- El Paso County Attorney
Border Mental Health
- Testimony by El Paso County Attorney José R. Rodríguez before the Texas Senate Health & Human Services Committee regarding Border Mental Health, March 26, 2002
I am José Rodríguez, El Paso County Attorney. I first want to thank you for the opportunity to testify on border mental health and the issues we consider of paramount importance to El Paso and indeed the rest of the state of Texas. I would like to focus my remarks on the key issue facing El Paso and other border communities regarding mental health and retardation services: lack of access to services due to inadequate funding.
As County Attorney, I have been involved in mental health issues since I assumed office in 1993. I have served on several mental health task forces, the most recent being the Life Management Center Task Force established by our legislative delegation in May 2001. That task force was charged with reviewing the inadequate operation of the local mental health authority and its board, and making recommendations for a new center, including a new interlocal agreement between the County, the City and the County Hospital District that is now in effect. In 1994, my office worked with the El Paso Court of Inquiry which investigated state funding and lack of access to mental health services. Further, last year I created a mental health unit in my office, and recruited committed individuals to work daily on issues troubling the mentally ill. Because of my statutory responsibilities, I believe my office has a unique perspective on the delivery of mental health services in the El Paso community.
THE COUNTY ATTORNEY'S OFFICE
The County Attorney mental health unit represents the State of Texas in mental health commitment hearings and works in collaboration with various local agencies and health care providers who serve the mentally ill. We have negotiated memoranda of agreement regarding the continuum of services for mentally ill criminal offenders. As a result of this work, last year we were instrumental in obtaining funds from TCOMI for a jail liaison program designed to quickly identify inmates with mental illnesses, to divert them to appropriate agencies, and to ensure a continuum of care for inmates with mental health needs.
My office also prosecutes juvenile criminal offenders, and represents the state in court proceedings involving Texas Child Protective Services and Adult Protective Services. We also represent the El Paso County sheriff's department, which deals with mentally ill citizens on a daily basis, whether out in the community or within the confines of the detention facilities.
MENTALLY ILL IN DETENTION FACILITY
Both the El Paso County Detention Facility and the Juvenile Detention Facility tend to serve as the de facto warehouses for mentally ill people in El Paso County. As a result, my office deals with the real life casualties of inadequately funded mental health services. For example, in the past six months over a third of our jail residents have been recognized as mentally ill and prescribed psychotropic medications by the jail health services.
The situation involving juvenile offenders is equally alarming. There exists an over-utilization of the juvenile probation department as a default treatment facility for children with mental diseases. This observation is underscored by JPD's report that 92% of the El Paso youth in residential treatment facilities are on psychotropic medications such as mood stabilizers, anti-depressants, and anti-psychotics. According to JPD medical staff, on an average each of these children are on 2-3 different medications.
JUVENILES IN NEED OF MENTAL HEALTH SERVICES
According to the Child, Adolescent and Family Branch of the Federal Center for Mental Health Services, 5 to 10 percent of American children are reported to have serious mental health disorders.
About 60 to 70 percent who have mental health disorders do not get the treatment they need. Consequently, children are trapped in institutional settings because of lack of treatment programs in the community. The result is children stuck in hospital emergency rooms while in full-blown psychiatric crises, children stuck on waiting lists (or "appointment lists") waiting for outpatient therapy or case management, and children being referred for juvenile prosecution or for protective services to provide them the services they so desperately needed. The report states that the problem is so widespread that it has prompted recent lawsuits demanding more outpatient treatment in states from New York to Idaho to California.
The El Paso community, unfortunately, is following and indeed surpassing, the national trend of failing to provide adequate mental health services for our children.
According to the El Paso MHMR Redesign Child & Adolescent Work Group, for every one youth and family served, there are at least five who are unserved and perhaps twice that number. Most recent statistics show that only 12% of the projected need for services were met for children meeting TDMHMR requirements of priority population. Only 21% of the need among those children living below poverty level were met.
Our children barely survive being tossed from one underfunded agency to another, and desperate parents face the choice of relinquishing their parental rights or filing charges with the police so that their child can gain access to urgently needed care. Horrific anecdotes have recently been reported of children with severe mental illness problems, repeatedly turned away or quickly discharged by the El Paso Psychiatric Center.
One child, for example, had four admissions and five referrals to the Psychiatric Center between July 15, 2001 and August 3, 2001. No local program would accept him due to the level of violent behavior he exhibited. He was admitted to the Psychiatric Center after attempting to choke a sibling and requiring police intervention.
The child admitted to suicidal ideation, and the parents expressed concern about the violence, stating that they were afraid to take him home. Seven days later he was discharged with the psychiatric staff comment that the child's behavior was "fine" while in the facility. On the same day he was discharged, he tried to choke himself. The next day he stabbed a sibling with a pair of scissors. Two days later he was referred to JPD for prosecution only because he was determined to be psychiatrically "stable." While in their custody, JPD then referred the child back to the Psychiatric Center. A few days later the local mental health authority representative stated that Big Springs State Hospital would not accept ten year olds, and that the San Antonio State Hospital only admitted children 12 and up. They had no suggestions for placement and released him. Often times, the only response received by the families desperate for help is that they "would just have to wait until the child broke the law before they couldget the help that they need."
Another example of the consequences of underfunding mental health services for youths is the story of a 13 year old boy recently sent to the Meadow Pines Residential Treatment Center in Longview, Texas until his 18th birthday. It was reported that this young boy was referred to the El Paso Psychiatric Center in January of this year because of self-mutilation and threats of suicide. Only two days later, he was discharged with anti-depressant medication. Only ten days after he was discharged, he was found to have bruises and bite marks resulting from another altercation at home. He was again taken to the Psychiatric Center but was immediately turned away due to his family's inability to pay. He was sent back home to the same person who had bitten and bruised him. Notwithstanding a complex history of violence in the home, as well as the child's own history of violent behavior, victimization, suicidal ideation, self-mutilation, multiple referrals to the Psychiatric Center, and continuous problems at school, the boy never received a designation as emotionally disturbed nor was he ever referred for special education behavioral intervention until he was criminalized and sent to the Juvenile Probation Department, then subsequently referred for a five-year placement in the Longview Facility.
There are no residential treatment centers for children in El Paso. Sending this young boy away from his home community will cost JPD $206 per day of service, nearly ˝ million dollars during the five-year commitment. Therefore, as a result of the state's underfunding, for meaningful mental health services the state is forced to spend criminal justice dollars to treat and punish adolescents whose behavior is directly linked to mental health problems. The use of the criminal justice funds to treat adolescents in need of mental health services is an imprudent, and in my opinion, disturbing use of public funds.
OTHER AREAS OF NEED DUE TO LACK OF FUNDING
The El Paso Psychiatric Center , announced on March 15, 2002 that its crisis stabilization unit will be closed until further notice. The announcement follows months of the Psychiatric Center working at maximum capacity and being closed to referrals from hospital emergency rooms due to its inability to provide adequate staff necessary to always have a bed available. The Psychiatric Center is consistently over capacity yet has an entire 3rd floor with 30 empty beds.
Our own county hospital also experiences the public's use of the medical facility in place of appropriate MH and MR service providers. This occurs primarily when the psychiatric center is on diversion status or has no beds available. This also severely strains already limited resources necessary to provide health care to the public.
Among those in need of MR services, there is no stabilization facility for dually diagnosed MR individuals with mental illness. There is no residential setting for Autistic children. And, according to our MR consumers, we have a tremendous lack of foster homes for mentally retarded persons.
We are constantly battling budget cuts and long waiting lists. On November 19, 2001, the El Paso Times reported that the local mental health authority was almost 1000 patients over capacity. Waiting lists are a fact of life. For mental health services, the wait for an appointment may be a matter of months. For mental retardation services, the wait can be for years. Most recently it was reported that El Paso has 600 people on waiting lists for MR services.
Likewise, it has been reported that every detox effort in El Paso has failed due to insufficient planning to address the difficulties of funding. Approximately 1,200 El Paso youth, ages 12-17, have a diagnosable addictive disorder, but it is predicted to be far more widespread. For these youths, only out-patient services are available. For adults diagnosed with addictive disorders, funding in El Paso is currently at about $123 per bed per day, when the minimum required by regulatory requirements for services provided is over $400 per day, and for many people with dual diagnoses or who require medical detox services, the actual costs can be several thousand dollars a day. Currently, Aliviane, the primary local drug rehabilitation agency, has funding for only 5 detox beds.
Despite the financial obstacles, the El Paso community is devoting its energies to solving these intractable problems; but now the state must find a way to provide meaningful access to mental health care in order to satisfy its obligations. Mental health services must be made a high priority in the next legislative session. The State must discontinue its unwise use of criminal justice funds to prosecute and house mental health patients.
As a result of recent legislative changes, outpatient services are being shifted to inpatient services at the Psychiatric Center. This may seemingly be a good alternative for some of the mentally ill, however without adequate outpatient care, quick decompensation and deterioration will most likely result upon discharge. The result is a circular chasing of in-patient treatment. It is imperative that the state not ignore the need for funding of outpatient services - fiscally and medically, it is the most prudent thing to do.
According to the U.S. General Accounting Office, between 1987 to 1997, states spending declined from 31 to 27%.
Texas is ranked near the bottom of the list in adequate MH funding. The national per capita expenditure for MR consumers is $70.
In Texas, the statewide average is $40. In El Paso, the level is $25 per capita. Our best statistical evidence demonstrates we need to double, and double again in the next five years, funding of community-based mental health services for our youth crippled by depression, substance abuse, or psychosis. Our mental health authority's crisis mobile outreach team and protective and regulatory service workers need additional staff, training, and state funded resources for services needed by their clients. Funding is needed for an Adolescent Residential Treatment Center to avoid placement hundreds of miles from home; for in-patient substance abuse treatment facilities; and, for a stabilization facility for individuals who have a dual diagnosis of mental illness and mental retardation. Finally, we need more funding for in community services such as assisted housing, additional ACT teams, crisis services, and more and better trained Adult Protective and Child Protective Services staff and mental health providers.
In conclusion, I want to urge this Committee to convey our message to the State of Texas during the next session of the legislature, that we are tired of its policy of neglect and indifference towards children, the elderly, and others with mental disabilities; that we are tired of a system that offers parents and their children the choice of accessing needed services only through the criminal justice system; and, that we are tired of maintaining a system of mental health services that does not begin to meet the needs of its citizens, all because we place no priority on adequate funding. By now, we should have learned the lesson that the cost to society and the State treasury are much greater when we fail to address people's needs sooner rather than later, after families have disintegrated, leaving us with a system of care we cannot fiscally or morally defend. Thank you.