In San Antonio, Trying to Survive the Budget Cuts

Treatment works, but will the Legislature pay for it?


Dave Mann

Imagine knowing how to save people’s lives, but lacking the resources to do it.

This is the position Leon Evans finds himself in. Evans runs the Center for Health Care Services—a government-funded community center in San Antonio that treats primarily Texans with mental illness, and drug and alcohol addictions. State funds have always been short, but Evans and his staff have achieved some remarkable success keeping the mentally ill and the self-medicating out of the criminal-justice system. That saves taxpayers money in the end. Now, he’s hoping pending state budget cuts don’t wash away all the progress.

“Treatment works,” Evans says. That’s not just his opinion. It’s a conclusion reached by numerous studies and put into practice around the country. For instance, studies have shown that paroled offenders who receive treatment for their mental illness or substance abuse are three-to-four times less likely to commit another crime. Instead, they’re more likely to become productive members of society—holding down jobs and paying taxes.

We know how to turn people’s lives around—in many cases, we know how to treat mental illness, how to pry them away from addiction. The question we face isn’t how to accomplish these things. The question is will we pay for them.

Texas has never provided adequate funding to its community mental health centers. The state ranks 49th in per capita spending on mental health. Hundreds of thousands severely mentally ill Texans already go without treatment statewide. The Center for Health Care Services provides outpatient treatment—medications and counseling—for more than 6,000 people a month (that’s 2,000 people more per month than the state pays for). Still, the center has turn away hundreds of people each month—either by placing them on a waiting list or by referring them elsewhere.

Since 2003, the center has partnered with county and city officials to run a Crisis Stabilization Unit—a 24-hour inpatient clinic for people enduring a mental breakdown who might harm themselves or others. The center also helps run a substance abuse unit that provides treatment for addicts. The two projects help keep at least 600 people a month out of the county jail.

But it’s not clear how much longer the center can sustain these programs. In the draft state budget, community mental health centers are facing up to a 40-percent cut in funding. Evans says he’s expecting to lose $8 million to $10 million—out of roughly $25 million he receives in state money. He could lose a third of his staff or more. “These cuts are basically going to cost shift on to the counties and cities and the hospital districts—cause these people will end up in jail or emergency rooms or homeless on the street,” Evans says.

The average homeless person costs taxpayers $30,000 a year worth of run-ins with law enforcement, and trips to county jails and emergency rooms, Evans says. A few hundred dollars worth of treatment for someone’s mental illness or addiction could save taxpayers tens of thousands.

“Why wouldn’t you fund a cost-effective treatment alternative to improve the public-safety net and save taxpayers’ dollars? Evans says. “Why wouldn’t you do that?”

It’s a question lawmakers may want to consider.