The Mental Health and Mental Retardation Authority of Harris County

For the first time – maybe the first time ever – a significant group of consumer, advocacy, and professional organizations have come together in preparation for the next session of the Texas Legislature – the 77th session. This group, called the Community Coalition, has put aside the individual differences of each organization and developed a consolidated request to the State Board of TDMHMR and The Texas Legislature. Simply put the request is as follows:

• Repair and Strengthen the Mental Health Safety Net. New funding for mental health services for high-risk individuals in the community and jail diversion.

• End the Waiting Lists. Over 20,000 Texans are currently on waiting lists for essential community services for a mental disability.

• Equity for Texans.
¯ Equitable funding among Texas communities in 2002-2003 to bring counties below the state average up to the state average.
¯ Equitable funding for Texas by reaching the National Average by 2005.

The Coalition’s request was heard and positively responded to by the TDMHMR Administration and State Board through its Legislative Budget Board (LBB) biennial budget request for fiscal years 2002 and 2003. The LBB budget guidelines are explicit: create a budget which holds the line – keeps the services and supports at the same level as in the current biennium fiscal years 2000/2001. The State Agency is permitted, through what are designated as Exceptional Items, to request consideration for areas of critical importance above this “maintenance level”. It is here – in the Exceptional Items – that TDMHMR has addressed those critical areas for additional funding as requested by the Coalition. Of the total Exceptional Items requested, those items of critical concern to the Community Centers, with their rank order indicated, are:

#1 Maintain Current Services – $36,124,686 - funds needed to cover the deficit, the shortfall in earned revenue experienced this (current) biennium.

#4 Service Expansion – HCS Program - $137,244,443

#5 Rate Adjustment – ICF/MR, HCS, Rehab, Service Coordination (Community) - $64,070,344

#7 Service Expansion – MH Community Supports - $83,891,720

#8 Service Expansion – MR Community Non-Residential Services - $34,402,533

#14 Equity Funding for Mental Retardation Community Services - $72,862,018

Why are these items so critical you ask – why – because the public “safety net” is unraveling. Why – because Texas is 43rd in per capita funding for mental health services in the nation – and 41st in per capital funding for mental retardation services. Why – because Texas – one of the fastest growing states in population in the U.S. – is 1st in its percentage of residents who are uninsured. Approximately 1 in 4 Texas residents currently have no health insurance.

Can you imagine – really – in a time of almost unprecedented prosperity – one in four Texans cannot access healthcare – except through emergency services, some of the most expensive to provide of all healthcare costs? Can you imagine, 43rd and 41st in per capita funding for public services and supports for persons with mental disabilities who fall to the “safety net” for the uninsured?

The impact of this level of resource deficiency is felt every day – each day – by so many members of our community. It’s in the hundreds and, yes, thousands of phone calls received by the Access Center each month by persons seeking services for themselves, or their loved ones, only to be turned away because they are not severe enough. Not severe enough. Can you image the hue and cry that would erupt if the fire department took calls based on severity? Sorry, we won’t send the engines out ‘til the house is consumed by fire. Oh, well, maybe in some areas of the state we can respond when only one or two of the rooms are engulfed in flames, not the whole house. In Harris County, we literally are at the former – people trying to access public mental health services have to be in a severe, emergent condition or coming out of the public psychiatric inpatient facilities, or being released from our penal facilities and meet priority population criteria to get in the door. Can you imagine saying to those “at risk” community residents – go have a heart attack, first – then come see us if you survive? Can you imagine having access to state-of-the-art medications, such as New Generation Antipsychotic Medications, prescribing as rapidly and appropriately as possible, but having almost as many people discontinue these medications as are started each month– and not having the staff resources to find out why, or to try to support the consumers as the medications are “switched” from the traditional, older neuroleptic antipsychotics medications? Having increased capabilities to improve the lives of persons with severe and persistent mental illness through these new medications is wonderful, thanks to the efforts of many concerned folks last session and a positive response from the Texas Legislature. Not being able to ensure their successful implementation is tragic, such that these consumers may be more capable of participating in other treatment and rehabilitation services and more fully participate in and contribute to our community. Can you believe it? Everyday, yes, it’s happening every day.

And, imagine you have a child with mental retardation – with significant medical and/or behavioral concomitants. You and your spouse are both working to make ends meet. When you’re home, your lives are consumed with her care – her needs require continuing attention – seven days a week. You love her deeply and find a gift in having her as your child that you would never have expected. It is a gift, an exchange so meaningful, as she looks at you and smiles in her special way. Your heart just feels like bursting – but you and your spouse are literally exhausted. Taking care of the family business, the house, the cars, let alone some time for the two of you, can often seem most daunting. Your child needs the companionship and socialization of others her age. You need some time away – to regroup – to address unmet other needs. You get some respite – a little funding through MHMRA – a little that you must carefully space out over the course of a year. But, in truth, it is just that, a little.
w
As you explore options to better meet her needs through your service coordinator (yes, that capability does exist on the MR side of the house), you learn about a Federal program called Home and Community Services (HCS). HCS has several wonderful features. It will permit personalized tailoring to meet her needs for wrap around services and supports, based upon the severity of her condition. Wow, a Federally funded program for which she will qualify. Where do we sign up? Then the bad news – the waiting list for HCS in Harris County is currently over 2,300 – and growing – over 10,000 statewide. And, you find out this year, for the first time in several years, MHMRA has been allocated new HCS community slots – 90 of them. Can you imagine, 90 slots with a waiting list of over 2,300? How can this be, you ask? How can such a valuable federally subsidized service, which has no federal “caps”, be capped or limited in its implementation. The answer – HCS must be matched by the State of Texas – it takes 37?¢ for every 62?¢ in federal funds. The HCS slots are restricted in addressing the waiting list because there is only a limited amount of state general revenue appropriated to match the HCS federal funds.

If the community Exceptional Items are funded in the TDMHMR budget request, an additional 3,000 HCS slots will become a reality across the state in FY 2002/2003 to address the waiting list – what will it be at that time? What will families do as they become physically exhausted, wear out, medically impaired, or die? What will we do as a society at that time?

The Coalition has prepared a video. It’s called: Texas Can Do Better. It is available to take to all and any groups: church, service, professional, neighborhood, family – anyone who cares to spend around 12 minutes to be touched by the stories of people for whom the Texas “safety net” is critical. Copies are available – here in Harris County and everywhere across the state. It is essential that each of us who knows the importance and impact of these services and supports on the lives of those in need of the services and supports of the public “safety net” take a copy and show it to each group with whom we have contact. Our Department of Public Affairs can be contacted (713-970-7165) to get a copy for community presentation. We must do this now, we must do this often. We must get the word out – what is happening, what is needed, and what is possible. In one of the “richest” states in the Union, during one of the most economically prosperous times in our history, Texas can do better.