AUSTIN — Melissa Shearer spends her days working with mentally ill Texans caught up in the criminal justice system — 90 percent of whom received care through publicly funded community mental health centers.
But Shearer, director of Travis County’s Mental Health Public Defender Office, told lawmakers Wednesday that it’s incredibly difficult to get information about what services are available to her clients through these local mental health authorities and whether they work. That’s why she favors a bill that would require the state to audit and publish performance and outcome data for these centers.
“There has to be much more transparency with local mental health authorities about public funds spent on services,” she said during a Texas Senate Health and Human Services Committee hearing Wednesday at the Capitol.
Senate Bill 26, sponsored by state Sen. Lois Kolkhorst, R-Brenham, would require the state to audit these authorities and publish online data related to mental health care. If the measure becomes law, it could help the public learn how often overcrowded jails are denied requests for mental health services for inmates.
Such denials can have life-or-death consequences in Texas jails. This lack of accountability was highlighted in a Houston Landing investigation published last month that found at least 33 percent – or 178 – of the more than 540 individuals statewide who died of unnatural causes in jail custody over the past decade had been flagged as potentially mentally ill at least once since the 1980s.
That number was even higher in the eight counties that make up the greater Houston area, where 46 percent of the 114 people who died of unnatural causes in jail over the past decade had been identified as mentally ill. Yet many of the inmates hadn’t received desperately needed care.
A day after the story published in February, Harris County Judge Lina Hidalgo cited the investigation in awarding $645,000 toward more than doubling the number of people whose competency can be restored through the Harris County Jail’s competency restoration program.
Kolkhorst said Wednesday her office has heard from constituents that mental health services are not being offered at all and, if they are, they’re not being provided in a timely manner.
“We have to figure out why that is — we do that with state agencies all the time,” said Kolkhorst, who chairs the senate committee. Her bill requires that the data must be updated online monthly or as often as possible.
Advocates have long said that more data needs to be collected about who is cycling through the criminal justice and mental health systems to ensure that funding is directed appropriately. This bill, they say, is a step in the right direction.
“This bill will hopefully give us a better picture of what’s going on in our communities that’s causing our jails to turn into warehouses of people with mental illness and disabilities,” said Krish Gundu, executive director of the Texas Jail Project — a nonprofit that advocates for people in county jails — in a statement.
Other data points the state would be required to collect and publish include:
■ Access to timely and adequate mental health screenings, as well as timely access to treatment, be it in a community-based setting or a psychiatric facility;
■ Improved functioning because of medication or psychiatric services;
■ The number of people referred to a state hospital or community-based hospital, as well as the length of time between referral and admission and the length of stay;
■ Quality of care both in community-based mental health services and state facilities.
Greg Hansch, executive director of the National Alliance on Mental Health Texas, has been hearing from mentally ill Texans for years about the inadequate psychiatric services they’re offered in the community.
The waitlists are astronomically long, he said. The level of care provided doesn’t match the level doctors originally prescribed. Interactions with their case managers are poor.
But these complaints are just anecdotal. Having data to back it up will help improve transparency, he said.
“This bill will go a long way so that we know … not only are they getting services, but are they getting the right services,” he said.
Lynn Rutland, CEO of the Andrews Center Behavioral Healthcare System, the local mental health authority in Tyler, cautioned the committee against requiring too many audits for these centers.
“We understand and embrace local accountability and transparency,” Rutland said. “But in nine months, we have had nine state audits. Nowhere is a unit of government more inspected.”
The bill also would require better coordination between state-funded psychiatric hospitals and mental health authorities to ensure people being discharged from those hospitals continue to receive the services they need.
Budget cuts to community mental health programs in the early 2000s, along with a law change that made it easier for defendants to be found incompetent to stand trial, has created a backlog in the state’s mental health system that leaves mentally ill Texans with nowhere to turn for care.
The state’s 10-psychiatric hospitals have long been filled to capacity – as of December, there were 2,500 people waiting for a bed. Texans in crisis have no option but to flood emergency rooms or jails.
Committee members did not vote on the bill Wednesday morning.