A recent newspaper article from the Associated Press of August 13, 2018, just a week prior to the posting of this article by Marina Villeneuve, highlighted an interesting development in the state of Maine. This psychiatric commentator felt this was worthy of attention on a larger stage as it illustrates several issues regarding the continuing struggles in this country to try to come to terms with our three decades old national mental health service delivery crisis.
The article entitled, “Company fights to keep details of Bangor psychiatric home a secret,” concern the efforts of the Republican governor of Maine Mr. LePage and a Florida-based company, Correct Care Solutions, to keep secret the disclosure of its contracts, legal arrangements, staffing patterns and cost proposals surrounding the construction and operation of a 21 bed “residential psychiatric home” apparently for less acute psychiatric adult patients. This psychiatric residential home is to be operated by this private corporation for at least 10 years. It is to be located on the state campus of the Dorothea Dix Psychiatric Center in Bangor Maine for “some psychiatric patients who no longer need hospital care.” It appears as though there had been openly shared cordial agreement among the “Governor, lawmakers and (mental health) advocates” that the “secure residence could shorten waiting lists and ensure millions in jeopardized federal funding for a state psychiatric center that had lost federal certification” (in the recent past).
However apparently in the recent past, the previously shared intentions aims and objectives among the parties in Maine had run afoul of Correct Care’s wish to keep many of its issues, past history and proposals surrounding the construction of this facility secret. In spite of the fact that the company was notified by state agencies that all its proposals would be public documents, the company submitted many of its proposals amid expected secrecy or ‘confidence’ as the company termed it. But it did claim publicly is that its facility would cost taxpayers less in day-to-day per patient cost than the state’s two inpatient psychiatric centers. This is not a startling proposal as inpatient care is always much more expensive than non-hospital-based nonacute level care.
Everyone seems to have heard about Rikers Island prison in New York City and its horrors, overcrowding, deaths etc. I suppose it does not help Rikers’ public image much since it has been mentioned in every episode of Law and Order for over 20 years on television. And I further suppose Harris County Jail has been happy to fly well under Rikers’ blip on the national consciousness radar.
Another acquaintance of mine in the Houston who is in government tells me the officials in the area governments are very sensitive to stories like this about their county jail and do not want it lumped together with other infamous jails such as Cook County (Chicago), Los Angeles, Phoenix, etc. And who can blame them? A quote from the article brought to me by my trusty Google Search New Bots hinted at this sensitivity: ” The Harris County sheriff’s office doesn’t want its jail to be the largest mental health facility in Texas anymore.”I must preface my coming complimentary remarks about Texas’ efforts in the state’s jail systems by stating that in my estimation, Texas is one of the several states in the country that is making huge and creditworthy reform efforts on many fronts in their entire state’s mental health care delivery system. The legislature formed a task force on mental health in 2014-5, and it actually DID something. It issued a very comprehensive report in a year’s time. It is a piece of landmark analysis and goals. And, to top it off, the state legislature in Texas started drafting and passing concrete reform legislation. They started talking about spending up to $500M initially in a few years to get the massive, multifaceted statewide effort underway. It was all the more amazing since the Texas state legislature was the same body that had a number of its legislators hide in motels across state lines in another state to avoid a politically contentious vote several years ago. It was the laughing stock of the country for a week or so as all kinds of media and Internet games and memes started about where the missing lawmakers were. Pseudo rewards were offered. Petitions were started by wags and satirists to rename the missing officials “Waldo.” Kinky Friedman the inimitable Texas satirist and sometime candidate for the Governorship had a field day. Molly Ivins, the late great political satirist of Texas, was said to have been sighted in the Legislature and her newspaper’s offices. It was great theater.
The Harris Co. Jail has a triaging setup that is situated RIGHT AT the front intake booking desk. A trained officer with a communicating wireless tablet can consult with a nearby consulting psychiatrist to start the referral process form evaluation and treatment within the jail complex. Harris Co. Jail has decided that it will not pursue a mental health “diversion” program like many other judicial systems have started. In point of fact, Texas has started dozens of pilot diversion programs in counties elsewhere in the state. This model is felt to fit better in smaller counties with much smaller local jail populations.
So rather than having the ‘diversion-referral process start in the courtroom, this process is situated at the receiving desk of the jail. The model is structured so that the staff, from the trained deputies to the consulting mental health providers (from counselors to psychiatric social workers and psychologists to the close-by psychiatrist) on down, have a more vertically integrated and functional system that makes sense. It can be activated for any arriving inmate right at the first contact within the jail. It is certainly a novel approach and should be studied and likely tried elsewhere.
The jail has its own inpatient unit, the Harris County Psychiatric Center, which has nearly 300 beds. This is filled all the time and has a waiting list from the rest of the jail’s population. The jail as a whole, has long known that 1 in 4 or its total population have mental illness and need medication based psychiatric treatment and management. Nationally, over 400,00 inmates have psychiatric illnesses needing ongoing treatment, a staggering number.
Texas’s and Harris County’s efforts are to be applauded, followed closely and studied. Hopefully, it is a sign of things to come.