This November, one of the biggest moves for mental health policies happened in Austin. It wasn’t an election and there weren’t a lot of politicians present. But the leader of the Texas House, Speaker Joe Straus, has made sure that mental health will get more than its fair share of attention during the next legislative session.
And with the final month of her administration coming to an end, Mayor Parker talks about the shift in city policy when it comes to substance use and why funding the Mental Health Division in HPD is a must for city leaders.
It is all about leadership and focus. For December 2015, this is Minding Houston. I’m Bill Kelly.
The State of Texas has challenges regarding how much and frankly how little is invested in public mental health systems. The November 10th edition of the Houston Chronicle explains:
Texas spends less per capita on mental health care than all but a couple states in the nation. Seventy percent of the counties here do not have a single practicing psychiatrist. Forty percent of children experiencing emotional, developmental or behavioral problems do not get any help. And the state’s biggest provider of treatment is the Harris County Jail.
Fair to say, there is work to be done. And while many leaders have found it convenient to not to focus on this issue, Speaker of the Texas House Joe Straus has decided to take a look at the public mental health system head on. The Chronicle continues:
Now, lawmakers are making their most deliberate effort in two decades to address the problems. House Speaker Joe Straus on Monday formed a special committee to “take a wide-ranging look at the state’s behavioral health system for children and adults.”
The House Select Committee on Mental Health, the first such panel since 1995, will study mental health care, as well as substance abuse treatment, recommend ways to improve early identification and treatment, and increase collaboration and measurement of outcomes. It will pay particular attention to services in rural parts of the state and for veterans and the homeless.
“We owe it to taxpayers to make sure the system is as effective and efficient as possible,” Straus, R-San Antonio, said in a statement announcing the committee. Republican Four Price of Amarillo will chair the committee, with Democrat Joe Moody of El Paso as the vice chair.
Republican Sarah Davis and Democrats Garnet Coleman and Senfronia Thompson of Houston will be among the 13 members. The announcement came as welcome news to mental health advocates and providers, many of whom expressed optimism while also noting the long way the state has to go.
The membership of the new panel also sparked optimism for advocates, such as Bill Kelly of the Houston chapter of Mental Health America, who noted that key budget-writers such as Price and Davis were included alongside policy experts such as Coleman and Thompson.
“That’s the A team,” Kelly said.
Coleman said that he expected the committee to make a difference, including by finding innovative ways to improve care without huge costs. “Mental health crosses into so many areas of public policy, whether it’s criminal justice, juvenile justice, education or health care in general and this is the best way to look at it, by bringing together people who are familiar with the different areas,” he said. “This is a great thing.”
According to the advocacy group Mental Health America, just 36 percent of Texas adults with mental illness receive help – 44th in the nation. For kids, the estimate of 40 percent is from Kaiser.
As a result of all that, the state’s criminal justice system has become the biggest provider of psychiatric treatment. Around 76,000 people with mental illness were arrested in Texas for minor crimes last year, according to the Texas Department of State Health Services.
One of the most encouraging statements from Speaker Straus in forming this committee was his wide-ranging view of how mental health affects different areas of government. With members from Corrections, County Affairs, Public Health, Criminal Justice, and perhaps most appropriately from Appropriations, Speaker Straus has ensured a comprehensive look at policy. In a supportive editorial, the Chronicle said of the committee, “it will take an IMAX-style approach, at least, to encompass the range of deficiencies in mental health treatment.”
While I would always question that Bill Kelly guy, the local members from Harris County delegation appointed the Select Committee are serious players that can be a strong voice for local concerns.
For example, Rep. Garnet Coleman is the chair of the County Affairs Committee and has been a leader in helping change the process and procedures for law enforcement on jail intake forms. He is widely regarded as the state’s expert on mental health policy in Texas.
Rep. Sarah Davis was one of the 5 House members on the Budget Conference Committee last session while also serving on the House Appropriations Subcommittee on Health & Human Services. She is one of the most knowledgeable members in either the House or Senate when it comes to mental health funding in Texas.
Rep. Senfronia Thompson is one of the most effective Texas House members . . . well in history. According to Capitol Inside’s Mike Hailey, “Thompson has shepherded more legislation successfully than any other state representative here in the past half-century if she isn’t the all-time leader in the respect.” For those that know, Mrs. T will fight for the “little dogs” and get things done.
For these committee members, MHA of Greater Houston will be looking to provide information and policy positions that can best represent the strengths of our region and also identify the shortcomings. Making sure our lawmakers have the best information available is exactly what the legislative advocacy of MHA of Greater Houston is all about.
As some of my fellow Houstonians listening to this can testify to, we’ve recently had an election in Houston. With a new Mayor, we wanted to sit down with Mayor Annise Parker to look back at the accomplishments of her administration and how she sees behavioral health policy at the municipal level.
Bill Kelly: We are here at City Hall with Mayor Parker. Mayor, thank you so much for sitting with us today for Minding Houston. We greatly appreciate it.
Mayor Annise Parker: Glad to do it. You know I don’t have many days left so it’s nice to look back over the accomplishments.
Kelly: Well, first question, when you supported the creation of The Sobering Center, were you actively looking at changing the city’s response to substance use and addiction from a criminal justice setting to more of a health care treatment one?
Parker: I would love to say that was the foremost reason I was doing it. It was really a much more practical need and the way it turned out we were able to address several important issues at one time. The city of Houston is the last big city in Texas that has its own jail. That’s a county function. Cities have gotten out of the jail business and we have been under a consent decree for at least two decades, trying to shut it down or rebuild it. The real solution is to merge with Harris County and one of the reasons that we had been unable to do it is just the capacity of Harris County. We did some analysis and on a given year we would arrest 17,000 to 19,000 people for public intoxication of some kind. And if we could take those out of the inmate stream it would significantly reduce the census and make that arrangement with Harris County easier. At the same time as we began to analyze, a wealth of benefits came out. It was an opportunity for intervention, clearly. It was an opportunity to get a police officer who picks somebody up out of the street faster. Fifteen minute turn around at the Center for Sobriety rather than a couple of hours booking somebody into jail. It means that someone doesn’t have a criminal record and there is a whole host of problems that come when you criminalize the behavior and hang that arrest record on somebody. And then finally, it costs significantly less to put someone in the Center for Sobriety than it is to put somebody in jail. So it was a win-win-win-win and it has absolutely proved that. Going forward now that we have a few years of history with the Center for Sobriety, the challenge has been that it has to be routine for law enforcement. You have to train them to really look at who they are picking up and make an informed decision and it has to become habit. We have broadened it; it started with police officers and broadened it to the larger law enforcement community here in Houston and they just have to get it to be a routine. But the next thing we have to do is – we don’t do a forced intervention. The premise is you come, you stay four hours minimum or until you sober up and are able to leave on your own, and you don’t have to talk to a counselor although the counselor is there. You don’t have to do anything but just get yourself under control and you can walk out the door. Well, then we discovered the frequent flyers that cycle through over and over and over again. And so this is a neutral space where all of the various agencies deal with addiction and substance abuse so all those turf wars don’t have to break out. We have a number of partners there, so now we are gradually adding in the appropriate level of intervention where someone is clearly a danger to themselves. If you are coming through more than once a month – even that is a lot, but at more than once a month we have to do something. So that’s the next phase and I am very, very excited about that.
Kelly: Picking up on some of your comments, the mental health division of the HPD is one of the national models and it is the only mental health division in the state of Texas for any major police department. What made you, in some lean budgetary times, make the investment in this public safety team?
Parker: Well again, it’s a very practical decision because we recognize that a lot of the interventions from the mental health team are in our homeless community and it dovetailed with the initiative that began four years ago to move the needle on homelessness. People aren’t chronically homeless because they like living outside. People are chronically homeless because they have substance abuse or mental health issues or both. So in the mental health unit they interact with an individual who may be in their own home and in crisis, but on a daily basis they also interact with the folks on the street who are chronically homeless and, in fact, they were among those who came to me and said ‘You know, we really need to do something to these folks other than put them in jail.’ Or send them over to the emergency rooms, which is the most expensive care you can provide. Sometimes doing the right thing, the most humane thing is also the most cost effective. It’s just a matter of analyzing why you are really doing something and how you are doing something and seeing if there is a better way.
Kelly: At a recent celebration at The Sobering Center you were able to say some remarks and really see this project to completion or to the status that it has become today. It was a particular person that you mentioned and pointed out who had dealt with addiction and substance abuse and was really an inspiration to you. What would you really look back and say, in view of the accomplishments of creating The Sobering Center and the expanded mental health division in HPD as it relates to him?
Parker: Well first I would say that many of us in America have people in our families that have dealt with addiction and substance abuse, as have I, but what is important is being able to acknowledge those who have dealt with their demons successfully and can be a resource to others and an inspiration to others. My very, very close friend of 30 years is a local judge. He has publically acknowledged that more than 25 years ago he had a substance abuse problem. He himself was arrested and he did what he needed to do. He faced his problems, he still goes to AA, he counsels others who have addictions. We have to get past the stigma of talking about substance abuse problems and addiction and the fact that he is a former elected official – I know he hopes to return to the bench in the future – but that he had made it a part of what he offers that it made him a better judge because it gave him compassion and understanding. He created our homeless court because he had that heart for what some of these folks who were in homelessness were going through. You can’t address addiction with punitive measures. It solves one piece of the problem, but it doesn’t solve the problem and it doesn’t heal the person. You have to have a combination of carrots and sticks and support and compassion and the worst thing you can do is to make it something to be ashamed of.
Kelly: Last question for you, Mayor Parker, in view of this week’s election what advice would you give incoming Mayor Sylvester Turner about the city’s role in mental health and substance abuse addiction issues?
Parker: The city has to be a full partner in this because it affects the greater society. It affects us directly through law enforcement, emergency services, through our health care system but it also affects us as a society and rather than treating it as ‘well, all we as a city only have to focus on – we arrest them, we take them here or there.’ We have to be a partner and I trust that the new mayor understands that and will continue to do that because he will have the opportunity to see how well our homeless team in the city of Houston and the mental health unit of HPD and the folks at The Sobering Center and our many, many nonprofit community partner based organizations that are engaged in this space all work seamlessly together to make sure that we give a safe dignified place to sober up if that’s what’s needed or assistance to those who need help and we keep everybody healthy together.
Kelly: Mayor Parker thank you not only for your time but for your service and particularly what you have done for behavioral health here in Houston.
We offer our sincere congratulations to Mayor-Elect Sylvester Turner. Turner’s concerns about mental health are clear not only from his voting record in Austin but also the fact that his campaign website had a “mental health” platform on his Issues page. A link for that page is below, as well as this picture of his campaign’s door hangers that specifically mentions mental health investments.
Our hope is that the incoming City Council members have the same focus that Mayor-Elect Turner has in continued support for our city’s behavioral health programs.
From all of us at Mental Health America of Greater Houston, we wish you very happy holidays and hopes for an exciting and prosperous new year!
This is Minding Houston, I’m Bill Kelly.