Pilot program gives hope to inmates with mental health needs

Precious Simon was ready for help.

After eight years of cycling in and out of jail for offenses such as trespassing and disorderly conduct, the Harris County woman wanted to put an end to the days of sleeping under overpasses and scavenging meals from dumpsters. She'd been hooked on crack cocaine, an addiction fueled by manic depression and bipolar disorder.

Following a 2014 arrest, Simon spent nine months behind bars until she was released in July and referred to a Harris County program to help repeat inmates suffering from a mental illness.

The program helped her get a new apartment in Sunnyside and land a job at a local bakery.

"I'm able to pay my bills again," Simon said with a smile.

County officials say cases like Simon's show that the pilot program, launched in 2013 by the state as part of an effort to reduce the staggering numbers of mentally ill people locked up in local jails, may be working.

While a sampling by the county shows more than half of those referred to the program wound up in jail again, a county official says the number would have been higher had the program not been in place.

Regenia Hicks, the director of the pilot program, said clients also had fewer bookings and that the amount of time each spent in jail went down by more than 50 days, potentially saving almost $3 million a year.

These numbers may be critical to the program's future as county officials prepare an evaluation due to the legislature in December.

"You can't overlook if you give somebody with a mental health issue a better life," said Harris County judge Ed Emmett. "Then they become a productive part of society. That brings benefits back to the taxpayers. As long as it's got a positive outcome, then I think we need to keep supporting it."

The Harris County Jail is often described as the largest mental health facility in the state because of the roughly 8,700 people housed there, more than one out of four has some form of mental illness.

Experts said the jail houses more mentally ill patients than do all of the state's public mental health hospitals. Each month, county officials estimate, the jail houses an estimated 2,300 inmates who have been in jail multiple times, bringing higher costs than other inmates.

"We get in trouble because who's paying that bill?" asked Limestone County Sheriff Dennis Wilson, the first vice president of the Sheriffs Association of Texas. "The people that are paying that bill is the local taxpayer."

Texas has for years lagged behind other states in mental health funding. In 2013, lawmakers began changing course, investing millions in substance abuse treatment and efforts to eliminate waiting lists for mental health services as well as creating the pilot in Harris County.

Since then, the state and the county have kicked in $4 million apiece per year for the diversion program, county budget officials said.

Hicks - who was tapped by Emmett in 2013 to lead the program - said 764 people have been served so far, with more than 200 connected with temporary and emergency housing. Last October, the program started connecting people - 21 to date - to residential treatment facilities, which provide both housing and help with substance abuse and mental illness issues.

Currently, the program has nearly 250 clients.

Better treatment

In Simon's case, her case manager helped connect her with transitional housing and job training and helped her to obtain needed medication.

Most of the program's clients have been referred through the jail. The program is open to those who have cycled through the jail at least three times in the last two years, allowing officials to focus on the toughest populations to help.

The overwhelming majority are African American and male and have been diagnosed with bipolar disorder.

Mental health experts said formally established diversion programs work, though they are not yet widespread in Texas.

In 2002, Bexar County established a program to help the mentally ill, which included measures that send police with special training to respond to both children and adults in a mental health crisis.

The aim: To avoid a trip to jail and connect the subjects with better treatment

The programs helped the county avoid building a costly 1,000-bed jail because the inmate population declined, said Leon Evans, president and CEO of Bexar County's behavioral health authority. Bexar County officials also screen every individual when he or she is booked to see if they can be let out on personal recognizance bonds.

Over the past six years, Bexar County has saved more than $11 million on just the administrative costs of processing people before a magistrate judge, not counting savings on jail-time and medical costs.

"Everybody is impressed with our program," Evans said. "What they're really impressed with is our collaboration."

A mental health authority serving eight counties in central Texas reported a 57 percent drop in recidivism among people diagnosed with mental illness prior to booking and a 68 percent decrease in those diagnosed after booking. That program has served more than 900 people since 2014.

Sheriff Wilson said that while he was keeping an eye on Harris County's program, the same approach might not work in smaller, more rural counties. Many don't have enough non-profit organizations and health care workers to provide the kind of support structure that's needed.

"Those of us in rural Texas will never have the tools," he said.

Expanding the jail diversion program would put a strain on the already limited amount of housing and the number of psychiatrists and social workers in Texas, said Katharine Ligon, a mental health policy analyst at the Center for Public Policy Priorities Texas, a non-profit organization that advocates for increased investment in health care.

'The right thing'

Another challenge is the limited number of individuals that can be helped. While the program has helped hundreds in recent years, there are thousands of mentally ill persons in the county and statewide who need help.

Although Simon said she knew she wanted to change after her last arrest and jailing, Hicks said not everyone is at that point.

Many inmates are on probation, and opt not to get involved with case management and counseling. The majority of potential clients are charged with misdemeanors, but Hicks said many choose to spend a few days in jail rather than take part in the program.

Some who express interest inside the jail don't follow up once they are released, Hicks said.

Lawmakers will weigh all these questions when they receive Hicks' report in December.

Mental health care advocates and county officials tend to agree that some sort of intervention is necessary. The question is how best to spend the money.

"My hope, and we will wait to see the results, is that doing the right thing by these individuals ends up also being the right thing by society with regard to protecting them and also ends up being the right thing with regard to the taxpayer," said Precinct 4 Commissioner Jack Cagle, who said he supports the program.

State Sen. Joan Huffman, a Houston Republican who sponsored the bill creating the program, said other jurisdictions in Texas, including some from the Dallas area, have inquired about how the pilot program is doing. Fort Bend County last year sought approval of a similar state-backed program.

"I'd like to see it expanded in other parts of the state where they want it and where it would be useful to them," Huffman said.

Wilson said the need will only increase as the state's population grows.

Simon is hopeful about her own future now.

"We have to have the courage to move on," Simon said.

She still faces temptation, she acknowledged. Group therapy is a regular part of her life. But less than a year removed from jail, she takes joy in hosting family and friends for dinner, a far cry from the handcuffs and jail bars that used to be regular features of her life.