Texas has a serious mental health problem

Photo by Shelby Tauber

There are a lot of upsetting numbers laid out in the new report on mental health from the Texas Judicial Council, chaired by Texas Supreme Court Justice Nathan Hecht.

  • Texans who experience serious mental illness in a given year: 1 million
  • Texans with substance use disorders: 1.6 million
  • Emergency room and justice system costs to address mental illness and substance use problems that aren’t receiving adequate treatment elsewhere in Texas: $2 billion
  • Texas inmates with mental health needs: 20-24 percent
  • Youth involved in the juvenile justice system with some form of mental health need: Up to 70 percent
  • Harris County’s 2013 spending on mental-health-related services for people in its jails: $49 million

It goes on, but you get the point. Texas has a serious mental health problem. Far too often, and far too expensively, we’re dealing with it through our criminal justice system and other systems poorly designed to help and support people with mental health challenges. As that report put it:

“These Texans and the communities in which they live frequently find themselves navigating the challenges of mental illness in jails, hospital emergency departments, adult criminal and juvenile justice agencies, schools, and child protective services. These settings often are more expensive and less effective for treating mental illness.”

The conceptual answer to this problem is simple, but the work is hard. We need to focus on good treatment and screening on the front end, before people end up in crisis. And when they are in crisis and do end up in the criminal justice system, we need to identify the people in need as soon as possible and then safely divert them into settings and treatments that can help most effectively and humanely.

Texas has been doing good, hard work on this front over the past decade. The challenge is to build and expand on this progress. The recommendations in the report are a good start for work on the intersection of mental health and the criminal justice system.

First, we can pay close attention to the results of the jail diversion pilot in Harris County, which was funded by the previous two legislatures. Funding expires in 2017, but the program can be reauthorized and expanded if the results of the initial pilot are shown to be positive.

Well-done jail diversion can reduce costs, reduce recidivism, and improve the mental health outcomes of the people involved. Texas should be alert to opportunities to double down on effective programs.

Second, we can continue to improve the state’s overburdened competency restoration system. Right now, too many Texans charged with non-violent offenses end up in state hospitals settings or in jails with inadequate mental health services. These individuals would be better served in outpatient or community in-patient settings.

In fact, there are people who spend more time in jail or state hospitals awaiting competency restoration than they have spent serving maximum sentences for their crimes.

The Legislature has already funded almost a dozen outpatient competency restoration (OCR) programs. Expanding OCR would allow judges to divert low-risk individuals in need of competency restoration to appropriate alternatives, using state hospitals as a last resort. The state could also provide resources and guidance to local communities to expand alternatives to jail or the state hospitals for people who are not violent and do not have complex clinical needs.

Finally, the Legislature can improve and refine what happens when people enter the system. Processes for identifying people with mental health needs can be improved. We can do a better job making sure magistrates know the mental health facts of people they’re assessing for potential bail or release. And we can give magistrates more flexibility to divert or release non-violent defendants with mental health needs.

Continuing improvement is going to be hard work, but it’s entirely possible and well worth it. The math is in our favor. We have too many people in the criminal justice system whose real “crime” is mental illness. We are spending too much money — often on unnecessarily and harmfully restrictive settings — that could be more effectively and humanely spent in the community, pre-empting crisis. The Legislature has been doing good work over the past decade that can be expanded and reinforced.

The more we can deploy the right options for our sons and daughters, husbands and wives, friends and the neighbors, the better off we’ll all be.

David Lakey

Associate vice chancellor for population health, UT System

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

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