State lawmakers created a mental health jail diversion pilot program in Harris County in 2013, allotting $5 million a year to keep mentally ill inmates from becoming repeat offenders. | Getty Images Houston’s biggest jail wants to shed its reputation as a mental health treatment center

AUSTIN, Texas — The Harris County sheriff’s office doesn’t want its jail to be the largest mental health facility in Texas anymore — but first it needs to find somewhere else to accommodate patients before they get swept up in the criminal justice system.

The office created a separate bureau last year responsible for mental health and jail diversion. While other law enforcement departments around the country are also trying to keep mentally ill and drug-addicted patients out of jail and into treatment, Harris County believes it’s the first to formally create a separate bureau responsible entirely for mental health and jail diversion. It has equipped deputies with tablets that connect to a psychiatrist for on-the-spot treatment or triage and will set up a central booking desk this fall to better sort those arrested into treatment before they get charged with a crime.


For the new programs to work, however, officials in Harris County, which includes Houston, need to seize on state lawmakers’ growing awareness of mental health. Without more treatment options in the community, the jail will keep doubling as a mental health hospital. Currently about one in four of its 10,000 inmates have a diagnosed mental illness and receive some form of psychiatric medication every day.

“We can only fill the slots we have,” said Republican county leader Ed Emmett, whose office is spearheading the efforts to keep mentally ill patients out of jail — and get them help in the community.

Harris County Psychiatric Center, which has nearly 300 beds, has long since reached its capacity and often closes its doors to officers who want to drop off patients instead of taking them to an emergency room or jail. In 2016, Disability Rights Texas filed a class action lawsuit against the state on behalf of nearly 350 inmates waiting for mental health treatment. That case is still winding its way through federal courts.

True pre-booking diversion “hasn’t totally occurred yet and won’t for quite a while,” said Emmett. Still, he said he’s hopeful “because everybody now is talking about the subject of mental health.”

The Harris County Jail already treats more mentally ill patients than the rest of Texas’ mental hospitals combined. In 2017, the sheriff’s office said it spent $22 million on providing mental health care in its jail.

The shuttering of state-run psychiatric hospitals over several decades has pushed jails like Harris County’s into the front lines of mental health treatment. With fewer treatment beds, jails are the only place for many mentally ill patients to go.

The number of people in state-run mental health institutions nationwide has plummeted to 45,000 in 2015 from 560,000 in 1955, according to a 2015 JAMA article. Meanwhile nearly 400,000 people behind bars around the country in 2016 had a mental health condition, according to the Treatment Advocacy Center. That’s about 20 percent of the jail population and 15 percent of the prison population.

“The reason Harris County Jail has become the largest mental health institution is because there is nothing else,” said state Rep. Gene Wu, a Democrat who represents the area, and who is also a former prosecutor in Harris County. “The jail has become a dumping ground for people who have minor violations.”

The sheriff’s office has worked on referring those arrested to mental health courts, treating and preparing inmates so they don’t get arrested again and training officers to respond to people with mental health issues to prevent situations from dangerously escalating. The effort has been going on for a few years, but now it can’t keep up with growing demands.

State lawmakers created a mental health jail diversion pilot program in Harris County in 2013, allotting $5 million a year to keep mentally ill inmates from becoming repeat offenders. Seeing success, the state Legislature started a grant program last year to help other Texas counties replicate such programs.

Since 2013, state lawmakers have also increased funding for new state hospitals and community psychiatry beds by hundreds of millions of dollars, and Gov. Greg Abbott called for more mental health funding after a May school shooting in Santa Fe. But state lawmakers will have to contend with a number of priorities when they next meet in January 2019 — including plugging holes in the Medicaid budget and funding the ongoing Hurricane Harvey recovery.

In the midst of that budget battle, Harris County is now focusing on keeping mentally ill patients from ever entering the criminal justice system — and getting a criminal record — in the first place. The sheriff’s mental health bureau began its pilot last December to move telehealth from the jail to the field, equipping three deputies with iPads that connect directly to a psychiatrist. They respond to 911 calls or requests from other first responders, and then the psychiatrist can handle the emergency, which can range from a mother who called because her daughter was suicidal to a person with schizophrenia talking to himself loudly in public.

The doctor could talk to or observe the person, holding an on-the-spot counseling session and figuring out a medication adjustment or deciding that the person needed more involved treatment. About half of the time, the situation could be cleared immediately, but often the deputies would have to call around to treatment centers and hospitals to find a place to take them in.

“It’s a challenge to get these consumers, to get them a mental health bed,” said deputy Jose Gomez, who participated in the pilot.

The sheriff’s office plans to eventually expand the pilot to 25 deputies later this year and rely more on counselors with master’s degrees, calling in psychiatrists when needed for additional assessments.

In September, the office is launching a triage desk at its main jail facility to centralize the efforts of the county’s 36 law enforcement agencies to sort mentally ill low-level offenders. A homeless person picked up for trespassing, for instance, is better off in a treatment facility than being booked and jailed.

Still, the county hasn’t expanded mental health beds fast enough for such programs to take off and to keep up with skyrocketing demand, especially as substance abuse disorder overwhelms law enforcement agencies.

“We try to do everything we can not to bring charges” against people who are mentally ill and haven’t committed a major crime, said Frank Webb, project manager at the Harris County Sheriff’s Office's new mental health bureau. “But we have to have somewhere to send them to.”

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