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.

Part of our professional code of ethics tells us that we’ll strive to “improve standards of nursing practice and promote … efforts to meet health needs of the public.” I’ve always taken that aspect of the code very seriously.

During the 12 years that I was a hospital staff and head nurse, I was also involved in local politics. During that time, an influx of foreign nurses pointed to the need for a clearer definition of nursing responsibilities in the Nursing Practice Act. After joining the Governmental Affairs Committee of the Texas Nurses Association, we set to work to rewrite parts of the act and then to lobby the Legislature for its passage.

It became clear to me during that time that policy work in state government was the most efficient way to improve nursing and health care for people. I could see that as a nurse I was in a unique position to make that happen, so I decided to run for state office. Having worked in local politics, I was able to garner a lot of support and campaign help.

Survey after national survey has shown that the public at large trusts nurses and holds them in high esteem. I certainly found that to be true both within my hometown of El Paso and within the Legislature. People in my district trusted me and re-elected me every term for 13 years until I retired in 1997. My fellow legislators relied heavily on me for expertise in health care. When I spoke on health care, it got their attention.

Was it difficult for you to juggle work and family?

That’s difficult for any woman. I had a husband and 10 children, so I needed to work. When the children were young, hospital work with its 24/7 coverage requirements offered me the opportunity to work a flexible schedule to accommodate child care and events.

I didn’t run for state office until the youngest child graduated from high school. Serving in the Legislature is a full-time job, whether in session or not.

What are you proudest of in your legislative work?

I feel good about the work I did for AIDS. When I was first elected in 1984, the AIDS epidemic was becoming public. Legislation was needed to cover many of the problems-like confidentiality, directives for health care workers (precautions), regulations, funding for education. My health care background was important in overcoming the hysteria. Every subsequent session, there was a lot of work to be done to refine legislation and to make sure that what was gained was not torn apart.

One of the first bills I worked on was assuring that licensed respiratory therapist regulations did not conflict with nursing practice. I worked with the Texas Nurses Association every term to update the Nursing Practice Act. I helped get funding for a huge study about the nursing shortage in Texas.

The Board of Nurse Examiners Sunset review would come up, and every session I worked to get the [board] the money it needed for testing and checking out complaints against people. I worked with [the Texas Department of] Mental Health and Mental Retardation for smaller group homes for the developmentally disabled and to review lawsuits for better care for custodial or institutionalized patients. I made sure state-funded institutions kept up with best-practice standards.

I am glad I was there to give my input from the nursing perspective to health care legislation and the budget wars. I know it helped. Serving on the Public Health and Appropriations Committees allowed me to balance finances with political considerations. That’s important work.

What reaction have your children had to your political activity?

I think it has affected them pretty profoundly. All of them really enjoyed helping me with my campaigns. They all tell me they’re proud of me for the work I’ve done.

My son, Chuck McDonald, was assistant press secretary to former Texas Gov. Ann Richards. He is now a busy political consultant with a public relations firm.

My youngest daughter, Elizabeth, is a neonatal intensive care nurse in Austin. She tells me that since becoming a nurse, she’s often amazed at seeing the tangible results of my labor in the Legislature.

For example, in El Paso, she made the connection with my work and how AIDS patients and those with mental illness were treated more humanely. She tells me she knows how my work has made life better for a lot of Texans, and that makes me happy.

The article points out that the merger would limit consumer choice. That’s true, but the merger is a good solution for the community.

While I appreciate sensitivity to consumer concerns, it’s helpful to explore the fundamental cultural and economic phenomena behind the situation we’re in today.

The core cultural problem is stigma. Disorders of the brain carry a frightening and mystical aura that separates them from other ailments. The end result: lack of insurance parity with other physical medical conditions. This is utterly irrational. Treatment success for serious mental illnesses ranges from 60 percent to 80 percent, whereas that of heart disease, for example, ranges from 40 percent to 50 percent.

People who have a mental illness fail to seek early treatment for mental disorders for fear of social and job discrimination. Not only is the opportunity lost to treat the medical condition early on, but often the first psychiatric encounter will occur only after horrific tragedy.

At the core of the economic problem is the cutthroat environment facing health-care institutions today.

The remaining two private psychiatric hospitals in Austin — Seton Shoal Creek and St. David’s Pavilion — do not stand alone. Operating the past few years either in the red or barely breaking even, they are part of larger health-care networks — Seton Healthcare Network and St. David’s HealthCare Partnership.

Both health-care networks are struggling financially because of low managed-care reimbursements, inadequate mental health benefits on insurance plans and crushing reductions in hospital Medicare payments brought about by the 1997 Congress, which ruthlessly balanced the budget on the backs of health care. And if that’s not enough, Seton, which serves as the de facto hospital district for Central Texas, has a mission to care for all comers regardless of ability to pay. With the uninsured in Central Texas reaching an alarmingly high rate of 25 percent, that’s a hefty number of people.

The American-Statesman article pointed out that the lengths of stay for psychiatric hospitals have decreased from 19 to six days in the decade beginning in 1990. This is not necessarily a bad thing. One reason is advances in psychiatric pharmacology producing drugs that target the exact brain chemical imbalance and leave the rest of the brain alone, resulting in far fewer side effects. A second reason is the massive shift in the past decade from inpatient to outpatient care.

An unfortunate reason for decreased lengths of stay is managed care limiting inpatient days to the bare minimum, as if it were reasonable to use a predetermined recipe per mental diagnosis for everyone. Under ideal circumstances, within six days a child or adolescent or adult may be admitted, obtain an accurate diagnostic profile, receive effective psychotherapeutic intervention including stabilizing medications. Meanwhile, the patient and family become oriented to healthy coping skills. Psychiatric hospital admissions tend to be devastating and frightening events for patients and families.

Six days for a psychiatric length of stay is indeed ambitious.

On the bright side, Austin is blessed with an exceptional cadre of dedicated and skilled mental-health caregivers — nurses, doctors and mental health aides. And the fact that two normally competing health-care networks have come together to collectively arrive at an innovative community solution to meet the private psychiatric hospital needs is extremely encouraging.

Austin is fortunate to have the public 312-bed Austin State Hospital, which typically operates at near full capacity, to meet the needs of the indigent and those committed by the courts. Austin is lucky to have the option of even one private psychiatric hospital given the cultural stigma of mental illness and the resulting parsimonious funding within the current harsh health-care financial environment.

If the state attorney general’s office approves a proposed merger of the Seton and St. David’s mental health-care facilities, the public will be better served in the short- and long-term with one high-quality, financially viable private psychiatric hospital than with two competing facilities operating on shoestring budgets, in the red.