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July 21st, 2008:

The jails and the mentally ill

Tough story to read in the Chron today about mentally ill folks and the role the county jails have played as de facto health care provider for them.

At the Harris County Jail, deputies and health care workers have a name for them — frequent fliers.

They are mentally ill homeless people who return to jail so often, sometimes on minor charges, that they become familiar to the psychiatric staff.

During a recent survey, county officials found that more than 400 of the jail’s 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.

When the mentally ill homeless leave jail — and leave behind its mental health care staff — many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.

Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.

At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.

“The jails have become the psychiatric hospitals of the United States,” said Clarissa Stephens, an assistant director of the county’s budget and management services office who has been studying the jail’s mental health costs.

The Commissioners Court is so concerned about the rising costs that it has retained a consultant — psychiatrist Avrim Fishkind — to study whether providing outpatient services and supervised housing would reduce the numbers of mentally ill revolving through the jail.

“The costs of reincarcerating and court costs far outweigh what the costs would be if you housed, clothed and supervised the mentally ill,” Fishkind said.

[…]

Some of the mentally ill — many of whom also are substance abusers — keep committing crimes and getting rearrested, in part, because few are properly supervised when they are released, said David Buck, a Baylor College of Medicine associate professor and president of Healthcare for the Homeless-Houston.

Houston isn’t alone in facing this issue. After many mental hospitals were closed in the 1970s and 1980s, countless patients were released in cities that were ill-equipped to house those who needed such care.

“What happens here happens in many communities. We are criminalizing mental illness,” said Betsy Schwartz, president of Mental Health of America of Greater Houston, a nonprofit that promotes effective treatment for the mentally ill.

I hate to sound like a broken record, but I’m going to do it anyway. We spend all this money to lock people up, when it would be more humane, more cost-effective, and more in keeping with the principles of justice if we’d look for alternatives for many of them. I have some questions about how outpatient sevices and supervised housing would work, and how successful the county would be at overcoming the inevitable (and, let’s face it, understandable) NIMBYism that would be the response to them, but the idea is solid.

Chief Deputy Mike Smith of the Sheriff’s Office said the jail’s mental health operation is comparable to the biggest non-jail mental health hospitals in the state.

Smith, as head of the jail, is among those credited with upgrading its mental health services.

“I’ve had people say I better watch what I say or I’ll come across as a liberal,” he said. “We shouldn’t be treating our mentally ill in the jails. We should be treating them in the free world.”

See, this is the sort of thing that shouldn’t be a “liberal” idea or a “conservative” idea but simply a sensible and humane idea. What we’re doing right now doesn’t work on many levels. There’s no compelling reason not to try something else. Let’s make it happen.

Incentivizing recycling

Though there’s been some recent good news on the recycling front, the city of Houston still has a long way to go to bring its program up to an acceptable level, which has been having problems for years now.

“Everything that comes out of your home or office is really a material stream that can be recycled or composted or even re-used,” says Darryl Lambert, who manages the AbitibiBowater sorting center where Houston sends its recyclables. “There’s very little true, true waste.”

That may be, but that does not mean Houston recycles as much as it could. Some residents blame the city’s modestly scaled curbside program, which offers residents no financial incentive to recycle and serves only 47 percent of the 342,000 homes that get public trash service. But the city says that more recycling companies need to come to Houston, build processing centers, and ramp up the market for used goods.

“Houston is a virtual gold mine of recyclable materials; it’s just a matter of companies mining that material,” said Harry Hayes, solid waste director.

“You need to build it, and I think the material will flow,” Hayes added.

Recycling surveys are notoriously fuzzy, relying on self-reports based on inconsistent measures. But one estimate puts Houston’s rate at a dismal 2 percent of all municipal solid waste — the nonindustrial and nonconstruction waste generated by homes, schools and businesses. The city claims it is slightly higher, if you count efforts in more than 50 city buildings, but officials acknowledge that recycling is the city’s “growth opportunity.”

“I think our current levels of recycling are unacceptable, and we need to do more,” Mayor Bill White said recently.

The city is on track to push its recycling rate toward 20 percent, White said.

[…]

Major sectors of the city — the Medical Center, downtown skyscrapers and apartment buildings — manage their own waste and aren’t mandated by the city. Other cities, like New York and Portland, Ore., require businesses and private haulers to do some recycling, but Houston leaves it up to them.

“Nobody is prevented from doing any of this,” White says.

Critics say that approach, based on volunteerism and education, is not enough.

“You are not going to educate the majority of people into recycling,” says Leo Gold, a financial adviser who also hosts a talk show on KPFT-FM (90.1). “The others have to be induced.”

“It took $4-a-gallon gasoline for people to get fuel-efficient automobiles, and it’s going to take creative pricing to get people to do recycling,” Gold added.

Gold recently presented a petition with specific suggestions for Houston to adopt regarding waste management and recycling. While I strongly agree with his list of proposals, I disagree on the matter of educating people about recycling. I think a lot of people don’t give the matter much thought, and have no idea about the costs of landfills or the real need to recycle more. I’ve advocated for this before and I’ll say it again: I think a big PR campaign, modeled along the lines of the classic “Don’t Mess With Texas” anti-littering program, would go a long way towards changing attitudes and raising participation rates. That should be done in concert with a campaign to get business centers to promote recycling on their properties. This is low-hanging fruit, and will help to get people into the habit and mindset that things like aluminum cans and plastic bottles do not belong in the trash can. I truly believe this is a necessary first step, and that it can be achieved relatively easily.

Now there’s no reason you can’t also do things like “pay to throw”, where trash fees are based in part on the size of your receptacle. Multiple approaches should be taken, and modified as needed if something isn’t working. This is a big opportunity for Houston to save money and be a little greener. I hope someone with a little ambition steps up and takes the lead on this.

Bell’s launch

And it’s official: Chris Bell has his formal campaign kickoff yesterday.

In a rally held in a sweltering tent outside his new campaign headquarters just blocks from his southwest Houston home, Bell said he sees the seat as “a golden opportunity to make progress toward the same goals I’ve worked for my entire career.”

Bolstering public education and fighting vouchers, health care reform and ethics enforcement were the main issues cited by the former U.S. congressman and city councilman.

After losing the Texas governor’s race, Bell –an attorney by professional — joined the Washington, D.C., based firm of Patton Boggs as a lobbyist, and penned a weekly political column for the Examiner Newspaper Group. (That column has been put in hiatus.)

“Running for office this year was not in my plans,” he told about 200 well-wishers. “But real leadership demands that you welcome opportunities to serve the public good even when it’s not convenient or according to some schedule you set for yourself.”

That’s a pretty good turnout for an event like this. This race is now one of the high-profile ones for Harris County – really, for the whole state – and assuming Bell can get the fundraising support he needs, it’s a great opportunity for a Democratic pickup.

The bypass blues

The bypass giveth, and the bypass taketh away.

If motorists on a new branch of Texas 249 glance out their windows as they zip past Tomball, they’ll see a blur of restaurants and shops that soon will be framed in their rear-view mirrors.

The bypass road, which local leaders prefer to call the “Tomball Expressway,” is helping commuters reach homes to the north and workplaces to the south more quickly. But some merchants along the road now known as “Business 249” say sales have dwindled as motorists pass them by.

“It’s definitely affected us. Our revenues are down 15 percent,” said Valery Norton, the assistant manager of a Starbucks on Business 249.

The effect of the new road on this northwest Harris County town of 10,000 illustrates the dilemma facing many Houston area communities adapting to the growth surrounding them.

As developers create new subdivisions and business centers on pastures and fields, towns such as Tomball increasingly become just a set of traffic lights motorists would prefer to avoid on their way to something else.

“These rural areas aren’t rural any more,” said Pat Waskowiak, a program manager in the Houston-Galveston Area Council.

“There’s an inherent conflict between trying to accommodate the commuter traffic and the smaller communities that are trying to retain their business and their character.”

Tomball City Manager Jan Belcher, however, said the town’s decision to support construction of the bypass was intended to benefit local residents as well as commuters. The Texas Department of Transportation opened the southbound lanes in January and northbound lanes in May.

The town and its chamber of commerce lobbied for the road, Belcher said, because Texas 249 was becoming choked with traffic. This created problems for local residents trying to get to businesses on the highway as well as for motorists headed somewhere else, Belcher said.

“It’s working exactly as it was intended,” Belcher said. “It allows the (commuter) traffic to get through, and it allows people on Business 249 to get in and out of the businesses.”

I don’t drive out that way, so I haven’t seen the changes this has brought. But I’ve been driving to Austin along 290 for 20 years, and the same kind of thing happened years ago to a lot of the small towns between here and there, like Prairie View and Hempstead. There’s a McDonald’s in Hempstead, just south of the Lawrence Marshall dealership and the junction with State Highway 6, that used to be a regular stop for me. I’ve no idea if it’s still there – the modern 290 so thoroughly bypasses Hempstead you hardly realize you’re passing through a town at all. It makes for a faster and more fuel-efficient drive to Austin, so I’m not complaining. But I do wonder what effect it’s had on the place.

You still get to see some of the towns along 290 as you drive through. Brenham is bypassed in the sense that there’s a “Business 290” that takes you on the slow drive through the old town center, but the stretch just north of the junction with State Highway 36 and the two miles or so south where the two roads are concurrent has places to stop and eat or sleep and even a few businesses that aren’t travel-dependent. Farther west in Giddings, 290 is pretty much as it was when I first started making that drive, with the road serving as the main local drag. It’s the only remaining locale where you have to slow down as much as 35 MPH, and there’s both traffic lights and an active railroad crossing to keep you slowed down, but I don’t mind. I like being reminded about places like that. It also has a lot of good choices to stop and deal with hungry or bathroom-needing kids, which I appreciate even more.

Check your citizenship

MSNBC recently asked the question “Could you pass the latest citizenship test?” Naturally, I had to find out. Here’s the answer:

I thought it was pretty easy, and I think most people reading this will find it easy as well, but I’d bet there’s an awful lot of folks who would have a hard time getting the 80% passing score. How’d you do? Link via Mike Falick, who did as well as I did, and Texas Weekly.