The Mental Health and Mental Retardation Authority of Harris County

This issue of Interface is the December 2000/January 2001 issue – the transition issue for the end of calendar year 2000 and the start of 2001. We are, truly, into the next century – a century that will hold incredible advances in so many areas that will affect our human existence. Nowhere will this be more evident than in our understanding of the human body (particularly our understanding of the human brain) and the advancements in medical knowledge impacting both diagnosis and treatment of mental disabilities. New, non-invasive technology is currently available and will even more effectively in the future permit us to “watch” the human brain “at work” and “at rest”, increasingly identifying differences in the brain of a “normal” person and that of a person with mental illness. The genome project is mapping the genetic “switches” which may permit us to identify which gene or genes create a predisposition toward or “cause” the major mental illnesses of schizophrenia, bipolar disorder, or major depression.

Perhaps we will be able to identify which gene(s) cause the condition known as autism or which impact the neurochemical development of the brain leading to what we now call mental retardation. New advances could not only enable us to produce earlier, more accurate diagnoses, but lead to effective genetic treatment strategies which “turn off” malfunctioning genes, “turn on” those which are underperforming, or even “substitute” replacement genes to enable the person to have a more permanent resolution of their condition. Maybe in this century we will actually be able to speak of a “cure” for one or more of these conditions. And, while we are waiting, we will see the development of new, more effective medications and intervention technologies which will enable us to hold these conditions “at bay” and, increasingly, reduce their debilitating impact on the people who have them, as well as on their families who love them.

But today we face a much different reality. Today we are actually slipping in Texas, slipping backward in Harris County in our ability to adequately and appropriately apply the knowledge we currently have, whether it has to do with diagnosis or treatment. We have been “required” through the performance targets included in the Appropriations Bill of the 76th Legislative Session, which is translated into the Performance Contract target numbers, to literally chase numbers – to serve way more people than the resources will permit. Because we do not currently have an approved benefit package for the uninsured mentally disabled of Texas with an adequate per capita case rate tailored to the person’s acuity/security level, we have legislative expectations to serve numbers of people that are too large for the resources available such that everything is negatively impacted: quality of care, effectiveness, array (type) and amount of services and supports, time with practitioners, as well as the satisfaction of both consumers and their families.

In addition, and at the same time, public healthcare, including behavioral healthcare, is evolving into an increasingly managed care environment. Serious concerns over escalating costs are pushing tighter controls over who is served (who actually is eligible for public coverage), gets what services (the actual, funded services and supports that may be delivered if medically/clinically justified), and for how long (the amount of time the condition justifies or the funding permits the delivery of the medically/clinically justified services and supports). On one hand the Legislature expects the state agencies and their extensions (such as MHMRA) to move increasing numbers of people who are uninsured into a form of third party coverage (i.e., Medicaid, Medicare, CHIP). However, administrative requirements by the “gatekeeping” state agencies which oversee entrance into these federally funded and state matched insurance programs require an increasing use of already stretched resources to assist the consumers to “prove up” their eligibility and gain coverage, thereby reaping the host of benefits that accrues with this eligibility.

An independent analysis of Texas Medicaid accessibility by staff of the MHA of Greater Houston Inc. has confirmed what many of us already suspected, Texas makes it very difficult for people with mental disabilities to obtain medical coverage.

To overcome these barriers, the public MHMR system must exert inordinate resources to document the “proof” of eligibility (in terms of functional limitations) and assist the consumer in obtaining these benefits – take time, energy, and resources from a care system that is already unable to adequately care for the numbers expected.

The reality, today, is we are slipping. Consumers and family members are increasingly frustrated and angry – not really understanding or believing. How can tens of thousands of people be on waiting lists for vitally needed services such that they may more fully reach their individual potential and become contributing members of our community? How can families be permitted to “burn out” such that their only recourse is to turn over the care of their loved one with a mental disability to the state – where the state then has the full cost versus only a partial cost of care if the family remains involved and participating? How can we reverse the trend of so many people with mental disabilities ending up in prisons or jails, under bridges or in homeless shelters? Have we as a society lost our moral direction and so quickly forgotten the “Shame of the States” as pointed out just a few decades back by Clifford Biers?

A significant portion of this newsletter is devoted to the incredibly important efforts of the Texas Coalition currently in process to inform the public as to the plight today of people with mental disabilities and the cost benefit for investing in their needed services and supports. “Texas Can Do Better” is the theme. The video conveys the heart-wrenching words of people who are living each day with these same conditions, and the positive impact that getting at least some service or support from the public system can have. Think of the pain and suffering of the thousands upon thousands who are getting nothing. To be able to deploy the advances, which are coming in this next century, we must be able to apply what we know today. We must be judicious and cost conscious – but we must catch up. It will take each voice speaking out now and continuing throughout the session to obtain the level of critically needed additional funding to catch up and move forward. This, by all accounts, is going to be one very difficult legislative session and appropriations process. Each voice is essential – all the voices together can and will make a difference.

The future – the potential of the future has never, ever been brighter. To make it a reality for our Texans with mental disabilities, we must join together, put aside our individual differences, and lock arms. Do you believe? It is possible – it can happen! It has started! This is 2001 – the first year of the new century and the next millennium.