(Dec. 19, 2016) In the latest installment of their series The Desperate and the Dead, the Boston Globe Spotlight Team looks to San Antonio, Texas for possible fixes for fatal flaws in Massachusetts' mental health system.
Law enforcement, criminal justice and health officials in San Antonio have worked together over the past decade and a half in order to develop a mental health system that sets residents with severe mental illness up for treatment success (“San Antonio became a national leader in mental health care by working together as a community,” Boston Globe, Dec. 11).
They’ve made immense strides together — including training thousands of police and emergency responders to manage mental health crises, building a crisis center for psychiatric emergencies, developing a transitional clinic to ensure people released from psychiatric hospitals have access to therapy and medication, and opening a reentry center designed to help inmates with mental illness transition back into society.
And it shows. To date, more than 100,000 people have been diverted from jail and emergency rooms into mental health treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period.
“San Antonio is still way ahead of the curve,” Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors, told the Boston Globe.
But the city, widely considered a national leader in behavioral healthcare, contrasts from others across the country, and these differences can sometimes mean the difference between life and death.
Texas vs. Massachusetts
For example, San Antonio is tackling many of the problems the Globe's spotlight team has exposed in Massachusetts, among them poor coordination among institutions, limited training for law enforcement and dwindling options for treatment.
The two are worlds apart in their approach toward treating people in psychiatric crises. The former offers short- and long-term options to stabilize and rehabilitate; the latter forces emergency rooms to serve as make-shift crisis centers that discharge people with severe mental illness without effective treatment.
“These people are getting out of the hospitals so ill they can’t take medications,” said Dawn Velligan, a psychologist and professor at the University of Texas Health Science Center. “They don’t understand what they’re supposed to do.”
Another big distinction between Texas and Massachusetts involves the use of assisted outpatient treatment (AOT)—a life-saving program that mandates court-supervised treatment within the community for people with the most severe mental illnesses.
Bexar County runs Texas' most active AOT program. The goal is to stabilize people and keep them out of state mental hospitals, emergency rooms and jail.
The result? The program has cut by more than two-thirds the number of days participants spent in hospitals.
Massachusetts can learn a lot from the great work being done in Texas. The state is one of only four that still hasn’t enacted laws to authorize the use of AOT.
Massachusettts should take heed and follow the shining example set by the Lone Star State to provide treatment before tragedy and #aBedInstead to those affected by serious mental illness.
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