With budget cuts in Texas, police perform role of "psychologists" for those needing mental health care

From The AP:

AUSTIN, Texas — In a state that offers meager funding for mental health, law enforcement officers across Texas have performed the duties of psychologists and social workers — roles they have neither the training nor the manpower to bear.

The Texas Legislature, which has never been generous to mental health clinics, has further withered services under the strain of a strapped state budget, and as a result, police and sheriff's departments say the number of mental health calls they respond to is snowballing.

And thanks to a new $27 billion budget crisis, it may only get worse.

Initial proposals would cut services provided by the Texas Department of State Health Services by 20 percent, making it more likely for mentally ill Texans to end up in emergency rooms, having mental breakdowns or being thrown behind bars.

"We're about to see huge setbacks. I think we're going to get slaughtered," said Leon Evans, chief executive of Bexar County Mental Health Care services. "We've been developing some tools so people don't have to go to the hospital and prison. But I think all these programs that are very effective, that help to reclaim lives, are at risk."

Experts say slashing mental health funding will have a painful and resounding effect across Texas when the mentally ill can't access the treatment and medication they need to function.

"What's happening is the criminalization of mental illness," said Polly Hughes, public policy chair of National Alliance on Mental Illness. "It shifts the responsibility of taking care of mental illness to the counties and officers who are already stretched thin."

Community services such as clinics, crisis hotlines and outpatient treatment are critical to keeping the mentally ill out of state institutions and jail.

The shortage of mental hospital beds means officers often have to drive a mentally ill person hundreds of miles to the next open bed.

"What we're facing in 2011 are law enforcement officers as de facto social workers and jails becoming asylums," Houston Senior Police Officer Frank Webb said. "Police officers are responding to more mental illness than social workers."

Jails are packed with mentally ill Texans who most often haven't committed a violent crime, but cycle endlessly through the system for minor violations, costing taxpayers thousands of dollars.

Texans with a serious mental illness are eight times more likely to be incarcerated in jails than treated in hospitals, according to the National Alliance on Mental Illness. A community health care program costs $12 per day to care for a patient, compared to $137 per day to incarcerate them, the group said.

Dallas County Sheriff Lupe Valdez said mentally ill inmates cost the county the most money, with more than a third of the county jail's 6,000 inmates requiring mental health services. The cost of housing and providing care for these inmates was nearly $19 million in 2010.

As the seventh largest in the country, the jail is already dealing with limited resources and overflowing cells.

"If community mental health services don't get the money they need, we're going to end up being mental health institutions. In fact, we're already there," Valdez said. "If we start overloading the system, we're not going to have what we need to take care of them."

The stream of people into jail is continuous because it's easier to get arrested than get treatment, Webb said.

Mental health cases are becoming so prevalent that departments across the state and nation have made Crisis Intervention Training a major part of department curriculum. Departments team up with local mental health authorities and receive specialized training to better understand mental illness and learn how to respond more responsibly.

Webb took the lead on engineering a unique program at his department that pairs a Crisis Intervention Training officer with a licensed therapist from Harris County. The pairs are designated as Crisis Intervention Response Teams and ride as partners to respond to the most serious crisis calls.

Webb said having a mental health professional to help with the diagnosis on the scene works effectively.

"If the person is in the (mental health) system, the clinician has direct access to the records and history, doctors and hospitalizations of the person," Webb said. "It's a stronger, smarter response."

Officers learn about major mental illnesses like schizophrenia and bipolar disorder from professionals as well as people who suffer from mental illness. Role-playing is a crucial element in preparing officers.

But fundamentally, Webb said police officers are trained to deal with criminal law, not the mentally ill.

"The average officer around the state and country sees this as a burden," he said.

The Washington-based National Alliance on Mental Illness found that between 2008 and today, 32 states and Washington, D.C., cut mental health services right on the heels of layoffs and home foreclosures that increased demand for services.

States are removing hospital beds, shuttering outpatient services or simply treating fewer people.

Dallas County expects a minimum increase of 60 percent in prisoners with mental illness next year. That can be tied directly to the state's decision to deeply cut mental services, Valdez said.

"We're the only ones who will pick up the mentally ill," she said.

And counties across the state will be saddled with similar costs and challenges. Law enforcement officials have no doubt that for the foreseeable future they are the state's front line social workers.

"Whether we should be doing it or not, whether we like it or not, the bottom line is that we are and we have to do the best job we can," Webb said. "The budget cuts are just going to make it worse."