“I’ve said it before: when the State of Texas does not provide sufficient solutions for addressing mental health, that fiscal burden is passed to County tax payers.”
Good afternoon. Thank you, Mr. Chairman and Committee members for your invitation to join you and colleagues to discuss mental health and operation of the county and jails throughout the State.
The operation, security and care provided by Texas’ County Jails has been in the forefront of the public’s scrutiny in recent months and years. This committee, along with your counterparts in the Senate, has an opportunity to identify shortcomings in the State’s treatment of the mentally ill, and the impact State programs have on Texas’ 254 Counties.
The challenges in evaluating the operations and standards of county jails often reside in the economy of scale. Minimum standards adopted for rural county facilities may not sufficiently translate to the county jails in the largest communities of Texas.
The Harris County Jail is a mammoth operation. Upon taking office in 2015, I came to respect the extraordinary responsibility of overseeing that operation, and undertook the steps my command team deemed necessary to address the care, custody and control issues arising from that operation.
On day one, I took steps to reverse past policies that allowed for lapses in the quality of care provided to the most vulnerable populations in the Harris County Jail. We’ve identified opportunities to introduce reformations unparalleled in other jail systems throughout the State, and worked closely with the Texas Commission on Jail Standards to ensure compliance and exceed the minimum expectations of a standard county jail operation, let alone one the size of Harris County. Our work continues, and the challenges are many. However I am here today to share my unwavering commitment to maintaining and improving the largest jail in the State of Texas.
I raised the minimum age of employment from 18 years to 21 years old to recruit a more mature and responsible workforce. We’ve also cancelled a controversial training model that allowed entry level detention officers to undergo the minimum online virtual training required to license jailers, and replaced that system with a 6 week intensive training academy operating out of the same facility we train certified peace officers, followed by six weeks of probationary mentorship with senior detention staff.
These actions were taken under my direction to ensure that the Harris County Jail continues to set the standards for 21st century county correctional institutions.
The revelation that County jails serve as clearinghouses for the State’s underprivileged mentally ill is neither novel nor disputed. I agree with the universal assessment that the county jail is never the best environment for persons needing medical and mental health attention. However, barring an alternative State or County facility with available forensic bed space, county jails throughout the state become the de-facto mental health service providers; like it or not. Likewise, our county taxpayers have become the default providers for this care to the tune of 22 million dollars for this fiscal year for mental health alone.
As such, we’ve undertaken an innovative approach to the housing of certain members of the Mental Health Unit’s population. I created a unique hospital environment on one floor in one building of our facility that allows us to concentrate the majority of our medical and mental health services in one place for patients with greater medical needs or ones who are in diagnosed as being “in crisis” for mental health.
The Social Learning Program, which we introduced in July of 2015, has opened up housing units formerly used for administrative separation. Inmates enrolled in the program spend up to 16 hours per day with an open door concept to engage in social interaction and improved psychiatric monitoring to instill socially acceptable and adaptive behaviors.
By nearly doubling the bed space available to the Mental Health Unit, we have equipped and embraced our partnership with the County Mental Health Authority in unprecedented ways. We have full time psychiatrists on staff and present to handle patients diagnosed with immediate or ongoing “crisis” situations.
In 2015, there was an average of 83,887 in house health services provided per month to inmates in the Harris County Jail. Services ranging from infirmary visits, dental hygiene and emergency dental procedures, prenatal care and obstetrics, HIV and AIDs clinics, and everything in between. In mental health services there were an average of 24,664 psychiatrist contacts with patients per month, and an additional 68,800 monthly contacts with LPHAs and RNs.
With comprehensive services at our disposal, I convened a working group led by the Harris Center for Mental Health and IDD comprised of teammates from the County Attorney’s Office, the Sheriff’s Office and our Mental Health Authority to apply the recommendations from the professional mental health community like never before.
Because, we cannot view the medical and mental health operation of the Harris County Jail through a myopic set of minimum standards intended for less robust correctional environments. This is why the application of the Jail Commission’s mandated screening form is projected to actually impede upon the high standards of evaluation and care already in place in our booking process. Forms developed to help untrained detention personnel identify possible risks factors cannot replace the evaluations of the licensed medical and mental health professionals that screen every inmate in Harris County upon intake. In a recent assessment of the State’s new mental health screening tool, we found that a 21% increase of prisoners would be erroneously forced to the front of the line for a detailed mental health evaluation that could otherwise be assessed by a medical professional in our intake process.
Our booking process now extends to almost eight hours to encompass the demands of multiple required screenings for issues such as suicide prevention, mental health issues, undiagnosed medical issues, as well as chest X-rays for every inmate placed into our detention facilities. All of these screenings and evaluations are done by licensed health professionals, not jailers and detention officers. Additionally we have trained 40% our detention personnel assigned to the hospital floor with a 112 hour mental health class to permit them to recognize and negotiate options for mental health issues as a force multiplier to the medical and mental health personnel on staff. This is well in excess of the routine Crisis Intervention Training required of most peace officers.
In a given year, the Harris County Jail is home to a population of 120,000 souls. Year to date there have been 143 serious assaults of inmates, or 0.1% of the population. Our suicide rate is 13.2 per 100,000 persons as compared to the national average of 46 per 100,000.
While it is accurate to say that there are better places for treatment, it is an affront to say that we cannot keep such inmates safe. Currently, I have 68 pre-trial inmates awaiting transfer to a State Mental Health facility to receive competency restoration services. The average wait time for inmates on that list: 72 days. Inmates at the top of that list have been waiting for up to 170+ days for a state forensic bed to become available. All of them would be better served should the State direct its attention to improving the process and availability of competency restoration facilities.
The Harris County Budget Management Office recently shared the following reported stats with me: in 1955, there were over 300 state mental health beds available per 100,000 persons in Texas. Today, that number is reported to be just 22 per 100,000. If this is true, it is a sad commentary on our focus on resolving such mental health issues.
Clearly, the State’s requirements for programs at TDCJ to resolve mental health issues stemming from drug use or abuse are insufficient to break the cycle of recidivism. It would seem obvious that a need exits for a stronger approach for programs to successfully address mental health problems stemming from such drug use. We know that 70% or better of those going to State Jails for felony drug use are likely to return to us, a cycle that needs to be broken.
The time has come for permanent reformations at the State level to account for the shortcomings in support of county agencies ultimately held responsible for providing this care.
I’ve said it before: when the State of Texas does not provide sufficient solutions for addressing mental health, that fiscal burden is passed to County tax payers. Jails and County Mental Health Authorities are woefully underfunded, yet forced to act as the de facto providers for the majority of mental health care services in their communities.
Harris County residents pay taxes to the State and Federal governments under an assumption that those funds will be used to support State services, such as State mental health facilities. Unfortunately, the burden is redirected locally, and residents are forced to double down on contributions for mental health care.
Curiously, in a country where everyone is supposed to be covered by some kind of insurance and we are supposed to have a presumption of innocence, County taxpayers continue to be the default providers for mental and medical care even prior to conviction. It may well be time to review an exception for Medicaid expansion for some of these types of expenses.
The mentally ill enter the criminal justice system, are treated at the county level to the best of our ability, and returned to the community to await their next trigger event causing the cycle to continue without intervention or reimbursement from the state. It is in the State’s best interest to assist in resolving these mental health issues to keep serious incidents from occurring in our communities.
I urge this committee to use this interim period to prepare to address this statewide shortcoming in the next Legislative Session. I am committed to working with our counterparts to explore opportunities for cooperation with local entities, and trust in your willingness to bear the burden the State has previously footed at the local taxpayers’ door.