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