EDITOR'S NOTE: This is the second of a two-part series about addressing mental health issues in East Texas.
More than a couple of years ago, a diverse group of East Texans came together to find solutions for improving mental health care delivery here. The Smith County Behavioral Health Leadership Team was born, and among its priorities is the establishment of a mental health crisis center.
Following the release of a report, compiled with the help of The Meadows Mental Health Policy Institute, they are getting closer to making that proposed center possible, as well as other initiatives. The leadership team plans to use the report's recommendations to create a formal strategic plan with measurable goals and track the progress.
"We're in the first steps of trying to really dig down in the issues," said Doug McSwane, co-chair of Behavioral Leadership Team. "I would hope that within two years we can have a functional crisis center with plans to establish a crisis destabilization unit."
A mental health crisis center would be a stand-alone facility offering immediate care for someone experiencing a mental health crisis. With a crisis destabilization unit, patients would have a longer stay and additional treatment.
Community members, including County Judge Nathaniel Moran, agree that there is a great demand for a crisis center in Tyler.
"Mental health crises affect so many individuals, businesses, medical facilities, the government itself and especially law enforcement agencies," Moran said. "So there has to be a dedicated plan that's presented to the community and government entities and other stakeholders to say 'this is what we can do today and how can we pay for it.'"
According to the report, released in November, 23 percent of Smith County residents have behavioral health needs, whether mild, moderate or severe. It shows that 8,000 people in Smith County have a severe mental illness. The majority of them—62 percent—are living in poverty.
The report also shows that 15,000 children ages 6 to 17, or 35 percent, have behavioral health needs. Of those, 3,000 have severe behavioral health needs.
There were no surprises in the report, McSwane said, as the area has long had too many health problems, including mental health and substance abuse, and not enough resources to tackle them.
"I've known for a while," he said. "I've known how extensive the needs are."
This effort started with Peace of Mind in 2014, a conference that brought together people concerned about the state of mental health care in East Texas. The event attracts about 800 attendants each year.
In June 2015, Behavioral Leadership Team members used the momentum of the conference to move to action. Members represent interested stakeholders, including The Andrews Center, local hospitals, law enforcement, and county and city officials.
The Samaritan Counseling Center of Tyler and Meadows Mental Health Policy Institute have been key in helping the leadership team spotlight the need to improve mental health services in East Texas.
Other cities have had success creating more resources for people with mental illness through crisis centers. The most notable is in San Antonio. In East Texas, cities such as Nacogdoches and Lufkin have opened crisis centers as well.
"This is an issue that is not uncommon to every county in the state," Moran said. "This is overdue, but we are certainly ahead of the curve where most communities are."
AVOIDING THE CRIMINAL JUSTICE SYSTEM
If a person has threatened to harm him or herself or others, a call usually goes out to police to handle the situation. The only option —if no crime has been committed—is to take them to a hospital for observation using a peace officer warrant (POW). Seeking treatment through an emergency department isn't always feasible. It's time consuming and the patient may not get appropriate treatment.
In 2017, Tyler police recorded at least 598 peace officer warrants. That was up from 486 peace officer warrants in 2016. These figures don't include welfare concerns and other mental health related issues. In Smith County in 2017, sheriff's deputies reported more than 1,950 mental health-related calls, which include peace officer warrants, mental health transports, and mental health follow-ups. That was up from 1,933 in 2016.
If a person with a mental illness can get to a crisis center when symptoms manifest, such as psychosis, the better they can manage their illness and avoid jail, where they are less likely to get appropriate care and resources.
Moran said they've already begun addressing jail diversion with mental health court. There, repeat offenders of misdemeanor crimes that could be attributed to mental illness can get the appropriate treatment and solutions to reduce the chances of committing future offenses. Judge Jason Ellis, County Court at Law No. 2, oversees cases, which began in October. That program was made possible by a state grant and county funding.
According to the Meadows report, there are several challenges as they move forward.
An early challenge has been getting members to come to a consensus on approaches, and to avoid working in silos.
"Now we're building a consensus as to where we go from here," McSwane said. "But it will be a communitywide effort. Now with this report, we've brought it all together and so the next step is to figure out how we work together."
Moran said he's pleased with the work the team has done so far, calling them the "backbone" of this movement in East Texas.
"I think it's great to see the energy going on in the community," Moran said. "There is now a great awareness and great understanding about mental health. The Peace of Mind conference is a great example of how the community is becoming more aware.
“There is still a lot of education that we need to do with the community,” he said. “The community has to get behind this for it to be successful in the long run.”
East Texas is a mental health shortage area. Some areas have a mental health provider-to-resident ratio of 1-to-25,000. In Tyler, which has the highest concentration of psychiatrists in the county, some patients still won't have access.
McSwane is confident that entities such as UT Health Northeast and The University of Texas at Tyler will provide training to produce more providers, but attracting and keeping psychiatrists to staff a crisis center is a piece they must work through.
UT Health Northeast receives funding for a psychiatric residency program, and offers a clinical psychology internship.
Funding the crisis center is another challenge. McSwane estimates the center would cost about $2.3 million, depending on the location and land use. It would cost about $1 million annually to operate, he said. Funding for the center and future initiatives will require a mix of public and private funds.
McSwane said they'd need to consider how people who are underinsured or uninsured could get access to treatment at the crisis center.
While some recent state and federal funding may be accessible, it may still be too little.
"Funds are always limited at the state level and solutions at the state level are hardly ever tailored to individual communities," Moran said.
The Behavioral Health Leadership Team will meet again on Jan. 25.
"People are talking," McSwane said. "People are communicating. We have a real opportunity to do some real good things."