Costs, Consequences, and Cures!!! An Assessment of the Impact of Severe Mental Health and Substance Abuse Disorders on Business Activity in Texas and the Anticipated Economic and Fiscal Return on Investment in Expanded Mental Health Services
The benefits from implementing a $20 million hypothetical jail diversion program would include a positive net annual impact of $1.074 billion in total expenditures and 6,420 permanent jobs. The yearly increment to State tax receipts that could be expected was calculated to be $53.964 million, or a return of $2.70 per dollar of investment and $53.71 in overall benefit.
A primary goal of the Mental Health Transformation effort in Texas is to make the mental health system consumer and family focused. The Department of State Health Services (DSHS) has allocated funding to establish a mental health consumer, family, and youth training and technical assistance center through a contract with Mental Health America of Texas and the National Alliance for Mental Illness-Texas.
Nominations are being accepted for members of a 15-member advisory committee that will define the role and scope of this training and technical assistance center. The majority of committee members will be consumers, family members and youth. The remainder will be other individuals in the mental health field who are committed to achieving consumer-focused transformation. Nomination forms are due by June 1, 2009. To request the nomination form or more information, call (512) 454-3706, Ext. 204, or email Kathi@mhatexas.org.
From My S.A. Nicholas Gonzalez, who comes from a San Antonio family of doctors, will soon be playing one on TV.
The Central Catholic High graduate portrays a first-year resident in a mental health ward in Fox's new summer medical-mystery drama, "Mental."
Gonzalez called the series groundbreaking.
"For the first time, we have a drama that delves into the head, the psyche, the subconscious of patients, rather than just giving us reactions from the doctors," he said in a phone chat from Los Angeles.
For instance, in one episode, a woman who suffers from the fear of water clutches the side of a hospital pool. When she's asked if she's ready to go underwater, we see what she sees: a frightening ocean of high waves and sharks.
Each episode of the Tuesday night series presents a new puzzle for the doctors to solve.
"Mental," which debuts at 8 p.m. May 26 on Fox, is one of many new and returning shows coming viewers' way this summer. Lots of reality shows will fill the warmer months, along with a sprinkling of scripted comedies and dramas.
The season also is known for taking more chances and introducing quirkier characters, such as "Mental's" Dr. Jack Gallagher (Britain's Chris Vance, "Prison Break") a radically unorthodox psychiatrist who becomes the new director of mental health services at an L.A. hospital.
Take Jack's entrance: As a naked delusional patient violently confronts the staff, Jack strips down to nothing as well to gain the patient's trust.
"Jack's got this edge to him," Gonzalez said, "he ramps it up and says let's screw the system a bit."
Gonzalez's character, Dr. Arturo Suarez, is the only one who likes Jack from the beginning and takes his side. Arturo also has his colorful moments. He's a bit scruffy with a light beard and confident to the point of being cocky. He's forever hitting on fellow resident Chloe (Marisa Ramirez) even though she's gay.
In a future episode, a woman who's addicted to sex checks into the ward, and "Arturo is forced to take a little of his own medicine," Gonzalez said.
Gonzalez gets back to his hometown whenever possible to visit his family, mom Sylvia Mosier and dad Dr. John Gonzalez, a prominent S.A. dermatologist.
Much of his time recently was spent in Bogota, Colombia, where the bulk of "Mental" was shot as an expense saver and where Gonzalez met his girlfriend, telenovela star Mimi Morales.
Gonzalez has had no problem finding work since landing the role of a boxer on former Showtime series "Resurrection Blvd" at the age of 24. He's guest-starred on many series, including "Grey's Anatomy," "CSI: Miami" and "True Blood." He's also starred in movies, was a regular on the PBS series "American Family" and played a sexy gardener on "The O.C."
Offscreen, he's an ace at cards as well, recently winning $50,000 in the latest World Poker Tour Celebrity Invitational.
At the age of 33, Gonzalez says he has never felt more fulfilled: "I'm in love with my 30s. It's been just awesome."
He's also excited about a future role. He says he has been cast in one of the most buzzed-about shows of the fall, the CW's remake of "Melrose Place." He'll play a detective trying to solve a murder.
"It's a fun character — a man among all these boys and girls," he said with a laugh, adding, "I used to be hot ass and now I'm just old ass."
Dear NAMI-Tyler, After seeing "The Soloist" it makes me want to ask the question does having a mental illness make us criminals? Then we should at least be treated with medications in prison. Does being homeless constitute a crime? Then I think society may need to improve it's treatment of us. If friendship can help a person who is living with mental illness recover then we need to use the people that are living with their mental illnesses to help those suffering the same things. The sick need a friend that can listen not with judgement but with an understanding mind and heart. The sufferers may find that the survivors of mental illness are particularly more able to understand them than someone that hasn't lived through similar situations. While we all have suffered loneliness, maybe not to the extent of sufferers of mental illness, we can in our humanness identify at least a little bit with them and can give sufferers a prayer, a kind thought or word just to say that there is a way out. There is a rainbow after the storm. You can live with a mental illness. You can have hope.
…The U.S. Department of Health and Human Services has designated 184 of the state's 254 counties as mental health professional shortage areas, meaning the number of professionals needed to provide adequate care to mental health patients is inadequate. That includes Gregg, Upshur, Rusk and Smith counties. …Since 2000, the number of mental health counselors and social workers dwindled from 72 counselors per 100,000 Texas residents to 66 counselors per 100,000 residents in 2007, according to a report by the Texas Hogg Foundation for Mental Health. The same reports also states that the number of psychiatrists dropped from seven per 100,000 residents to six per 100,000 Texas residents in 2007. From the Longview News Journal.
Dear NAMI-Tyler, Well, you know a while back 'stop the madness' was a slogan in our country for something. I think drug abuse. I'm not sure. But the madness to me means stigma and intolerance to differences in people. Anyone that seems strange no matter what they really are inside - good or bad - are just picked on more. Maybe I'm the only one that feels this way. The trials I've lived through may have made me 'different'than others. Because I felt and heard so many angry remarks and felt so many hard feelings I would get very angry at people. I realized working w/ a man who has Alzheimer's (a mental illness) that we are all very human indeed. And all of us need to be understood. And I don't just mean those living with mental illnesses. I mean everyone. And if we don't watch it intolerance in this world (town) will win and we will be our own victims. And we will let the victimizers win the game. And you can print that. Thanks for listening. Sincerely yours, Karma Conaway
Each May, mental health providers and agencies prepare themselves for Mental Health Awareness month by exploring opportunities to increase public awareness and understanding regarding mental health. A great example, "Hope for the Mentally Ill," was aired on KEYE-TV, reported by news anchor and New Milestones Foundation Board Member Michelle Valles.
But over the last couple of years, addressing people's mental health needs has become increasingly critical. Primary care physicians report dramatic rises in the difficulty of obtaining mental health services for their patients and more than two-thirds of the doctors were unable to obtain outpatient mental health services for their patients (twice the number that reported difficulty accessing other specialists).
Nationwide, community mental health centers are experiencing a 20 percent increase in demand for services, according to a recent survey by the National Council for Community Behavioral Healthcare. At the same time, demand is increasing, at least 32 states are known to be enacting mental health funding cuts -- reducing services, closing programs, imposing hiring freezes, and cutting or freezing reimbursement rates for providers.
However, I am hopeful. With 27 days left in the Legislative Session, funds have been included in the budget bills on transitional services for the mentally ill, continuation of new crisis funds and bills to address mental health treatment for returning veterans. Progression and continued improvements can build toward a true "system of care." The big unknown is the stimulus money impact and hopefully the "Rider 48" provisions can be used to expand service access.
Federal disability programs provide financial and medical assistance to workers who become disabled, however there are no federal programs designed to prevent workers with significant health problems from becoming disabled and dependent on federal assistance. In Texas, where one third of workers are uninsured, many workers with significant health conditions become disabled and rely on public programs for assistance.
Working Well, the Texas Demonstration to Maintain Independence and Employment (DMIE) is a ground-breaking study designed to help keep people well and working. Working Well tests whether providing health coverage and employment supports will keep working people with mental and physical disabilities off federal benefits, such as Medicaid, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). The study includes over 1,600 participants in the Harris County Hospital District, making it one of the largest federally-funded scientific studies of its kind in the nation. Working Well will help national and state policy-makers understand why workers become dependent on federal disability benefits and what interventions help them remain independent and employed.
Here's the report from Texas Public Policy Foundation, Center for Effective Justice.
The relationship between crime and mental illness has always been complex. Contemporary attitudes and knowledge concerning the treatment of mental illness indicate the urgent need for careful restudy and reshaping of this relationship. Reformers in the late 1960s and early 1970s pressed successfully for deemphasizing institutional care, which they contended often led to abuse of patients. Their idea was that patients could function in society with supervised reliance on medications for the control of erratic, sometimes anti-social, behavior. In the 1950s mental institutions housed three times as many patients as prisons held convicts. Both populations, at that, were small by current standards. Throughout the U.S. today, prison inmates total more than 2 million, compared with only 338,029 in 1970. General population growth is partly responsible; even more significant factors are increased crime and tougher sentencing laws. In Texas, the prison population is 13 times larger than in 1970—12,000 back then vs. more than 157,000 today. Particularly striking is the recent estimate that “deinstitutionalization”—the release of mental patients into the general population —now accounts for up to 14 percent of the growth in incarceration. Today, eight times as many mentally ill persons are admitted into prisons and jails as mental hospitals. Mentally ill offenders also contribute to the probation and parole caseloads. Texas has a significant percent of offenders with mental illness throughout its prison, probation, and parole systems. Mental illness also has a substantial impact on county jails. Of the 1 million offenders jailed every year, 17 percent are former MHMR clients. Some 20 percent of Harris County Jail inmates receive medications for mental illness. Here's the rest of the story from Texas Public Policy Foundation, Center for Effective Justice.
Dear NAMI-Tyler, I joined the NAMI organization in 1993. I was still a patient in Terrell State Hospital serving a 2 year commitment. I had been admitted to Terrell in 1990 following a suicide attempt and several months of severe unremitting illness including psychosis and suicidal/homicidal thoughts. I asked to be sent to Terrell. I realized I had no insurance and my mother was footing the expensive costs of a private local hospital. I had no idea what I was letting myself in for. The first time I was attacked was by a staffperson for throwing my cigarette lighter down the hallway of the women's side of the acute ward. Evidently this was part of their "treatment". I had already gone totally wild in the seclusion room without my meds. Before I got in Terrell I had gotten out in the middle of the highway trying to either get hit or get help. Fortunately, someone stopped and rendered aid. But, unfortunately, for me, Terrell back then practiced a treatment called PMAB. It consisted of restraints of out-of-control patients. So, several times without knowing why I would act out and would be restrained by the muscular young men and women staffpeople who would physically restrain me by pinning me down. Other patients felt sorry for me. I now realize I was being picked on for some reason. Why I don't know. Now I realize I repressed those memories from my mind but that they recently surfaced so that finally I could deal with them. Their repression is what cause a great deal of trouble in my life for the last 19 years. Just yesterday I read in the NAMI-California Connection newsletter that restraint and seclusion have zero therapeutic value and may cause "great harm and even death". And California is trying to do something about it. I think it is about time. And I can finally deal with the problems that those repressed memories had caused me all those years . The reason I joined NAMI in 1993? So future Terrell State Hospital patients would not have to go through the horrid treatment that I suffered at the hands of people that were supposedly there to help me. Sincerely yours, Karma Conaway
NAMI Medical Director Ken Duckworth, MD, discusses Schizophrenia.
The Soloist is an emotionally soaring drama about lost dreams and the redemptive power of music. In the film, which was based on a true story, Journalist Steve Lopez (Oscar® nominee Robert Downey Jr.) discovers Nathaniel Anthony Ayers (Oscar® winner Jamie Foxx), a former classical music prodigy, playing his violin on the streets of L.A. As Lopez endeavors to help the homeless man find his way back, a unique friendship is formed, one that transforms both their lives.
The film explores such issues as homelessness and mental illness, as well as the healing nature of music. The social action campaign for the film will focus on these issues with educational and legislative initiatives to help guide audience members who are interested in getting involved.
Arlington, VA— The National Alliance on Mental Illness (NAMI) has launched a new Web site, www.nami.org/soloist, as part of a social action campaign with Participant Media surrounding Friday’s release (April 24) of The Soloist, starring Jamie Foxx and Robert Downey, Jr.
Thursday, April 23, 2009
The Released: Frontline Investigates What Really Happens To Mentally Ill Offenders When They Leave Prison PBS April 28, 2009
Five years ago, FRONTLINE’s groundbreaking film, The New Asylums, went deep inside the Ohio prison system as it struggled to provide care to thousands of mentally ill inmates. This year, FRONTLINE filmmakers Karen O’Connor and Miri Navasky return to Ohio to tell the next chapter in this disturbing story: what happens to mentally ill offenders when they leave prison. The Released—airing on Tuesday, April 28, at 9 P.M. on PBS (check local listings), is an intimate look at the lives of the seriously mentally ill as they struggle to remain free. http://www.pbs.org/wgbh/pages/frontline/released/
The Texas Comission on Alcohol and Drug Abuse built an extensive research and reference collection in the area of substance abuse prevention and treatment. Upon our merger with Mental Health in September 2004, we began collecting materials in that field.
The Information Center collection includes not only books and journals, but an extensive video collection that circulates to individuals within Texas to aid them with their instructional training and educational programs.
By Marc Levin Mental illness is a key factor in driving up correctional costs in Texas.
There are 42,556 offenders with a mental health diagnosis in prison, 55,276 on probation, and 21,345 on parole. Additionally, some 170,000 mentally ill inmates are admitted into Texas county jails every year.
Mentally ill inmates cost more to house and they stay longer. They are also more likely to recidivate.
Fortunately, there are policies that can reduce both the recidivism and cost associated with the mentally ill in the criminal justice system.
First, counties can divert mentally ill offenders from jail through programs that protect public safety while saving taxpayer dollars.
Bexar County has established a successful three-pronged jail diversion program that can serve as a model for other Texas counties.
First, it employs specially trained law enforcement personnel called Crisis Intervention Teams (CIT). These teams are often able to defuse incidents involving the mentally ill without an arrest. Participants in CIT programs spent on average two more months out of jail than non-diverted individuals, resulting in significant jail cost savings. While the largest Texas metropolitan police departments have CIT personnel, smaller police departments can create a CIT program through cooperatives with other nearby departments.
With Bexar County’s second prong, arrested offenders are screened for mental illness and, if not a threat to public safety, released on a mental health bond or to a treatment center. Screenings are conducted at the Crisis Care Center, a 24-hour facility that provides significantly quicker service at a lower cost than the emergency room. Once stabilized, offenders are released on a mental health bond. Because the wait for a trial date can be as long as six months, outpatient monitoring significantly reduces the utilization of county jail space.
Finally, Bexar County diverts such misdemeanants from jail through an initiative called MANOS, which includes intensive case management that consists of outpatient medication management and counseling.
Of the 371 offenders admitted to the MANOS Program, only 6.2 percent were re-incarcerated. This compares to a re-incarceration rate of 67 percent for mentally ill offenders without the intensive case management services offered by the jail diversion program.
Savings from Bexar County’s jail diversion program are estimated at between $3.8 million and $5.0 million per year.
The state can also take steps to address the impact of mental illness on the criminal justice system. About 2,500 probationers and 800 parolees participate in a state-funded initiative involving intensive case management and a smaller caseload with a specially trained officer.
The three-year re-incarceration rate is 15.1 percent for participating probationers is and 16.0 percent for parolees. In contrast, there is a 52 percent re-incarceration rate for mentally ill probationers and parolees who do not receive treatment. Increasing the number of probationers and parolees in this program could more than pay for itself through lower recidivism.
Another way to address mental illness in the criminal justice system is through mental health courts. Several Texas counties -- including Bexar, El Paso, Tarrant, and Dallas -- have established mental health courts in which a judge orders the defendant to obtain treatment and supervises his progress. A RAND Institute study found significant cost savings from mental health courts due to lower jail utilization.
Finally, defendants who are mentally incompetent to stand trial can be diverted from a state hospital. In 2008, the state launched outpatient competency restoration pilot programs. Taking Travis, Tarrant, Bexar, and Dallas Counties together, some 427 offenders are projected to be served in 2009. The total cost of these four programs is $2.16 million compared with the state hospital cost of $14.95 million based on an average cost of $35,000 per offender. Accordingly, it makes sense to expand these pilot programs to additional sites.
Mentally ill offenders will always pose a substantial challenge in the criminal justice system. But through initiatives like these, we can achieve our goals of enhanced public safety and reduced costs to taxpayers.
Marc A. Levin is Director of the Center for Effective Justice at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin.
In 2007, the 80th Texas Legislature appropriated $82 million to the Department of State Health Services (DSHS) to address problems in the state’s mental health and substance abuse crisis service delivery system. Texas A&M University was selected to serve as an independent, external evaluation team to examine the impact of Crisis Service Redesign (CSR). This report contains the initial evaluation findings regarding the first year of CSR. Utilizing a combination of visits to selected Local Mental Health Authorities (LMHAs), interviews with law enforcement officers, judges, and emergency room staff, statewide online surveys of key stakeholder groups, and satisfaction surveys of users of CSR-funded services, the evaluation team has generated 6 findings regarding the impact of CSR.
FOUND ON STIR CRAZY IN TEXAS: NAMI Board Advocates for Decriminalizing Mental Illness In a move designed to draw attention to the critical problem of criminalization of people with mental illnesses, the NAMI National Board of Directors has released a report calling for more jail diversion, improved services for people at risk of criminal justice involvement, and better collaboration between criminal justice and mental health professionals. The report, entitled "Decriminalizing Mental Illness: Background and Recommendations," provides a concise analysis of the history and scope of criminalization, and includes public policy recommendations to address these critical problems. Go online to access the full report and an executive summary.
A technical report by Rand Corporation. Consumer providers (CPs) are individuals with serious mental illness who are trained to use their experiences to provide recovery-oriented services and support to others. There are several demonstrated benefits to employing CPs: They can serve as role models, voice and broker the needs of consumers, provide information and motivation, and mentor others (including potential CPs). CPs can have a variety of roles, including, among other things, assisting clients, providing support services (such as skills assistance and transportation), providing liaison services, dispelling possible stigma or bias toward clients, and augmenting overburdened mental health systems. Despite these roles and benefits, there are also challenges to and misconceptions about employing CPs, such as staff concerns, organizational issues, and perceived barriers related to the abilities and competence of CPs. As mental health providers turn to CPs to augment current services, it is useful to review these issues through the lens of hiring and integrating CPs into provider teams. This guide is intended to be an easy-to-use reference for agencies that are seeking to strengthen or expand consumer involvement, employers who are considering hiring CPs, consumers who are interested in applying for CP positions, and advocates for CP involvement in mental health care. The information and recommendations presented here are the result of interviews with relevant stakeholders at Lamp Community, a Los Angeles-based nonprofit serving the mental health needs of the homeless and formerly homeless; interviews with national experts; and a review of current literature on the subject.
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