Cuts to mental health may leave Texas jails warehousing more mentally ill

As was predicted even before the 82nd Texas Legislature began, large budget cuts to front-line mental health providers are handcuffing community-based treatment programs and shifting the burden (and cost) to local police and county jails. Reports Kevin Krause at the Dallas News (Nov. 27, behind paywall):

Dallas County officials and homeless advocates say millions of dollars in planned state cuts to mental health care will severely tax an already overburdened system and could lead to increases in the homeless and jail inmate populations.

Money for Dallas County and six neighboring counties that receive mental health services under a privatized system called NorthStar will see $10.7 million less in the 2012 fiscal year, officials said.

That includes about $5 million used to treat people who are sent to state hospitals such as the one in Terrell.

Dallas County commissioners recently sent a letter to the Legislature’s two top budget writers, explaining the situation and asking for help. Ron Stretcher, the county’s criminal justice director, said help was promised.

But it may not come soon enough.

“We’re asking to have that money restored,” said Stretcher, who acknowledged that that is unlikely. “We’ve had to start cutting.”

The first round of cuts will go into effect Dec. 1, he said.

Between 70 and 100 clinic-based caseworkers will be laid off, Stretcher said. And less inpatient psychiatric care will be contracted for at Green Oaks Hospital.

Also, an after-hours clinic operated by MetroCare Services for people who missed appointments or have trouble seeing doctors will close, he said.

And the county will have fewer case managers at housing projects for those who previously were homeless because of mental illness or substance abuse, Stretcher said.

Those cuts cover about half of the expected deficit, he said.

The same story, no doubt, could be localized nearly everywhere in the state. Of all the dunder-headed, penny-wise, pound-foolish decisions affecting criminal justice coming out of the 82nd Legislature, this one strongly competes for top billing (perhaps along with underfunding prison healthcare by $100 million without reducing their number of patients). At this point, ironically, for some folks on the lowest rungs of society, the only way to access mental-health services really is to commit a crime.

In particular, cutting "case managers at housing projects for those who previously were homeless because of mental illness or substance abuse" has real public-safety implications, taking some of the support out of "supportive housing" often aimed at frequent flyers from the jail. It also has implications for the county budgets, since most big-county jails are full and the mentally-ill often cost several times as much per day to incarcerate as the average prisoner.

As a practical matter, this year's cuts to community-based mental-health programming amounted to an all-but-overt decision to dump the costs onto local criminal-justice systems, particularly county jails, as a back-end, off-the-books substitute for community-based care. As a result, “'We’ve won the race to the bottom,' said Matt Roberts, president of Mental Health Association of Greater Dallas," to Kevin Krause.

The justice system has a lot of moving parts, some of which, as with community-based mental health services, aren't formally even part of the justice system. In too many cases, when somebody's homeless, mentally ill and stealing, trespassing, begging or sleeping where they oughtn't or even engaging in aggressive behavior, local authorities have few short-term solutions available to them besides the jailhouse. This year's cuts narrowed locals' options even further, by this account gutting community-based supports in Dallas that divert folks from jail and prevent crime.

Shifting costs to counties in a way that costs taxpayers even more isn't so much a conservative budgeting approach as it is an abdication of leadership. If your goal were to cut overall costs to the taxpayer and maintain or improve on the all-time low crime rate the state and nation enjoy at the moment - and if, heaven forbid, you didn't suffer from the myopia of focusing one funding stream but instead sought overall cost containment - a wiser strategy would be to boost resources for community-based alternatives to avoid using (more expensive) local jails as a primary mental-health provider whenever possible. Instead, the Lege de facto chose the most expensive and least practical approach to the problem, further transforming large wings of the jailhouse into mental health wards while cutting social services on the front end.

That's a helluva way to run a railroad.