, and I believe in professional mental health care - we are mind, body and spirit; mental illness is an entirely separate issue from spirituality.

So, by saying all christians believe in Easter bunnies, you are being just as ignorant as anonymos above.

Educate yourself. Show respect. And shut your mouth if you have nothing constructive to say!

Anonymous said...

GFB @5:59
Jennings is actually suggesting privatizing out some or all of the health care services, correct?

Mr. Christian is taking a populist stance of "No new funding," correct?

Neither is a solution to the bigger underlying problem. MHMR is a self-auditing agency for starts. That is the equivalent writing your own agency's job description, then giving itself its on performance appraisal which coincidentally is always perfect, and like a broken record repeatedly saying that we need more money.
ISSUE #1 is not that not near enough of the money being handed to MHMR is being used for direct services to clients. How many people are aware that MHMR only serves one-third of the counties they say they do? They set up shop in a large county and then basically tell surrounding counties that if you don't come to us you don't get services. But MHMR receives money to provide services to those counties. Many clients would be on medicine prohibiting their ability to drive. MHMR is supposed to have satellite offices in all the counties they serve.
ISSUE #2 MHMR is the reason not the solution for why so many people in prison have untreated mental illness. MHMR Should have to regularly provide statistical reports that 1 accurately report every person referred to their agency from the criminal justice system, 2 Reports how many of those did MHMR turn away as ineligible, 3 how many did MHMR declare eligible and then treat, 4 what is the average length of time MHMR provided services to the eligible group.
What will immediately stand out is that almost everyone who has untreated mental illness in the prison system was at one time referred to MHMR and turned away.

For years MHMR has lamented "more money" while proportionately providing less and less direct services. Its time to scrutinize MHMR and publicize how the money is spent. Then clean house creating an efficient agency that spends the funding to treat mental illness rather than empire build, fat administrative pay, and chicken shit sized caseloads.

Now if Jennings is advocating for privatizing to down size the administrative excess and overhead in order to spend on direct services, I agree with him. If he is merely suggesting privatizing as a justification for more money, he is pretty much pissing into the wind in my opinion.

Regarding TACOMI/TACOOMI that was heralded as the almighty solution to incarcerated Mental Illness, those two money pits are living proof that Sunset Review is a joke. Send to the scrap pile and use the money saved to provide more direct services to clients.

Anonymous said...

Yo Death Breath, lot of rhetoric but very little substance. If you actually deleted out all the name calling and broad off topic political hate speech, you might have 5-10 words that actually refer to the Mental Health topic. Maybe

Obviously you are personal friends with GFB because your posts don't get removed when you name call and spew nothing more than hatred speech.

Bryces Battle said...

I got an idea of how to have more funds for mental health services, why not take a break from all these reasearch grants, that turn out articles upon articles, and phamplets upon phamplets and on and on and on...including another few minutes of notoriety/fame on the internet, TV and here and there...how much would that add up to?