Point Austin: A Blueprint for Mental Health

Not many Austinites are going to plow through the "Final Report" of Mayor Wynn's Mental Health Task Force, released last week. It's a dispiriting subject – even couched optimistically as part of the mayor's "Fittest City in America Initiative" – and the report features the bureaucratic language issued inevitably by an 80-person umbrella committee, filtered through two consulting firms. So we get plenty of sentences that inflate the obvious, like, "While the prevalence of specific mental disorders may vary based on demographics, all ages, racial and ethnic groups, genders, and socioeconomic groups are subject to their effects." (That is, mental illness affects all of us, indeed touches directly most of our families.)

There are additional banalities generated by the methodology, which required each of 39 "criteria" to complete the formula "A mentally healthy community is ..." Thus, "A mentally healthy community is willing to provide adequate resources and funding for all aspects of the mental health system." Hard to disagree with that – but alas, by that implacable standard, all of us are madmen at ease among the mad.

Most of the criteria have more substance, like the top priority designated by both the Justice Systems subcommittee and the Short- and Long-Term Treatment subcommittee: "A mentally healthy community has a least one Psychiatric Emergency Center in an existing hospital with a detox center attached and 24-hour psychiatric emergency beds in other local hospitals." Indeed, there's an undertone of desperation to that "Infrastructure" criteria, considering that Austin is nominally a modern city of more than half a million people, yet it lacks even one psychiatric emergency center. On the Justice subcommittee were representatives of the courts, the DA, Austin/Travis County Mental Health Mental Retardation, and Judge Guy Herman, who has made a personal crusade of these desperate community needs; the Treatment subcommittee also included members from the State Hospital, SafePlace, the Austin Police Department, homeless advocates, etc. They know whereof they speak.

---

A Community of Needs

The conventional statistics are intimidating: defined broadly, more than 3 million Texans suffer from mental illness of some kind, about 130,000 of them in Travis Co. Of that number, roughly 22,000 are in the "priority" population – adults with "schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders" and in need of immediate or long-term care, of whom "only about one-third [are] receiving services." Unless one of those people is in your family, the statistics only come home when there's a headline tragedy, and a police officer ends up doing the extreme crisis resolution that should have been prevented by an adequate mental health system.

The size of the task force might seem unwieldy, but the report makes clear that this is an attempt at a communitywide approach. The recommendations range from adequate hospital beds down to education at the primary school level; the time lines range from immediate to several years forward, when it is imagined that Austin's indigent mentally ill might have access to "sufficient, safe, affordable, accessible, and integrated housing units." (That would certainly beat sleeping under I-35.) The goals are grouped into five categories – infrastructure, marketing (i.e., getting the word out), policies and plans, programs, and training and education. Some are little more than exhortations ("A mentally healthy community treats all individuals with dignity and respect"), but the report makes the case that it will take a communitywide effort – politicians, business people, health and education professionals, neighborhoods, and families – to turn around a crisis situation that is seldom directly confronted unless there is a singular explosion.

---

Trickle-Down Disaster

This project focuses on solutions, so doesn't spend a lot of space examining road blocks. But it does politely address one major institutional factor that underlies the growing burden on local communities: the decreasing acceptance of responsibility by the state of Texas. "The implementation of HB 2292 by the Texas legislature," says the report decorously, "is considered by participants to be problematic." That is, the Lege's social services "reform" of 2003, still not fully implemented, limits state services only to psychologically extreme diagnostic categories, requires "disease management" and therefore even further limitations on service, and limits most treatment to drug management by psychiatrists. "Task Force participants fear that along with budget cuts to local mental health authorities, the effect of these legislative changes is to limit access to services and place the burden of care on local communities." Problematic, indeed.

Oddly enough, I didn't hear those particular fears mentioned in Gov. Perry's cheerfully self-congratulatory State of the State message last week. He was instead full of excoriations of high local property taxes, and explaining how he and his legislative colleagues were going to get local government off the backs and out of the wallets of Texas taxpayers. Noble goals, no doubt. And yet one has to wonder: As the feds cut back on funding health care and education while underwriting empire, and the state cuts back on health care and education while funding highways and corporate welfare, and the governor saves us from local property taxes ... with what straw do we hope to make the bricks of a "mentally healthy community"?