The ‘system’ isn’t failing to rescue Texas’ mentally ill. We are.

Austin American-Statesman, June 4, 2004

An administrator of a Central Texas nonprofit rural hospital asked me last week, “What is going on out there? Our ER, and even our general medicine floor, are suddenly full of patients with mental problems. Even the family practice docs are calling me saying their caseload is filling with people with serious mental illnesses that they don’t feel competent treating.” Ask any emergency room nurse or doctor if mental patients in the ER are a big problem, and you’ll get an ear full.

As the American-Statesman recounted in a recent article, a homeless man discovered the body of Samantha Harvey hanging from the limb of a cypress tree along the Town Lake hike-and-bike trail last August, her wrists freshly bandaged. Just four days before, she had deeply slashed herself, was treated at a for-profit hospital and released after a few hours. Samantha had bipolar disorder and had tried in vain to get medications and therapy when her candle burned out.

In May, Kelsey Patterson, who had intractable paranoid schizophrenia, was executed after Gov. Rick Perry refused to grant executive clemency — despite the state parole board’s rare recommendation, on a 5-1 vote, to commute the sick man’s sentence. Strapped to the gurney, Patterson ranted incoherently as the lethal drugs made their way through his veins.

By all accounts, Patterson had no idea he was about to be put to death or why, thus clearly not meeting the legal requirement for execution: mental competence. By failing to show mercy, the governor sent a message: If you commit a crime and are sick enough, by God, this state will put you to death.

Where does the blame lie for this mental health imbroglio — where people die trying to get help; where wildly delusional inmates are executed; where people with gravely serious mental problems routinely show up in hospital emergency rooms, rural family practice doctors’ offices and prison?

The blame lies squarely with every one of us. We look the other way when we see a ranting homeless person. We make no effort to try to understand complex diseases of the brain. We think criminal defense lawyers are exaggerating or faking their clients’ conditions. We think their families are at fault, or that they brought it on themselves. We think, maybe if these people would just pull themselves up by their bootstraps . . .

We watched last legislative session as our elected representatives, acting as trustees of the public, cut $14.8 million in mental health funding, even though our state already ranked 46th nationally in per-capita mental health spending. They then went on to legislate that Medicaid would no longer cover therapy by professionals such as psychologists, therapists, counselors and social workers. (The bulk of people served by the Texas Department of Mental Health and Mental Retardation are eligible for Medicaid.)

Those decisions took a tattered Texas-style mental health safety net and ripped it wide open. Forty-one community mental health centers across Texas struggle to care for our poor mentally ill. Each runs on a shoestring budget with caring, dedicated staffs who do their best to care for society’s most vulnerable. Human errors can occur in community mental health centers, just as in the best hospitals. In either setting, these failures can be fatal.

A deeply embedded stigma surrounding mental illness pervades our culture and directly affects our leaders’ decisions about funding. Our lawmakers find little public sympathy for the mentally ill, and our governor shows no mercy, no disdain for injustice, no nobility of the soul. We all have the blood of Samantha Harvey and Kelsey Patterson on our hands.

Inglis is a practicing neonatal intensive care nurse in Austin and a member of Austin Travis County Mental Health Mental Retardation Center Board of Trustees.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident, is a retired neonatal intensive care nurse and editor of NursingNews. She also wrote a monthly opinion column for the Austin American-Statesman editorial pages for 10 years.