Sunday, April 24, 2016

Pay Now or Pay Later

Brandi Grissom of the Dallas Morning News (DMN) has, yet again, raised the specter of our county jails becoming the venue of reluctant choice for the feeding, housing and (lack of) treatment of the mentally ill. Grissom writes:
State mental hospitals are once again out of room for the criminally insane. 
More than 380 men and women statewide are waiting in county lockups, sometimes for months on end, because state mental health facilities don’t have enough beds to provide treatment for inmates declared incompetent to stand trial.
This problem will only become worse. There is a tangible lack of access to mental health services, at least among the unsophisticated, uneducated and working (and not working) poor whose children show signs of mental illness. Thus, many adolescents who initially develop symptoms of schizophrenia are not treated. Adolescence is the first and best opportunity to diagnosis and treat this potentially dangerous mental illness. Instead many turn to self medication. This only serves to aggravate the problem in the long term.

Many adolescents with psychosis act out and become enmeshed in the juvenile justice system, just to be handed off to the adult system when they turn 17 years of age. The juvenile justice and adult criminal justice systems have simply become the de facto treatment system for this category of mentally ill.

State lawmakers are in slash-the-state-budget mode. Our state judiciary has been as effective as a neutered pup in their role as judicial watchdog of state constitutional rights. Witness the the Austin Court of Appeals' recent decision allowing draconian cuts in reimbursement to providers of home care therapy for autistic and disabled children. From another DMN story this week by Robert T. Garrett;
Some have warned the cuts would disrupt care for tens of thousands of disabled children, especially in rural Texas. But the the three Republican judges who heard the case said providers and patients lacked jurisdiction to sue. The plaintiffs have no vested right to a certain reimbursement fee, the judges ruled.
'Medicaid benefits are entitled to constitutional protection, but this protection does not mandate that a Medicaid participant has access to a particular provider or that a participant’s provider will continue to receive payment or reimbursement rates at a previously set amount,' Justice Melissa Goodwin wrote.
Translated, this means although the state constitution entitles the poor to benefits, those benefits can be so parsed as to make them unobtainable. A right without means of delivery is one that as a practical matter does not exist. This toothless right will therefore result in these children growing into the cast offs now warehoused in our county jails.

The average county taxpayer does not seem to care. Why? Their taxpaying ox is in not in the proverbial ditch. Or so they think. Grissom attempts to imbue these taxpayers with a little knowledge. It is a "pay now or pay later" choice.
Taxpayers in large counties, such as Dallas, bear the brunt of the cost. Sheriffs, prosecutors and mental health advocates across the state are urging lawmakers and the department to find more space at state hospitals for mentally ill inmates. Jails, they say, don’t have the resources or the funds to deal with severely mentally ill inmates. 
It leaves sheriffs in constant fear that their facility might see a suicide or face a lawsuit. The waits also complicate court cases for prosecutors. And advocates for the mentally ill say defendants’ constitutional rights are violated when they are forced to stay in lockups instead of getting the treatment courts have ordered.   
This does not consider those mentally ill who are currently undiagnosed because they have fallen through gaps of our social safety net big enough to drive an (unregulated) truck through. Many of the undiagnosed mentally ill are ticking time bombs in our jails waiting to go off.

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