Health

By LAUREN GROVER
Staff Writer

A recent state mandate has carved out a new treatment path for indigent mental health patients, one local officials are calling unhelpful and carelessly brought about.

All state-funded mental health centers are now required to outsource their in-patient, outpatient and residential treatment to as many willing private providers as possible.

The process began in April and won’t be completed for at least two years.

In Tyler, the Andrews Center held a public forum Tuesday to hear comments about its transition into a mental health authority, where it was once a primary provider.

“We will still be the local authority, doing screenings, but at that point patients will be given a list of providers and able to choose,” said presenter Jim Hartung, a director at the Andrews Center.

Though upbeat, Hartung said the future is a bit grim. In its 40th year, his facility has developed a network of mental health care it’s being asked to walk away from.

Like others around the state, Andrews Center officials have become professional dollar-stretchers. Last month, the center used its state funds to see 900 patients more than it was paid to treat. Last year, it gave out $2 million in free medications to patients.

“Through this new structure, it’s the people outside our target that are potentially left out,” Hartung said. “There are cracks that people fall through.”

The mandate was pushed through the state Legislature to give indigent mental health patients more choices for care.

Center officials said this might be a good move if mental health services weren’t parched all over the Texas — the state is listed 48th in mental health funding per capita.

“We’re almost dead last,” said Susan Rushing, CEO of Burke Center in Nacogdoches.

What’s confusing is the mandate requires more work, but no extra funding, Rushing said.

Services outsourced must be coordinated and monitored by the local mental health authority, many, like the Andrews Center, that have no money to spare.

“I’m concerned about how to manage that,” Rushing said. “To have oversight, that monitoring capacity, we’ll have to create that. We just hate to spend any more on overhead.”

Hartung said the legislation occurred not to better access to care, but to bring more business to private mental health facilities.

A local psychologist, Dr. Paul Andrews, agreed, saying the decision seems obtuse.

“The change is driven by private interests rather than making the most sense,” he said.

The Andrews Center and others could be accused of hoarding indigent patients, but Dr. Andrews said those bundled services — including counseling, medications, case management, and alcohol and anger treatment — are a blessing.

“People can go there for all these things,” he said. “If these are parceled out, who’s going to do them? Who’s going to coordinate it? And who’s going to transport that person to all those different appointments?”

Transportation has popped up as a general concern about the outsourcing of care on surveys distributed by the Andrews Center, Hartung said.

“Right now it’s one-stop shopping, and for many consumers they can get everything at one place,” Hartung said. “They could have several places to get to this way, and many of these folks don’t have cars.”

The state’s attitude toward mental health money is part of a culture of “taking care of our own” in Texas, Rushing said.

Though the state receives nearly the lowest funding per capita for mental health service, facilities have learned to make the most of it, she said.

“In our report card our state gets, how we manage money, Texas gets a good solid B,” she said.

The Burke Center is one of a handful of facilities to receive some of the $25 million the state allotted to mental health crisis programs in April, Rushing said. She’s excited for the new venue of care for desperate patients.

A 2007 state health assessment identified mental health treatment as the most difficult service for individuals to receive in East Texas.

Less than 200 child psychiatrists practice in Texas, a shockingly low number that creates access crises.

But deficiencies in accessing mental health services float to the surface in other, more devastating ways, too.

In June 2007, Lynn Smith, 43, of Whitehouse, was released from mental health treatment and was shot and killed days later when she threatened a policeman.

Health officials also link Smith County’s skyrocketed suicide rate with unmet mental health needs — in recent years, 18.2 per 100,000 people committed suicide here, 65 percent higher than the state’s average.