Dateline

Nearly two months after Hurricane Rita passed through town, residents of Beaumont are cobbling their city back together. Most businesses and restaurants have reopened, the traffic lights are nearly all up and working again, and homeowners—the ones whose homes are still standing anyway—have begun rebuilding. What worries Dan and Mary Wilson, however, is how their community will deal with the damage that isn’t so visible.

The Wilsons run Schmidt Saw and Knife Works in an industrial section of Beaumont, southeast of downtown. As you might imagine, business has been brisk since the September 24th storm. On a recent Wednesday morning, Dan Wilson was explaining the subtleties of the world’s many kinds of saws to a steady flow of homeowners and handymen in his pegboard-lined showroom. “The cheaper the saw, the less power it has,” he tells one customer on the phone. “You could get that [model]. It depends on what you need. That’s not enough saw for what I got in my backyard.” Dan Wilson is a straightforward man. In conversation, he cuts to the point, rarely wasting time on extraneous details or pleasantries. When they’re not selling saws, the Wilsons are advocates for the mentally ill. They’re active in the Texas chapter of the National Alliance for the Mentally Ill, a group that advocates for increased spending on mental health care. The Texas public mental health system is perhaps the most neglectful in the country: The state consistently ranks 49th or 50th nationally in per capita mental health spending. Across the state, hundreds of thousands of severely ill Texans simply go without treatment because the Legislature won’t spend the necessary money. The Wilsons and other advocates are wondering how a state with such a horrendous record of caring for its mentally ill citizens, especially those in crisis, can meet the needs of potentially thousands of Texans experiencing post-traumatic stress after hurricanes Rita and Katrina. In Beaumont, the resource-starved mental health community center already struggles to treat the severely mentally ill, especially those contemplating suicide. Now, after the storms, it may only get worse.

Like many mental health advocates, the Wilsons were thrust into activism after caring for a troubled family member and fighting with the state system for years. Their son Will suffered from symptoms of mental illness since kindergarten. As he got older, Will often was angry and would sometimes shout at his family or destroy objects. Doctors offered a series of diagnoses for Will’s behavior, including attention deficit disorder, pervasive developmental disorder, and, finally, severe depression and bipolar disorder. The Beaumont Independent School District never gave Will the attention he needed, Mary Wilson says. Yet Will shuffled toward graduation; public school officials finally discovered his dyslexia in his senior of high school.

Unable to hold a job after graduation, Will became increasingly erratic in his early 20s, and Dan and Mary moved him out of their house and into a nearby apartment. The couple covered the rent that their son still couldn’t earn. Finding treatment for Will was harder still. For a family with modest income, there are few options. Private care costs tens of thousands of dollars, and insurance plans offer minimal coverage. That leaves the public system, which in Beaumont means Spindletop Mental Health and Mental Retardation community center.

The Wilsons never thought Spindletop MHMR provided enough care for Will. They often felt the doctors who treated their son weren’t competent. Dan recounts that several years ago a Spindletop MHMR doctor prescribed for Will the drug Wellbutrin, which, he says, caused his son to hallucinate. “He thought there were worms crawling out of the floor,” Dan Wilson says. “He cut a hole in the mattress and put a lamp in it to see where the bugs were coming from.” The Wilsons, fearing that Will would commit suicide or set his apartment on fire, decided that he needed in-patient care. Will was never an easy patient and always refused to be hospitalized. So in mid-2003, Dan and Mary obtained a mental health arrest warrant from a district judge to have their son committed. A police officer picked up Will and took him to Spindletop MHMR.

It’s difficult to legally hospitalize people against their will. An intake screener at the center evaluated Will and determined he wasn’t a threat to himself or others, which is the legal standard for commitment. The center released Will the next morning. “They never talked to us or anyone else about it,” Dan Wilson protests. Two days later, they tried to have Will committed again, fearing that he was becoming violent or might harm himself. This time, Spindletop MHMR released him within a few hours. Dan and Mary would attempt to have Will hospitalized a total of three times, and all three times the community center refused to admit him.

About a year later, on October 17, 2004, Will swallowed enough sleeping pills to kill himself. He was 26. Despite his parents’ efforts, Will was never hospitalized. “His entire life, we were fighting for him, fighting for him to get help and help his mind,” Mary Wilson says. “It just never happened.” Dan and Mary partly blame their son’s death on what they say was Spindletop’s refusal to do more for their son than give him pills and send him home.

Sally Walden, director of network services at Spindletop MHMR, refused to discuss Will Wilson’s case due to confidentiality requirements, but she defended the center’s handling of mentally ill patients in crisis. “Not everybody meets the criteria for being held against their will every time they’re brought in,” Walden says sitting in Spindletop’s southside offices that still show signs of flooding from Rita. “You can’t keep holding them just because you know when you release them they’re going to start doing poorly again. Holding them won’t prevent all that.”

Nevertheless, the Wilsons complained to state officials in Austin about Spindletop’s handling of mental health crisis services. After the complaint, the Texas Department of State Health Services opened an investigation into the center in November 2004. The resulting report, obtained by the Observer, cites Spindletop for multiple deficiencies in its handling of patients in crisis, including turning people away or hurrying their release when the center’s in-patient beds are all occupied. The report noted one recent incident in which police brought in a man who “thought he was Jesus.” Spindletop couldn’t find an appropriate place for him. The man was released and hanged himself the next day.

Advocates and bureaucrats agree on the source of problems at Spindletop MHMR: a dearth of resources. The center has a limited number of beds for the mentally ill who need in-patient care. There is a 16-bed local crisis center, and the center can send a few patients to nearby Rusk State Hospital. But a handful of times each year, the patients in crisis outnumber the small number of available beds. That’s when Walden and her colleagues at Spindletop must get creative: calling local hospitals to check for free beds or paying a staffer overtime to sit with a suicidal patient, perhaps all night, until a bed becomes available. And sometimes, according to the state report, police are asked to hold mentally ill patients in the local jail on trumped-up charges until a bed becomes free. In these overcrowding situations, Spindletop officials also will release patients from the crisis center earlier than they should to make room. “With fewer beds, you’re cycling people through the system a little faster,” Walden concedes.

Spindletop MHMR’s situation is emblematic of a statewide problem. State officials completed a scathing report on Austin-Travis County MHMR earlier this year that identified similar shortcomings. And advocates for the mentally ill say that they suspect nearly all 41 MHMR community centers around the state have the same issues as Spindletop—the state just happened to investigate in Beaumont and Austin. Advocates are calling for a statewide review of all 41 centers for crisis services, and, not surprisingly, for increased funding.

Walden of Spindletop MHMR isn’t sure if more funds and beds would save lives, but she argues that increased resources would improve the center’s care tremendously. “If there were more beds, the rotation through the system would take a little longer and we would have the luxury of being able to keep people in order to stabilize them a little longer,” she says. In the meantime, officials at the Texas Department of State Health Services, which oversees the 41 community centers, want Spindletop to rectify its problems. But without further funding, Walden says, there’s only so much she can do when the center has more patients than beds. “I can’t make resources that don’t exist. I can’t make a hospital accept somebody who doesn’t have insurance. I can’t make Rusk State Hospital accept somebody who doesn’t meet their criteria. There are, in some cases, gaps in services.”

It’s likely that increased pressure will further expand those gaps in services. Mental health advocates in Beaumont believe that thousands of area residents need treatment for post-traumatic stress following hurricanes Katrina and Rita. Walden agrees: “The burden of having a lot of additional residents in our community who are Katrina evacuees who are most certainly experiencing some post-traumatic stress, then fold on top of that our own community who’s been through a traumatic event, and I think it’s safe to assume that we can expect some repercussions from that.” Those who can’t afford private treatment will turn to Spindletop MHMR. The Federal Emergency Management Agency (FEMA) recently granted the center $300,000 to treat the several thousand Katrina evacuees in the area. Walden hopes a similar grant for Rita victims will be approved soon. Still, that’s not much of a funding boost for Spindletop, which has an annual budget of $27 million. And here’s the catch: The grant is only for community outreach and counseling, not in-patient care or medication or anything else.

The center will use the FEMA money to hire 20 temporary counselors who will help residents cope with the effects of the storms. Yet Spindletop has no additional funds to help residents who need more than short-term counseling. If more people suffer mental health crises, as some advocates expect, Spindletop MHMR will somehow have to stretch its already inadequate funds even further. Walden doesn’t expect any additional disaster money from the state or federal government for services beyond counseling. But, she says, “It’d be great if there were.”