We have an off/on mental patient (female) who has been committed and released from the state mental hospital at least 30 times. We have a male patient (who has insurance) whom we have committed 5 times in the last 5 months. The private mental hospital keeps him only 3 or 4 days to give medicine and then releases. Next week, the deputies are out chasing him around his parents home because he is running around naked or making some other mayhem. Same with the female patient. I guess many of you have the same problem. Do we just have to keep taking these people, who refuse to take medication, back and forth to the mental hospitals until kingdom come?

It's been a few years since I've done involuntary mental health commitments, but if I recall correctly, we only refer patients who are a danger to themselves or others. If they're not, we don't take them. It's frustrating for the families when there's no evidence of danger because they feel helpless for their loved one (frequently the revolving door patients who are really off, but not dangerous), but I believe it is a legal requirement that if it's an involuntary commitment, there has to be some evidence of potential for them harm themselves or others.

The answer to the question at the end of your post is, "Yes, you do," but with a couple of footnotes. Efforts to de-institutionalize the mentally ill began back in the 60s and 70s, and the truth is, there are hundreds of thousands of mentally ill citizens who are living productive lives in the community because they stay on their medications, stay in contact with counselors/case managers, and have the self-awareness to understand when they are headed into a tailspin, knowing that it's time to utilize the resources that are available to them. You don't hear much about these folks.

The folks you do hear about are the ones such as you described. The "haul 'em in, medicate 'em, cut 'em loose, repeat as necessary" process has troubled law enforcement and mental health professionals alike for years. If you search the phrases, "police shoot mentally ill," and "officer killed by mentally ill," you'll get far too many hits. This problem seems to stay under the radar until you have an incident like the one in Austin a few years where an officer killed a mentally ill woman who was about to stab a housing worker. Expectedly, the community outcry was loud, and the finger pointing went 360 degrees (she should have been hospitalized, the cops should have tazed her/negotiated with her, etc.).

The guy with the most tricks up his sleeve on this topic is Frank Webb, the coordinator for the Houston P.D. Mental Health Crisis Intervention Team. He was a key player in the concept and curriculum development for the TCLEOSE-mandated crisis intervention training. I'm sure he'd be happy to provide some insight or suggestions for your situation. Frank can be reached at 281-230-2456.

Good luck.

Just talked to one of our folks who currently do involuntary mental health commitments, and he said in addition to overt act/danger to self or others, if someone has severe deterioration such that they can't take care of themselves then we do the commitments on those also. So my previous answer was not completely accurate (I guess I'm not Rabbit after all ). Naked man running around not on meds has probably deteriorated. So I concur with R.W. that probably yes, you'll have to deal with the same folks over and over if there's deterioration. The question, though, is why are they being released? If they're not staying in long enough to be monitored and counseled on a treatment plan that they get used to and are comfortable enough with, then why let them go? The only answer I can come up with is bed space. Mental health services don't have the funds or the beds to keep low-risk patients.

There seems to be a shortage of bed space for even the high-risk patients. We routinely see cases in which markedly psychotic patients with schizophrenia or schizoaffective disorder beat the bus back from Wichita Falls. It is a disturbing set of circumstances, though it is not my intent to poing any inculpatory finger at any of the providers involved. Money's tight everywhere, I suppose.

I am presuming, perhaps wrongly, that you are in Cooper and the Terrell SH catchment area.

But, viz. civil commitment, whether the receiving facility is either a state or private facility, as in Paris or Tyler, the criteria are (a) mental illness and (b) likely danger to self or others, or (c) the deterioration standard, coupled with "a recent overt act" or "continuing pattern of behavior".

The problems are multifold, Scott put it rightly that there is a lack of availability of bed space in the state facilities. And on the local level, there are few community resources which have an aggressive outpatient treatment program that will go to the patient if the patient refuses, or has few assets, to get to them. There are, however, depot or long-acting antipsychotic agents which can be administered by injection (2 wks, to 4 wks. duration depending on the agent) if there is a psychiatrist in the area, or cooperative family physician in the absence of a psychiatrist, to prescribe such.

The short answer to your question is "yes" - recividism is high in this group. Some 40 years ago, there were 10 state hospitals and about 4000 patients in each - they grew their own food and provided work opportunities for chronic patients. Now there are still 10 state hospitals, but about 400 patients in each and the other 45,000 are walking about our communities lying in the doorways of those institutions dedicated to the preservation of their liberties, but covered in their own filth and excrement. And we call that "progress."

Good luck. On any procedural issues, feel free to contact me back channel. I would try for extended commitments - and outpatient ones that allow modification on a simple form with an abbreviated hearing.

What you are dealing with, Mike, is the result of "mental health reforms" from the early 1960s. Apparently, state mental hospitals were declared "bad" all over the US, and not just in Texas. Seriously mentally ill patients were released, to be handled by neighborhood mental health clinics.

The trouble is, that the people who were in these hospitals were there because they could not manage their meds, or were otherwise too dangerous to release. And so, in an effort to give them the dignity they deserve, they were released from the safe and secure hospitals to live on the streets, as Floyd describes. Many of these people commit crimes, including murder, and end up in prison, where they are extremely vulnerable to other inmates.

The most humane thing the legislature could do is repeal the "reform" legislation, and go back to the way things were in 1959.