Alex Smith is the executive director of the North Texas Behavioral Health Authority, the agency that oversees the North Texas public mental health care system. He's made his living deciphering the ins and outs of the very messy system here, and is well versed in what it takes to properly care for indigent mentally ill patients. In fact, thanks in part to the policies enacted by the NTBHA, North Texas clinics have no waiting lists for needy mental health patients, a rare feat in Texas, Land of the Underfunded.
But Smith is worried about how long North Texas' record can stand untarnished. Despite last session's much-lauded budget increase for state mental health services, Dallas has seen a paltry a 0.6 percent increase in funds. And with an ever-increasing population of needy mental health patients, the chump change isn't cutting it, Smith says. "Our system sees 34 percent of indigent mental health patients," Smith says. "But we only receive 18 percent of state funding."
Dallas County's mental health care system falls under something called NorthSTAR, a public-private system that partners NTBHA with a private operator to disperse state funds to needy mental health care patients in seven North Texas counties. In the 2013 legislative session, lawmakers voted for a $259 million increase in funding for mental health care. Plenty praised the initiative, local mental health care officials included. But more than a year later, mental health care facilities in Dallas have barely seen an impact.
The state, it turned out, prioritized funding for facilities with patient waiting lists -- logical enough. But even when the wait lists are cleared, the money continues to flow into the same places, officials here say. Meanwhile, because NorthSTAR didn't have a waiting list to begin with, NorthSTAR's funding has remained mostly stagnant. It doesn't make much sense, unless you consider the state agency at hand: the Department of State Health Services, which was recently excoriated by a state watchdog, the Sunset Commission.
"We got a pittance of that big  increase, because the way the DSHS chose to allocate those funds disadvantaged our area, or any area that didn't have a waiting list," says Matt Roberts, president of Mental Health America of Greater Dallas. "So if the big funds go to cities with a waiting list, and you don't have a waiting list, you don't get that money. It incentivizes inefficiency."
Liam Mulvaney is president of Lifenet Texas, which provides mental health services to NorthSTAR eligible patients. Lifenet receives a prorated state-funded amount each month to provide services to needy mentally ill patients. If the clinic ever has an excess of money at the end of the month, he says, it has to send that money back. But if the clinic overserves patients, they are generally not reimbursed for those extra services.
"At times we have to turn people away because we feel like there's not going to be any reimbursement for our services. And we're not unusual in that regard," Mulvaney says. "Without a doubt, we're turning people away. We either refer them to another provider or suggest they come back another day."
The result, he says, is poorer service. Some patients may be seen by a psychiatrist every other month, instead of every month. Case managers aren't always able to regularly trek out to a patient's home.
"We tell people, 'You have to find a way to get into our clinic.' And that's hard for the people we deal with. Many have to take one or two bus lines, and they aren't very organized. They have trouble getting out of bed, let alone making transportation arrangements," Mulvaney says. "We at Lifenet feel very strapped for resources and are very overwhelmed with the need for services we need to provide."
Smith says some providers are already contemplating pulling out of their relationships with NorthSTAR, leaving indigent patients with even fewer options. "Clinics and hospitals that are taking care of our patients are considering not renewing their contracts with NorthSTAR. They're telling us that at some point if financial relief isn't found, they may not be able to sign future contracts."