We’ve talked about funding and workforce needs for mental health services. So why is it so important that Texas lawmakers prioritize mental health services in view of all the other needs in the state? Well, my argument would be we are already paying for these mental health services, in a much more costly and difficult way: the criminal justice system.
This is Minding Houston, I’m Bill Kelly.
Before we start this, I have a caveat I’d like to place on the connection between mental health and criminal justice. Way too often, we closely associate the two and it sometimes seems that having a mental health condition makes you a criminal or a risk to society.
The Hogg Foundation for Mental Health recently hosted a forum about violence prevention and mental health at the State Capitol. Some interesting stats that Dr. Joel Dvoskin the University of Arizona brought up included:
- People suffering from a Severe and Persistent Mental Illness are 11 to 12 times more likely to be victims of a violent crime
- If all violence related to mental illness were to go away, the overall reduction in violent crime would be only 4%
- The odds of someone with schizophrenia killing someone is approximately 1 in 140,000
Let me be very clear: the only thing criminal about mental illness is the way we have failed to invest in access for treatment.
With that, let’s get back to how mental health and criminal justice are connected. Far too often, this failure to invest in access has lead to individuals entering the criminal justice system, instead of the public health programs. This leaves jails and prisons becoming the safety net for Texans suffering from a mental illness. The statistics clearly bear this out.
The Meadows Mental Health Public Policy Institute list “Smart Justice” as a priority for their work. The statistics they offer show exactly why:
- Individuals with untreated mental health and substance use disorders at 8 times more likely to be incarcerated, often due to the lack of access to appropriate crisis services and ongoing care.
- 34% of Texas inmates have a mental health need and most have substance use disorders
- 17% of adults entering jails and state prisons have a serious mental health illness (SMHI)
What does that mean for us here in Greater Houston? Well, just listen to Sheriff Garcia talk about how much of his work is consumed caring for inmates who are mentally ill:
Sheriff: I completely agree and look, I take pride in a lot of things being Sheriff of Harris County, but the one I don’t take pride in is the fact that the Harris County jail system is often referred to as the largest psychiatric facility in the state of Texas. And look, we don’t want people in the county jail for being sick. We want them there for having committed some terrible crime, but we don’t want them there because they are sick and that it is there illness that principally drives them to come to the attention of local law enforcement. And so we need the state to be responsible about this issue, responsible about the care that these individuals need and provide the citizens of Texas a better way to respond to those challenges that some families inadvertently are confronting.
Craig Cohen: Roughly speaking, what percentage of the jail population falls under the category of ‘these are people who are mentally ill and need in patient care and by default you have to provide it?’
Sheriff: Approximately 30%. I mean, just as Bill mentioned that number is very accurate. It’s about 30% of my population at any given time and you have to recognize the significance of the fact that it’s been 30% regardless of when I was overcrowded and at 12,000 – nearly 12,000 capacity or right now when I’m not overcrowded it’s still 30%. And again, they’re there principally because they are sick, not because they are bad people.
Now, Sheriff Garcia sees the consequences of a lack of access. Another elected leader who has dealt with the state’s criminal justice system is long time Texas Senate Criminal Justice Chair Senator John Whitmire. He clearly draws the line between the lack of access for the population to mental health care and prison.
According to the Department of Criminal Justice, roughly one third of the people in the Texas prison system have some form of mental illness.
Houston state Sen. John Whitmire chairs the Senate Criminal Justice Committee. He says those inmates end up in jail because they fell through the cracks and were not being treated for their illness.
Harris County Crisis intervention Response Team
“Thirty-two-thousand have been identified, that were in a mental health program before they ever committed a crime. But because of the lack of community mental health services in this state, because of budget cuts at 2003, they do not get assistance when they’re having an episode or crying out for help,” said Whitmire.
The re-entry program for these people doesn’t exist anywhere in the state, and Whitmire says that probably means a return to prison.
“They don’t get their counseling. They don’t get their medication. They’re bipolar; they’re schizophrenic. They have an altercation with their family or a neighbor. Law enforcement is called, then they have an altercation with law enforcement. Welcome to the criminal justice system,” said Whitmire.
With these statistics and testimonials, I think we can all agree about the problem facing those with mental illness and the unfortunate burden on the criminal justice system in providing care.
So how do we make treatment more available and accessible so jails aren’t the largest providers of mental health services?
Harris County has an idea: let’s keep patients out of jail.
Last Session, Senate Bill 1185 created the Harris County Mental Health Jail Diversion program. With bipartisan support from Senators John Whitmire and Joan Huffman, County Judge Ed Emmett pushed the Legislature to match Harris County’s investment to establish a system to address individuals suffering from a mental illness that cycled in and out of the Harris County Jail. SB 1185 looks to concentrate resources and coordinate social services so that patients get the care they need outside of jail cell.
The Harris County Mental Health Jail Diversion program is the product of legislation passed by Texas lawmakers last year, that provided $5-million dollars for the launch.
Director Reginia Hicks says some goals of the program include the reduction of the frequency of arrests, incarcerations and the number of days spent in jail, to increase access to housing, health and social services, and to improve the quality of life.
“We have a special mental health program within our jails. We have specialty courts with judges that are focusing on behavioral health issues,” said Hicks. “We have providers with many years of experience.
We have the opportunity of making some earlier interventions.”
After the official launch, Harris County Judge Ed Emmett said he felt confident the Mental Health Jail Diversion program will serve as the model for other cities to emulate.
“The Legislature wants us to do it for four years, and then we will present to the Legislature what works,” said Emmett. “Because if it applies in Harris County, it clearly applies in the rest of the state, and then perhaps even the nation. So, I hope that what we develop here is the model program for the whole nation.”
Emmett and other officials often describe the county lockup as the “largest mental health facility in the state of Texas.”
It seems an obvious notion that people suffering from mental illness would be better served in clinical, rather than criminal settings. It is also much less expensive to provide acute inpatient or outpatient mental health care than the constant cycling of through county jails, prisons, and courts. The Houston Chronicle lauds the local programs that try and address this problem with this from their Editorial Board:
Harris County has adopted some strong programs. Teams of police officers and mental health professionals partner on targeted calls to help ensure that people with mental illness are not arrested unnecessarily. Through its pilot jail-diversion program, judges work with these professionals to keep those with mental illness from cycling through the criminal justice system.
However when Texas fails to invest in the needed clinical capacity for providing mental healthcare, we pay for it in terms of tax dollars and suffering. In a separate Editorial focusing on this need, the Chronicle states, “Our current system is pennywise and pound foolish,” and concludes with the following:
Harris County is the most populous region in the state. One in 5 people, or 350,000 adults residing in Harris County, will suffer from mental illness during their lifetime, according to Harris County Psychiatric Center. The Legislature should act next session to expand the capacity of the mental health system and give us more beds for patients in Harris County, preferably in a modern facility closer to home.
Given the strong support from our local elected leaders about the need for resources to expand capacity, who are our state leaders making these decisions? As of last week, both the Texas House and Senate have named committee chairs. What do those positions mean for mental health policy in Texas? More on that, next time.
This is Minding Houston, a presentation of Mental Health America of Greater Houston. I’m Bill Kelly.
Music from this episode: “Please Listen Carefully” by Jahzzar, “The War of the Sun Fist” by Gasc@t, “Impact Prelude” by Kevin MacLeod, “Manhattan Skyline” by DeeTunez , and “I’m Fine, Dear” by Dexter Britain. To listen to the full interviews and news sampled in this program visit Houston Matters, Houston Public Media and the Houston Chronicle. And a very special thank you to Cody McGaughey for lending your voice to this episode.