Tag: Harris County

The Largest Psych Hospital in America, Psst. It’s A Jail…

A couple of years ago I wrote a post in another blog about the incongruity that the Harris Co. Jail in Houston TX was the country’s largest inpatient public psychiatric hospital in disguise. This week an article in the local Houston press reminded me of Houston’s Harris Co. Jail ‘claim to fame:’Houston’s biggest jail wants to shed its reputation as a mental health treatment center
Ever the trickster brother even in my elder years, at that time, I actually brought this to the attention of my non-mental-health-issues-aware sister who lives there. I would tease her and ask her to arrange a tour for me there when I had an upcoming visit. I laid the teasing on thick, adding a hint, dear to her heart, that I might consider moving there since Harris County Jail was advertising for psychiatrists to work there, and a large number, FIFTEEN back then.

 

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.

 

A Good Idea from a Texas Mental Health Leader

Texas, like many states, has been struggling for the better part of the last two decades with its public mental health system’s needs. Like almost all other states in the United States, it has seen its share of declining state funding for state-wide mental health services. Ageing state hospitals for the acutely mentally ill, chronically mentally ill and developmentally disabled have been closed or downsized. Short-falls have gradually appeared in the provision of outpatient services recommended and hoped for, to supplement or replace those reduced state hospital beds.

Texas for a number of years has begun to experience the enormous increase in jail populations of the mentally ill, mirroring many other states, especially New York with its travails at Rikers Island, perhaps the country’s most famous metropolitan jail facility, serving New York City. Rikers Island has lamentably been in the tragedy borne headlines in the last few years with repeated suicides of mentally ill inmates, and lawsuits by families and repeated efforts at reform and improvement, recently occurring again by necessity under the mayoralty of Bill DeBlasio.

Harris County Jail, of Houston Texas, has become known as one of the largest “psychiatric” facilities in the country. Several years ago I recall that the Harris County Jail had to increase its psychiatrist staff roster from three psychiatrists to fifteen and add a number of psychiatric physician extenders and other staff to serve the needs of this swelling psychiatric segment of the inmate population. What happened in Harris County, encompassing metropolitan Houston, was not unique to the country’s correctional systems at all, but became known readily nationwide as one of the first such settings recognized for this tell-tale barometer of the deficiencies in any area’s public mental health service system. Harris County, on a personal note, is known quite well to me, as that extended area was where my father came from and is where I have my only sibling living all our adult lives.

A very recent article online written by Stephen M. Glazier, one of the nation’s leading mental health care executives and head of UTHealth Harris County Psychiatric Center of Houston, outlined one of the best-written definitions of the concept of psychiatric “continuum of care,” that I have ever read. His article appearing at TribTalk.org, “Bridging the Mental Health Treatment Gap,” on May 9, 2016,  provided insight into Texas’ progressive efforts in just the last 1-2 years on improving the state’s mental health reform and care delivery efforts which have not received the recognition they deserve.

Mr. Glazier pointed out the common issue seen in many states who have had to face the need to close or replace aging state hospitals, and the multifaceted dilemmas of what to replace them with. He eloquently wrote of the concept of providing what he termed the middle range of less intensive residential and non-hospital based psychiatric services in the overall continuum from hospital to home or ultimate living placement for the mentally ill person. He delineated some key concepts and facts: 1) that Texas’ state psychiatric bed ratio has declined since 2001 from 13.4 beds per 100,000 persons to 10.9; and that, 2) even if Texas had ‘kept up’ with the growing mental health needs, the rapid growth population growth in the state of Texas, which has always been in the top five states in the US, the state’s level of services would still have fallen behind previous levels of beds per 100,000 population.

His idea is not a new one, that increased and nuanced provision of these middle ground “residential,” transitional psychiatric services, would to at least some degree, not only replace some state hospital beds, but reduce the spill-over, or “trans-institutionalizations,” (the new buzzword) that we are seeing as ever more rapidly increasing numbers of the seriously mentally ill, shift from non-existent state psychiatric hospital beds to jails, hospital ERs, and the streets and shelters, all never intended to serve this population. But Mr. Glazier’s description of what is needed in filling in the gaps in the continuum of care of the mentally ill is well worth reading.