Mental Health In Texas:

The Hidden Cost of Budget Cuts

Presented By: Lillian Ortiz, MSW Mental Health America of Greater Houston Lt. Mike Lee Houston Police Department Mental Health Unit Amanda Jones, JD Harris County Office of Legislative Relations

Mental Health in

4.3 million Texans have a diagnosable mental health disorder, including 1.2 million children

Texas ranks 49th in per capita spending on mental health services Over 6.1 million Texans are uninsured Most Texas counties are federally designated mental health professional shortage areas as of March 2010
Source: Texas Department of State Health Services

Of these individuals, 1.5 million are not able to function at work, school, or in the community due to their illnesses
Source: Texas Medical Association

Texas Public Mental Health System

TX Department of State Health Services

State Hospitals

Local Mental Health Authorities & NorthStar

Community Hospitals

Funded Mainly With GR Dollars

th 78

Texas Legislative Session

In 2003, a $10 billion deficit led lawmakers to make serious cuts to mental health programs

Cuts to community mental health services Cuts to state hospital capacity Changed priority populations Cut most Medicaid mental health benefits Eliminated in-home and family support benefit Consolidated state agencies

Results of Cuts

Limited slots for community based services

Only those with big 3 diagnoses, which include bipolar disorder, schizophrenia, and major depression, are eligible for services Significant waiting lists for these services Lack of community based services forces individuals into repeated and expensive crisis episodes Lack of intermediate care/step down programs State psychiatric hospital beds increasingly used for forensic commitments, meaning people need to go to jail to get a bed

Crisis driven

Forces people into criminal justice system

Harris County has more children and adults with severe mental illnesses than any other county in Texas

552,000 adults in Harris County have a mental illness

153,000 of these individuals have a serious mental illness Only 18% of adults with serious mental illnesses in need of services from the public mental health system in Harris County are able to access treatment Daily waiting list of 900+

186,000 children in Harris County have a mental illness

83,525 of the these individuals have a serious mental illness Only 25% of children with serious mental illnesses in need of services from the public mental health system in Harris County are able to access treatment

Source: Mental Health Needs Council

Lack of Access to Treatment

Individuals unable to access community-based services end up in our publicly funded emergency rooms

Source: Healthcare Cost and Utilization Project

12.5% (12 million out of 95 million) of ER visits in 2007 were related to mental illness or substance abuse Over 4.1 million visits had mental illness or substance abuse as a first-listed or principal diagnosis 40% of the 12 million resulted in hospital admission, making ER visits for mental illness and substance abuse 2.5 times more likely to lead to hospitalization than visits for all other conditions

Individuals unable to access community-based services end up on the streets

Approximately 60% of homeless individuals are mentally ill Half of these individuals also have a substance use disorder
Source: SAMHSA

Utilize emergency services for care

Criminalization of Mental Illness: Adults

Harris County Jail is the largest provider of mental health services in the state

About 25% of inmates at HC Jail receive mental health services, which is more than our ten state psychiatric hospitals combined According to the US Department of Justice, the national average in local jails is 16% 80+ inmates at the HC Jail are waiting for a forensic bed at a state psychiatric hospital for competency restoration services

TDCJ estimates the rate of offenders with mental health issues to be at 19% According to the US Department of Justice, incarcerating inmates with serious mental illnesses is roughly 60% more expensive than housing typical inmates

Criminalization of Mental Illness: Children/Youth

Half of the children in the Harris County Juvenile Probation Department have a diagnosable mental illness
Source: Mental Health Needs Council

55% of the children in the Harris County Juvenile Probation Department have been diagnosed with a substance abuse and/or chemical dependence problem
Source: Mental Health Needs Council

According to the Texas Youth Commission:

47% of their new arrivals in FY 2009 were chemically dependent 37% of their new arrivals in FY 2009 had serious mental health problems

Economic Impact on Texas

2009 report by Texas economist Ray Perryman stated that:

Expanding funding for both traditional and innovative treatment options would pay sizable economic benefits even beyond the immeasurable quality-of-life improvement for those involved and represents an appropriate and highly productive use of State funds.
Even beyond the often devastating consequences for the

individuals involved, severe mental health and substance abuse disorders cost the Texas economy some $269.343 billion in total spending each year and 1,675,582 permanent jobs. Finding ways to reduce these negative effects is clearly a worthy goal.

Source: Costs, Consequences, and Cures!!! An Assessment of the Impact of Severe Mental Health and Substance Abuse Disorders on Business Activity in Texas and the Anticipated Economic and Fiscal Return on Investment in Expanded Mental Health Services

80th &

st 81

Legislative Sessions

80th Legislative Session

Appropriated $82 million for crisis mental health services Appropriated $109.4 million for maintenance of crisis mental health services $55 million in new funding for transitional and ongoing community mental health services Additional funds for indigent psychiatric inpatient services, childrens services, and adult services

81st Legislative Session

nd 82

Texas Legislative Session

DSHS has identified $134 million in proposed cuts to the public mental health system

$80 million from states 39 publicly supported community mental health centers

Expected to eliminate services to 11,000 adults and 2,000 children statewide

$44 million from five state psychiatric hospitals

Austin, Terrell, San Antonio, Rusk, and Wichita Falls Expected to cut 183 beds, 12% capacity, which have the potential to serve thousands of individuals Expected to cut care to 6,000 people statewide

$10 million from psychiatric crisis services