EDITORIAL: State mental health program is in crisis, requiring immediate action

July 05--The staff of the state's Sunset Advisory Commission, in reviewing the agency it refers to as "a grand experiment" when created in 2003, has issued a report calling for major changes in the Department of State Health Services, with particular emphasis on the failing mental health system under its control.

Noting that the department has more than 200 programs, 165 funding streams, 12,000 employees and a $3 billion budget, the report says although "this experiment was well-intentioned, in many ways DSHS was set up to be a 'jack of all trades, and a master of none.' "

One area where the department has failed is the state's mental health hospital system and associated community mental health and substance abuse programs.

The commission staff, in pointing out that more than 22,000 Texans received inpatient psychiatric treatment in fiscal 2013 for serious illnesses like schizophrenia and bipolar disorder, said the state's mental health hospital system is in crisis and that it requires action -- now.

The problem has been exacerbated by the number of patients being committed through the criminal justice system to the state's nine mental hospitals and other facilities. Because of a significant decline in capacity of those hospitals since 2001, there can be long delays in getting patients admitted.

That means people charged with a crime needing inpatient care often remain in jail "untried and untreated," the Texas Observer reported. And with more judicial commitments, fewer beds are available for the civilian population in need of the services.

Jails should not be de facto mental hospitals, but reversing that trend under current conditions will not be easy, as many other factors contribute to the problem.

"These issues have been compounded by the remote and outdated condition of the state hospital facilities, critical shortages of clinical staff and a lack of effective communication with the judicial system," the staff report said.

It recommends that the department work with the Court of Criminal Appeals in developing training for the judiciary in identifying alternatives to inpatient mental health treatment.

There are also problems with the community mental health service and the department's inability to deliver integrated programs that include treatment for substance abuse -- this in a state where more than 500,000 people have been diagnosed with serious mental illness and 2 million more with substance abuse problems.

"On the most basic level, 11 years after consolidation, DSHS has still not integrated 'front door' assessment, screening and referral services for mental health and substance abuse, allowing people more easily to fall through the cracks," the report said.

Because many people who suffer with mental illness also abuse drugs and alcohol, the staff recommends requiring the department to integrate mental health and substance abuse hotlines, screening and assessment functions and to focus funding equity efforts for local mental health authorities on targeted capacity needs rather than narrow per-capita funding.

The staff would also require the department to overhaul regulations for community-based behavioral health treatment facilities.

Because of its multifaceted functions, including administering 70 regulatory agencies and licensing more than 360,000 individuals and facilities, the department has failed in the crucial oversight of the state's mental health programs.

The review process will continue through the fall along with all of the health and human services agencies, and the staff may recommend organizational structural changes at that time, including whether the department should continue as a stand-alone agency. It could also consider placement and management of direct-care facilities such as the state mental health hospital system.

Once the Sunset Advisory Commission adopts a report and recommendations, they will be sent to the Legislature for consideration in the next session.

This is one issue that lawmakers must take very seriously and act on expeditiously.

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