Texas MHMR agency to shift 1,500 clients with mental illnesses onto waiting list for services

From the El Paso Times:

EL PASO, Texas -- When about 1,500 mentally ill clients of El Paso Mental Health Mental Retardation are shifted to a waiting list for services starting next week, they'll walk away with little more than a one-month supply of medication and a list of other possible mental-health providers.

The state-funded agency serves adults and children diagnosed with major depression, bipolar disorder and schizophrenia.

Without services, some could suffer increased symptoms of their mental illnesses, including aggressive behavior, hallucinations or violent thoughts.

"They will go into crisis. The ultimate risk is suicide or homicide," said Selene Quintana, chief administrative officer for MHMR. "Anybody that has a mental illness runs that risk, and the only thing that's keeping them stable is their medication."

The agency is contending with an ever-growing number of clients and stagnant state funds, and has been operating in the red for three years. It met with clients and other agency representatives to discuss the issue on Monday.

"We cannot continue to operate at a loss. We already went through our reserves," Quintana said. "We've done it as long as we possibly can without funding."

Starting next week, the most stable of the agency's consumers will receive letters alerting them to the situation and calling for a face-to-face meeting.

They'll receive an evaluation, be placed on the waiting list and encouraged to seek help elsewhere as soon as possible.

"Their biggest concerns are what are they going to do when they run out of their 30-day supply," Quintana said.

She said the agency cannot provide them with a prescription extension beyond the 30 days.

It will, however, conduct a phone assessment every 30 days with the clients. Those who appear to be reaching the crisis point could again be cared for by the agency.

Joseph Minjarez, 48, was nervous about the waiting list and attended Monday's meeting. He has been a MHMR client for 10 years.

"I was very worried. I depend on my medication and my doctor to be stable," he said. "I hope I'm not affected. I don't know what I'd do."

MHMR plans to discharge 1,107 of its 4,441 adult clients to the waiting list. About 320 of 1,350 children at the agency will also be moved to the waiting list.

They will no longer receive care by a psychiatrist, nursing, care, counseling, rehabilitation, case management or medication.

Those to be discharged were evaluated for the severity of their mental illness, stability and their payer source.

Those funded by Medicaid will not be affected.

The most stable clients, such as those who have had no recent hospital admissions, who have jobs and are productive in the community, will be among those placed on the list.

"They're pretty stable, but the problem is they're stable because they're receiving services and medication and that won't last for long," Quintana said.

"We're hoping they can find other resources."

These resources would include private psychiatric care or care by clinics such as Centro San Vicente or Centro de Salud Familiar La Fe.

She said the 1,500-person waiting list is expected to grow steadily. Quintana said MHMR now screens about 600 new clients a month and enrolls about 200 of those in services.

Almost all new clients will go directly to the waiting list after Sept. 1.

All clients on the waiting list will continue to be eligible for crisis services from MHMR.

Quintana said as clients spend more time off their medication, the area could begin to see more mentally ill in the area's hospital emergency rooms. Law enforcement will take those who are mentally ill and commit minor crimes to the ER.

Sheriff's Office spokesman Deputy Jesse Tovar said de puties received mental-health training earlier this year.

"We're not saying everyone off their medication is a criminal, but some of them do need medication and when they're not on their medication they may be prone to violence," he said "Hopefully, they don't hurt themselves or a third party."

He said the Sheriff's Office is not expecting an increase in calls involving mentally ill people from the waiting list, but he said it is prepared to handle them if they should occur.

MHMR officials said they considered implementing the waiting list last year, but decided to wait until after the state legislative session out of hope that the state would increase funds.

The agency initially requested $17 million over two years from the state to expand services, then dropped its hopes down to about $2 million more per year.

The funds were denied.

Quintana said MHMR is applying for several grants and pursuing federal funds. She said clients will be moved off the waiting list to active status as funding improves.

She said one good thing that could come from the waiting list is forcing the state to see the need for increased funding for mental-health services in El Paso.

"If we keep going at the levels we're seeing, the whole center would shut down and we wouldn't be able to serve anyone," MHMR spokesman Rene Hurtado said.