Mental Health and Public Safety

By James G Baker, MD, MBA

There is little doubt that the funding for mental health care in Texas is inadequate for the task. But as we try to improve the quality of care for people who struggle with mental health challenges as one strategy for reducing the chance of future tragedies like Newtown, we must keep in mind that our conservative Texas legislature is generally more interested in how dollars are leveraged, not on how many are spent.

So we need to offer up the most cost-effective approaches to improving mental health care and increasing public safety. Here are three possibilities:

First, the legislature can pass laws that make it easier for family members to get help for a mentally ill loved one before he becomes dangerous. Families need to be able to ask courts to compel a loved one to take necessary medication, attend counseling sessions, and go to substance abuse treatment.

Second, the legislature can expand and reform Medicaid in Texas under the Affordable Care Act, virtually eliminating the current barriers to obtaining care for mental illness. The sad reality is that access to mental health is so difficult that many get treatment only after getting themselves into jail, a much less cost-effective approach than providing the care through Medicaid.

Finally, the legislature can support Medicaid waivers and new state programs that increase the availability of housing for people with mental illness, especially for those who have had previous run-ins with the law. There is a significant overlap in the homeless population, the population with mental illness, and the population involved with the criminal justice system. Housing is the most critical factor in helping people with mental illness adhere to treatment, and severely mentally ill individuals who adhere to treatment are no more dangerous than the general population.

Each of these three approaches offers the potential to reduce the suffering of people with mental illness (and their families), to improve public safety, and to reduce the price that each of us pays due to untreated mental illness. In addition to reducing the possibility of new tragedies down the line, they are win-win-win for patients, families and taxpayers right now.

Dr. James Baker recently retired as CEO of Metrocare, the public mental health and developmental disabilities center for Dallas County, and now practices psychiatry full-time in one of the center’s clinics.