Mental Health Help, Texas Style

Having worked at Austin Travis County MHMR for several years, I know firsthand the distress caused to clients and the community by funding cutbacks. When I saw the article below in Sunday’s news, I was compelled to reprint it here for my future reference. My hope is that someday I’ll be able to read it in my archives and reflect on it as the “bad old days.” But they say I’m a dreamer; one doesn’t enter the profession of human services unless one is a bit of an idealist.

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A Lost Life
One woman tries — and fails — to navigate Texas’ shrinking mental health system

By Andrea Ball
AMERICAN-STATESMAN STAFF
Sunday, May 23, 2004

A homeless man found Samantha Harvey on the Town Lake hike-and-bike trail, her lifeless body hanging from the limb of a tall cypress tree.

He called for help, and soon the woodsy area frequented by bikers and joggers was swarming with police, firefighters and emergency medical technicians.

They didn’t know the blond, 19-year-old woman with the aqua dress and freshly bandaged wrists; didn’t know of her long battle with depression, her previous suicide attempts, her efforts to get help.

To them she was just a sad story. That story ended on Aug. 27, 2003.

But mental health experts say she is more than that. To them Samantha symbolizes the thousands of people the Texas mental health system fails each year. The system is a patchwork of 41 community mental health centers across the state that vary in size and budgets, offer different programs and medicines and have no uniform computer or record-keeping center to connect them.

Samantha was mentally ill, poor and uninsured — a typical person lost in the system. Months after Texas legislators trimmed millions of dollars for mental health care, experts worry others will suffer the same fate.

“This is what happens when you have people falling through the cracks and not getting adequate care,” said Melanie Gantt, public policy director for the Mental Health Association in Texas.

In 2003 legislators cut $14.8 million in funding to the community mental health centers, a 5.11 percent decrease that forced agencies to drop services, lay off employees and turn away clients. They cut most therapy benefits for more than 800,000 Medicaid recipients, leaving the 128,000 people using it scrambling to find care.

Since then, mental illness-related visits to hospital and clinics have increased as much as 50 percent in the Austin area. Emergency visits to the Austin-Travis County Mental Health and Mental Retardation Center have risen 5 percent.

Things soon could get worse. Starting Sept. 1., community mental health centers will accept people with bipolar disorder, schizophrenia and clinically severe depression only. The 17,000 other people currently being treated for ailments such as panic, anxiety, and obsessive-compulsive disorders will be phased out of the system and left to find care elsewhere.

“When legislators started all of these cuts they weren’t hacking at the fat,” said Christine Malson, a member of the Texas chapter of the National Alliance for the Mentally Ill (NAMI Texas). “They were hitting the bone. Now you can see the mental health system bleeding all over the place.”

Sunshine, storms

Samantha Harvey entered the world on Oct. 14, 1983, with a touch of drama.

Samantha, the first child of a California couple, suffered respiratory distress after sucking in amniotic fluid during delivery. Doctors rushed her into the prenatal intensive care unit and hoped for the best. She recovered a few days later.

As she grew it became clear that the little girl with the platinum blond hair and big blue eyes had two sides to her colorful personality.

The willful side frequently landed her in trouble at school, said her father, Steve Harvey. Her attention-deficit disorder made it difficult for her to concentrate, follow instructions and be quiet. She spent most of her preschool days in time out, Harvey said.

The creative side loved art and swimming. She kept a journal, made up stories and climbed trees. When the family moved to a Michigan farmhouse, she doted on their four dogs and 14 cats.

“Samantha Sunshine and Samantha Storms,” said her sister, Allison Harvey. “That’s what she was like. When she was happy, her whole personality took up the room. When she wasn’t happy, she was miserable.”

Samantha’s family life didn’t help matters. Her parents divorced when she was 10.Samantha became a rebellious teen who skipped school, did drugs, stayed out all night. When she was 14, her psychiatric records show, she was hospitalized for severe depression and thoughts of suicide.

“She later told me that she had suicidal thoughts at as early as 5 and 6 years old,” Steve Harvey said.

Over the years Samantha saw many doctors and psychiatrists. She spent several years in a therapeutic foster home. Her records show she was diagnosed with borderline personality disorder and major depression, among other problems.

At 16 Samantha dropped out of high school. She moved to Chicago to live with her mother and started dating a local man. She got pregnant. It was a confusing time for the troubled teen who loved children but knew she wasn’t ready for motherhood.

“Even when she was little she would talk about how she wanted a daughter and how she would dress her up and name her Lilah,” Allison Harvey said. “And that’s what she did.”

But Lilah’s birth triggered severe postpartum depression. In 2002 Samantha went to Chicago-Read Mental Health Center, a state-run psychiatric hospital in Illinois. She stayed there for 3 1/2 months.

In January 2003 Samantha moved to Texas. She had arranged an open adoption for Lilah with family friends who lived in Austin. She planned to live with her aunt, Lori Harvey, who was moving from Seattle.

Samantha wanted a fresh start. She still needed psychiatric care, but Lori Harvey said they thought they could find what they needed. After all, Harvey said, Samantha was a willing patient. She took her medicine and went to appointments. She wanted help.

“Little did I know that I was moving into the dark ages when I moved to Austin,” she said.

Help, Texas-style

Depression and anxiety, the two most common mental illnesses, each affect 19 million American adults annually, according to the National Mental Health Association. Of the 54 million Americans who suffer from a mental illness each year, 8 million seek treatment.

Not having treatment can be catastrophic. More than 90 percent of suicide victims have a significant psychiatric illness at the time of their deaths, according to the National Alliance for the Mentally Ill. Those disorders are often undiagnosed, untreated or both.

Texas habitually lands near the bottom for per capita mental health spending among the states. In 2001, the most recent year for which rankings are available, Texas was 46th. In 2003 the state could afford to help only 39 percent — about 159,000 — of the adults eligible for state mental health care, according to the Texas Department of Mental Health and Mental Retardation.

Last year was particularly rough. The sagging economy left the state with a $10 billion shortfall, and legislators were looking for ways to save money. In January 2003 Gov. Rick Perry instructed all state agencies, including the Texas Department of Mental Health and Mental Retardation, to cut their budgets 7 percent.

Community mental health centers stopped filling jobs and started cutting services. Those with cash on hand were forced to return some money to the state. The Austin-Travis County Mental Health and Mental Retardation Center sent $143,000 to the state.

Samantha qualified for help when she moved to Texas. She was unemployed, uninsured and had a history of serious psychiatric problems.

By the end of January, Samantha was suicidal. She went to the one place in the Austin-Travis County system that everyone can go for immediate help: Psychiatric Emergency Services.

Whether they’re suicidal or delusional, everyone who enters the Austin-Travis County system in crisis is processed through Psychiatric Emergency Services. Eight employees, including a psychiatrist and case workers, staff the building on 56 East Ave. It is always open, and staffers see approximately 45 clients each day.

After evaluation some people are taken to Austin State Hospital, which accepts only people who are imminently dangerous to themselves or others. Some are taken to the “Inn,” a 16-bed short-term facility for crisis care where clients voluntarily check themselves in for medication and education. Others are given appointments for outpatient care in the Austin-Travis County system.

Staffers at Psychiatric Emergency Services determined that Samantha needed immediate care.

“(Samantha has) suicidal ideations with multiple plans (cut herself, jump out of a car, overdose, drowning), but has not acted yet on thoughts . . . because of 5-month-old-daughter who has recently been given up for adoption,” psychiatric records state.

On Jan. 31, 2003, Samantha checked in to the Inn. She spent 10 days there and received medication. On her release staffers scheduled a follow-up appointment at the East Second Street Clinic, an Austin-Travis County facility that provides out-patient care for more than 5,000 people a year.

A few weeks later Samantha moved to Williamson County, where she turned for help to Bluebonnet Trails Community Mental Health and Mental Retardation Center.

Doctors at Bluebonnet — the Williamson County equivalent of the Austin-Travis County mental health system — diagnosed Samantha with rapid cycling bipolar disorder, which causes people to suffer four or more episodes of mania and/or depression in one year. They gave her drugs including two medications that lifted the depression and helped her think clearly, said Lori Harvey, Samantha’s aunt.

“It was like a new life started for her with that combination of drugs,” she said.

Hope and heartache

By the spring, Samantha was healthier than she had been in years.

Her new medicine kept mood swings at bay. She got regular therapy with SafePlace and the YWCA, Lori Harvey said. She applied for help from the Texas Rehabilitation Commission (since renamed the Department of Assistive and Rehabilitative Services ), a state agency that offers job training and education for people with disabilities. She talked about becoming an art therapist.

Samantha also joined the choir at Trinity United Methodist Church. The shy soprano said little at practices but appreciated members’ efforts to welcome her, said Sid Hall, senior minister of the church.

“She seemed so unaccustomed to that, so each person that did it made a huge impact on her,” he said.

Samantha — the one-time wild child with a penchant for partying — didn’t go out much during this time, Lori Harvey said. It wasn’t easy to make friends or hit the town in rural Williamson County.

One day in the spring of 2003, Samantha was waiting at a North Austin bus stop when she met Dan Bowers, an Austin man who worked for a document management company. The pair clicked, going from polite chitchat to talk of personal problems within a matter of minutes.

They had lots in common, Bowers said. They liked the same music: rock, metal, hip hop. Both played chess and enjoyed lounging by the pool.

The couple was soon living together in a North Austin apartment near Burnet Road and U.S. 183. In the meantime, she got a job as a clerk at a North Austin adult video store.

“She used to laugh about it,” said Allison Harvey, Samantha’s sister.

Samantha talked to Bowers about her difficult childhood and psychiatric problems but never seemed to dwell on them, Bowers said. In fact, she often amused him with her quirky personality.

“One time I walked into the kitchen while Samantha was cooking,” he said. “There she was, mooing at the steak.”

For others like Samantha, life was getting worse.

After losing services from their community mental health centers, more mentally ill began showing up in local hospital rooms and medical clinics.

Austin-Travis County Mental Health and Mental Retardation Center saw more emergency clients. In 2002, 2,235 people received services from Psychiatric Emergency Services. In 2003 that number rose to 2,355, a 5 percent increase.

That trend has continued, according to the Indigent Care Collaboration, a nonprofit that tracks medical care for poor people in Travis and Williamson counties.

Mental health diagnoses in 20 Austin area hospitals and health clinics rose steadily over the past year, jumping 37 percent from January 2003 to January 2004. In February 2003 there were 50 percent more diagnoses than in the previous February, according to the Collaboration.

Despite the good times in the spring of 2003, Samantha would soon be among those needing help. Now that she lived in Travis County she could no longer receive services from the Williamson County system.

“I told her, ‘Don’t tell Bluebonnet you moved,’ ” Lori Harvey said. ” ‘We’ll find a way to get you there.’ She wouldn’t listen. She thought she could get the same care in Travis County.”

Harvey knew there was no guarantee that Samantha would get what she needed in Travis County, but Samantha was optimistic. She had a new love, a new life and plans for the future.

This time, she promised, everything would be fine.

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