Low-Bidding Mental Illness
The idea of putting Kerrville and Texas’ other mental hospitals up for privatization didn’t come from any state agency, but from the Texas Legislature. Who in the legislature slipped this measure into a rider on an appropriations bill last year isn’t so easy to determine.
“We oversee the hospitals as directed by the legislature. So we were following their direction in putting out the bid,” Williams said.
The rider directed that all the state hospitals for the mentally ill be offered up as public-private partnerships — but GEO Care’s bid for Kerrville was the only one received for any of the hospitals. The legislature tried the same thing in 2003 but got no takers at all, probably because that measure called for a 25 percent savings to the state.
This time the rider was attached in appropriations committee hearings during the regular session and again during a special legislative session in August.
“There’s crap that gets slipped into the appropriations bill every session,” is how State Rep. Lon Burnam put it. The Fort Worth Democrat is opposed to privatizing any public service, but he particularly detests the anonymous, back-door method by which this major change for an important institution was put in motion.
“Riders are simply attached to the appropriations bills with no ownership,” he said. “No one is the recognized author, and they are not voted on separately when the appropriations bill is voted on. If members of the legislature don’t go through the riders and pull them out to amend them if they don’t like them, well, then, when you vote on the appropriations bill, you’re also voting for the riders.”
Burnam finds the use of riders fundamentally flawed because they’re not done in a way that’s open to the public. “In fact, they’re not even added with the awareness of anyone in the legislature who is not on the appropriations committee,” he said.
When the legislature meets in January 2013, consideration of GEO Care’s bid for Kerrville will be on their to-do list.
Adrianne Kennedy, president of the National Alliance on Mental Illness, said it would be premature for Texas to award the Kerrville contract to GEO or any other company until the issue is first studied extensively. Her group is the nation’s largest grassroots mental health organization, dedicated to helping those affected by mental illness.
Privatization of a public institution requires strict oversight to protect the public interest, she said. There are complex community issues at stake, she said, and “it can be deceiving to be saving money on the front end and in the course of these illnesses, you wind up spending money on the back end.”
The push toward privatization is only one part of the serious crisis in mental health care and treatment in this country, Kennedy said. Because there aren’t enough resources in most communities, mental health issues often don’t get treated early, when they are manageable, but only when they become major problems to individuals, families, and the community.
“We have a huge population of people with mental illnesses who received little or no care until their situation was in crisis,” she said. Many mentally ill people didn’t have to wind up entangled in the criminal justice system, she said, if they’d received help early on.
Those who develop mental illness all too often become “throw-away people,” Kennedy said. “One day they are the stars of their football team, leaders of their class, and then suddenly their mental illness crops up, and they just fall off the face of the earth. And they didn’t need to.”
To privatize state mental hospitals before the deeper challenges of mental health care are addressed is putting the cart before the horse, she said. “The truth is we have to make mental illness something we can talk about and something that constituents care about. Otherwise those people will always be marginalized.”
Repeatedly, advocates and others asked where legislators think the 10 percent savings — on top of a profit percentage — is going to come from at Kerrville or any state hospital in Texas.
“The hospitals are already run on a shoestring,” said Lynn Lasky Clark, president of Mental Health America of Texas, the state’s oldest mental health advocacy organization. “So where are you going to save that money if not [by reducing] the care of the patients? Who will they hire for staff? Will they provide less benefits to their workers? Less pay? All of those things will [affect] the caregivers, which in turn will affect the patients.”
Katherine Ligon, mental health policy analyst with the Center for Public Policy Priorities, described the financial situation of Texas’ mental hospitals this way: Wring all the water out of a washcloth, until it’s bone dry. That’s the current Texas mental health budget. Now try to take 10 percent more water out of it. That’s what the legislature is demanding GEO Care do at Kerrville.
“We don’t spend any money on mental illness in Texas to begin with, so how can we possibly reduce that without jeopardizing the quality of care we provide?” she said. “We want to assure the quality of care of those patients and put that above the costs or possible profit of a private company.”
Garnett said MHMR facilities and agencies in Texas are asked periodically to review whether a private company could provide some of their services better and/or for less money. That’s a legitimate consideration, she said, but she fears the public may think that the private sector will automatically do a better job. “And that’s not always true, particularly in the case of mental institutions, where saving money and lowering care is not a good equation.”
When GEO Care came in to run mental hospitals in Florida, it was to help remedy a situation in which the state was under court order to improve a poor level of care.
But no one questions the quality of care being delivered at Kerrville, Garnett said. “In Texas it’s all about appropriations, that’s all.”