Cutbacks in state psychiatric services have put more and more mentally ill Texans on the streets and forced police officers into a complicated new role—with sometimes deadly consequences.
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That’s what the staff of the Harris County Psychiatric Center told Joyce Guillory as they discharged her 39-year-old schizophrenic son, Steven, from the hospital. She had wondered aloud what she would do if his mental state deteriorated again and she was unable to control him. “Call 911,” they told her. And so a few days later, on July 21, 2007, when Steven came at her with a knife, Joyce ended up on the phone with a Houston Police Department dispatcher, frantically pleading for help. What happened next would plunge a family into grief, ignite community outrage, and prompt serious soul-searching by the HPD.
When the first patrol car pulled up, Steven was outside the Guillorys’ south Houston home, gesturing menacingly with a large length of pipe. Two officers ordered him to drop the pipe, and when he didn’t, they fired a Taser at him. Far from having the desired effect, the Taser enraged Steven, who began methodically smashing the patrol car’s windows and headlights. A backup patrol car arrived. At some point, a piece broke off the pipe, and Steven hurled it at the officers. Again, they demanded he drop the pipe. When he moved toward the police officers, they shot and killed him.
In life, Steven Guillory was just one of tens of thousands of mentally ill Texans competing for scant public health resources to treat their chronic and brutal disease. In death, he would become a rallying point for reform and Exhibit A in the case proving the perils of sending armed officers to deal with a mental health crisis.
With state hospitals long emptied of all but the truly incapacitated and with outpatient services chronically underfunded, responsibility for the mentally ill has fallen—by default—to law enforcement. The result is a tragic phenomenon known in mental health circles as transinstitutionalization, the migration of the mentally ill from hospitals to jails and prisons. One recent study found that by nearly eight to one, Texans with mental illness have greater odds of being in jail or prison than in a psychiatric hospital. Only two states, Nevada and Arizona, fared worse. The largest psychiatric facility in the state of Texas is not a hospital or a clinic or an outpatient center. It’s the Harris County jail, which treats and houses, on a daily basis, about 2,500 mentally ill people—more than all ten of the state’s mental hospitals combined.
Texas already ranks forty-ninth in the country in state funding for mental health services. Advocates such as Houston state representative Garnet Coleman, a Democrat who has been pushing for better mental health funding since he arrived in the House, in 1991, say the system has not yet recovered from the 2003 legislative session. Facing a budget deficit of $9.9 billion, lawmakers reduced mental health benefits for children, eliminated Medicaid counseling for adults, and consolidated twelve state agencies into the massive Texas Health and Human Services Commission. Altogether they cut $400 million out of mental health funds. But while state leaders like to claim that consolidation saved the state $1 billion, Coleman argues that it created “a pipeline to the county jail.” “It wasn’t the consolidation that saved one billion dollars,” he told me. “People just didn’t get care.”
Budget cuts in the 2003 session also resulted in new limitations on the diagnoses that could qualify a person for public mental health services. Previously more than five types of diagnoses had been covered, including crippling anxiety and compulsive tendencies, but after 2003 only individuals suffering from schizophrenia, bipolar disorder, and major depression with psychotic tendencies were eligible. Since one fourth to one third of all Texans have no insurance at all, this put a lot of disturbed people in dire straits. In Harris County, the Mental Health and Mental Retardation Authority—the local agency that provides treatment to indigent mentally ill citizens—gets state funding to treat 8,500 clients every month, but an estimated 170,000 Harris County residents need public mental health services. Thousands of mentally ill Texans simply go without treatment every year.
Texas is now facing a fiscal shortfall as high as $20 billion, nearly twice what it confronted seven years ago, and state leaders are pledging to balance the budget with no new taxes. This has mental health advocates nervous, especially since an early proposal would have trimmed two hundred beds from four state mental hospitals. That draconian idea has been taken off the table, but there is little hope that funding will increase. Meanwhile, the state’s population grows, and demand for services continues to soar. “This is real life,” Coleman says. “These people are sick. It’s not different from cancer. When they don’t get treatment, they are likely to get worse.”
And with mental illness, “getting worse” often means the police get called. Last year, the HPD responded to some 25,000 crisis intervention calls, including 47 “suicide by cop” scenarios, the grim shorthand for someone who, in violent, gun-waving despair, tries to force the police to kill him. Of these, 3,300 resulted in emergency detention orders for psychiatric evaluations. According to an analysis by the Houston Chronicle, five mentally ill Houstonians were killed or injured by HPD officers last year (the HPD will not confirm this number).
New policies implemented after Steven Guillory’s death were supposed to change all that. Following the shooting—which came on the heels of two other police shootings involving mentally ill Houstonians—the HPD redoubled its efforts to confront the unwelcome but undeniable responsibility thrust on its shoulders by the meager public resources available for the mentally ill. Now dispatchers routinely ask callers if a disturbance involves a mentally ill person. In volatile cases, the HPD sends a special patrol team that pairs an HPD officer with a professional therapist (though sometimes the nearest unit arrives first). Houston’s new police chief, Charles McClelland, says he believes his crisis intervention response program—copied by departments across the country—has “saved lives and injuries to our citizens and officers.”
But McClelland can’t control the escalating numbers of untreated mentally ill people living in Houston. “I just hope our state legislators think about this,” he said. “If they do cut funding that decreases facilities, bed space, or treatment that we can give to the mentally ill, then where do they think these individuals are gonna go? What do they think is going to happen to these individuals?”
One sunny day in April I rode around in a patrol car with Patrick Plourde, a sergeant who supervises the department’s crisis intervention response teams. Mounted on the dashboard was a computer screen flashing various addresses where people’s lives were falling apart. Watching the screen, I began to think that all the normal activities—commuters headed to work or lunch with friends, shopping centers abuzz with traffic—were no more than a thin veneer over a cauldron of roiling craziness.
A call came in, and we raced down toll roads and residential streets to the home of a schizophrenic woman. She was big, angry, and delusional. Her words came in loud, spittle-laced bursts that were punctuated by violent, thrashing gestures. Occasionally, she would interrupt her narrative to curse someone in the room. She recounted improbable tales of sexual torture by unseen assailants. Her eyes bugged with fury; her hair shot out from her head at cartoonish angles. Her sister, who had called a crisis hotline looking for help, stood somber vigil by the front door, while an elderly woman using an oxygen tank sat in the corner, shaking her head in grief.
What happened next was a perfect example of how changes in policy can affect lives on the ground. When Plourde and I arrived, an officer named Joe Osborne, following the HPD’s new crisis intervention response protocol, was talking in soothing tones to the woman. “Now, that sounds pretty serious,” Osborne murmured softly when the woman briefly paused her tirade. “Can you come with me to the doctor so we can tell him about it? Kisha and I will stay with you the whole time to make sure nobody hurts you.” Meanwhile, therapist Kisha Lorio was interviewing family members about the woman’s drug regimen. After that she went and grabbed the woman a change of clothes. Their goal: to persuade her to walk of her free will to the back of their patrol car, so they could escort her to Harris County’s NeuroPsychiatric Center; there she’d be held for a mental evaluation and possible hospitalization. It worked, though she hesitated at the car.
With the patience of Job, Osborne stood about four feet away from the woman and repeated his promises of help.“Just go ahead and slide on in the backseat, and I’ll get the air conditioner going for you,” he said. “Nobody’s gonna lay hands on you.”
Family members looked as if they would cry with relief when Osborne clicked a seat belt over the woman and shut the patrol car door. Later, Plourde told me that Osborne’s tactic of letting the woman feel as if she were choosing to come with him was strategic: “There’s no way we’d leave her there when there’s an elderly woman who would be at risk. But if he had gone in yelling, ‘Hey, you’re coming with me!’ how do you think that would have gone down? You’d most likely have a fight on your hands.”
As incidents like this one have become more and more common, training for police officers has come to include more and more mental health education. “The police are being asked to fill a very difficult and unfamiliar role—as skilled clinicians,” Harris County sheriff Adrian Garcia said. Since 1999, the Houston Police Academy has offered cadets crisis intervention classes, in which they’re taught basic information about mental illness and various “de-escalation techniques.” (The first responders in the Guillory case, however, had not received this training.) Shortly after my ride-along with Plourde, I visited one of these sessions, led by an officer named Frank Webb. A wiry man who exudes energy, Webb bluntly told a class of about twenty veteran officers that when dealing with a mentally ill person, their attitudes would have to be “180 degrees different” from what they would normally bring to a crisis. “You come up in a uniform,” he said, “and it can be a powder keg of a situation.”
Psychotic people, he told them, “are hearing voices, and those voices are as real to them as my voice is to you right now. And those voices are very negative and saying some very weird stuff.” In psychosis, the brain’s frontal lobe, which controls judgment, shuts down, Webb warned his class. He counseled his students not to be surprised if a mentally ill person ignored them. “It may not be because he’s a butt but because he’s hearing three or four voices in his head and he doesn’t know who is talking to him. Or he could be having hallucinations. His voices could be telling him he’s gonna have to kill you.”
Though this sort of training has been set in motion by the increasing number of mentally ill people who go untreated, it could have helped generations of cops. It was not available when Garcia joined the HPD as a rookie, in 1980. Not long after he became a patrol officer, he encountered a guy named Jerome, an intimidating mountain of a man who was always rambling on about “all the dead people around him.” The first time he arrested Jerome, for drunk and disorderly conduct, Garcia confesses, “he scared the bejesus out of me.” After Jerome was handcuffed and sitting in the back of his squad car, Garcia offered to take him home. Jerome made a deal: “He said he would give me an address, so long as I would let him play with the siren.” Garcia had several more encounters on the street with Jerome before he transferred to an investigations unit. Sometime later he heard news that haunts him to this day: Jerome, violent and wielding a hammer, had been fatally shot by police.
Various crises, not only those involving the mentally ill, have caused the department to reform over the years. McClelland began his career a few years before Garcia, in 1977. That same year, five Houston patrol officers beat a Hispanic man named Jose Campos Torres so badly that when they went to book him into the city jail on charges of being drunk and disorderly, they were ordered to take him to Ben Taub Hospital for medical attention. Instead, they left him in Buffalo Bayou, where he drowned. The case sparked race riots; to this day, the name Jose Campos Torres conjures a dark history of brutality by the HPD.
“We’ve had a few officers who did some atrocious things that alienated this community,” McClelland told me as we sat at a long conference table in his downtown Houston office, one month after his appointment to chief. “Actually, those times during the seventies probably gave rise to the biggest reform era in HPD history. HPD didn’t change because we thought it was a good idea and decided to change. The community forced us to change.”
The same could be said of the HPD’s new response to the mentally ill: Each new step has been prompted by the outrage and introspection that follows a shooting. But should some of the community outrage be channeled toward policy makers in Austin? Sure, in each tragedy a cop fired the deadly weapon. But could it be that our lawmakers have created this nightmare for law enforcement? And the worst part is that it may end up costing us more money in the end. It is significantly cheaper for the Harris County MHMRA to provide treatment for an adult (around $705 a month) than it is for the Harris County jail to house an inmate in its mental health unit (up to $265 a day). Wouldn’t the fiscally prudent—and humane—option be to support treatment programs that keep as many mentally ill Texans as possible from ending up in the county jail in the first place?
“It’s a simple proposition—fund our programs for the mentally ill appropriately,” says Coleman. If the state’s budget deficit leads to a replay of the 2003 cuts, he cautions, “It will be an absolute disaster.”