As in the Clayborne case, attorney Maloney says a lack of adequately trained workers contributed to Steele's death. Specifically, Maloney says Laurel Ridge follows a morally bankrupt treatment program in which it relies on entry-level workers, instead of doctors and nurses, to care for children who are so sick they can't function in mainstream society.
But Maloney is not an advocate for more rules. "This industry already is regulated to death. Staffing is the scandal of these places."
Maloney's arguments echo what most mental health advocates, including health care providers, say is the root of the problems relating to restraints: Facilities can't or won't keep enough quality workers on the job. Instead of treating its patients' illnesses, they simply medicate and warehouse them.
Peggy Perry, the woman who oversees the state's adult psychiatric facilities, won't dispute that she has trouble with staffing. At TDMHMR, Perry says she is constantly battling high turnover rates--particularly among nurses, who in the past five years have left the agency at an average rate of 36 percent a year.
While Laurel Ridge is a for-profit corporation, TDMHMR is dependent on state lawmakers for money, and, historically, they haven't given enough of it to help people like Perry offer competitive salaries. The problem has been exacerbated as the state's economy boomed and workers were in short supply. State lawmakers did provide some rare relief when they recently voted to give all state employees a raise; they even increased the salary rates for their mental health workers. Still, the pay for an entry-level mental health aide at TDMHMR is just $1,423 a month.
"It had gotten to the point that in most areas folks could go to McDonald's or Taco Bell and almost make more money working there," Perry says.
Fort Worth Senator Mike Moncrief, one of the mentally ill's best advocates in Austin, has been trying for years to pass restraint-related legislation, among other efforts on behalf of the disabled, but his efforts never seem to get past the Finance Committee. Today Moncrief fears his colleagues have missed their window of opportunity: They failed to pass more funding for social services programs when times were good. Now that the economy has turned south, Moncrief is dreading what'll happen next session.
"We have painted ourselves into a corner. We have not kept up with the growth of the state and the demand that places on our social services," Moncrief says. "We need more eyes and ears telling us what's going on in these facilities, not less. We need to pay those providers a commensurate rate of reimbursement for their services. We need to pay our doctors on time. It's a huge financial issue."
The end result, Perry concedes, is patients really don't get any effective treatment--especially at places like Terrell, where they are simply kept until their medications kick in and they no longer appear to be a threat to themselves or others. Then they are sent away.
"The most effective thing we do is psychoactive medications," Perry says. "That's probably the most important treatment intervention we have."
Medication is about all Macie Stafford got when he wound up back at Terrell in November 1999.
Stafford had been there once before, committed in December 1998 and released the following May. While he was there, he was diagnosed with neurosyphilis, a disease that had reached its heyday before World War II when it filled the nation's mental hospitals with victims. They commonly died in a state of dementia after the disease robbed them of their ability to remember and left them sinking in despair.
In between his commitments, Stafford occasionally stayed with his daughter, Katherlyn LaGale Walker. She thought he had "syphilis," the early stage of neurosyphilis, and says she never really understood what was wrong with her dad. When he was acting OK, he'd spend his time fixing cars at various garages, where he would also sleep. When it got cold, he came home.
"I was trying to make sure he was taking his pills and stuff," says Walker, who also took him to and from the local MHMR facility where he got his medications. "They would ask him a couple of questions, refill his medications and send him off."
That fall, Stafford started acting like he wasn't OK. Walker knew he was really off when he failed to fix her car. He was becoming increasingly disoriented. He didn't know what year it was. One day he was cooking spaghetti and cornbread together. Then he started leaving home for days at a time. Invariably he'd call Walker and she would bring him home. Walker would probe him to see if he was still taking his medications.