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A Guide to Public Mental Health Services in Harris County

Mental illness is more common than heart and lung disease, yet many refuse to seek treatment because of the stigma associated with mental disorders or they are uninformed about how or where to go for help. One in five people, or 350,000 adults and 130,000 children residing in Harris County, will suffer from a diagnosable mental illness during their lifetime.

Multiple agencies are involved in providing mental health services so at times receiving care can become a difficult task, creating a greater concern for continuity of care. Providing timely and appropriate care is a priority of each agency as they look for the least restrictive treatment environment for their patients.

The following agencies comprise the public mental health system in Harris County: The Mental Health and Mental Retardation Authority (MHMRA) provides outpatient services to more than 30,000 people annually and operates the NeuroPsychiatric Center providing 24-hour crisis evaluation and treatment. The University of Texas Harris County Psychiatric Center (UTHCPC), operated and staffed by The University of Texas-Houston Health Science Center, provides hospitalization to more than 5,000 patients annually. Ben Taub General Hospital operates emergency, inpatient, and outpatient services for persons eligible for Harris County Hospital District (HCHD) services. The Rusk State Hospital, operated by the Texas Department of Mental Health and Mental Retardation, provides long-term hospitalization to those in need. Other entities within the public mental health system are the Harris County Probate Courts # 3 and # 4. These courts hear more than 5,000 cases annually for those requiring court-ordered mental health services.

Members of the public mental health system and the community came together to prepare the following information in the hope that those in need of services could access them more easily with an improved understanding of the Harris County mental health system.

Mental Illness - The Warning Signs
Some signs of possible mental illness, if persistent or severe, for which professional help should be considered are:

* Change in thinking, mood or behavior
* Confusion, poor concentration, indecision
* Depression, apathy, sleeping pattern changes
* Anxiety, fear, withdrawal
* Inappropriate emotion responses to people or events
* Feelings of losing control
* Addiction to chemicals, people or events
* Thinking or talking about suicide
* Delusions, hallucinations

What To Do In An Emergency
During psychiatric emergencies, the following options are available:

If the person voluntarily seeks treatment, he or she may call or go to the NeuroPsychiatric Center (MHMRA), located at 1502 Taub Loop, telephone 713-970-7070, or Ben Taub General Hospital (HCHD), located at 1504 Taub Loop, telephone 713-793-2000. Both of these facilities are in the Texas Medical Center.

If the individual is in immediate danger or is endangering others, call 911 or the local police department. When calling the Houston Police Department, request a crisis intervention team, or CIT, so officers trained to recognize and communicate with the mentally ill can be sent to help. The police will assess the situation and may, but are not required to, bring the person to the MHMRA Neuropsychiatric Center for psychiatric intervention. If the law enforcement officer elects to transport the person to NPC, the police will file a request for an Emergency Detention Order so that the person may be kept involuntarily in the hospital for a psychiatric evaluation.

If there is a medical complication, an individual may go to the Ben Taub Generalgraphic for when to call 911 Hospital Emergency Center, 1504 Taub Loop, in the Texas Medical Center. Emergency room physicians will treat medical injuries resulting from a suicide attempt or trauma, and acute medical conditions resulting from a drug and/or alcohol overdose or other co-occurring medical illnesses. For treatment of psychiatric problems, the social worker will make referrals to a mental health facility.

Treatment is also available at the emergency center of any hospital that has a psychiatric unit. Those with insurance should contact their insurance company to determine which hospitals are designated on their care plan.

If the person is a veteran who is eligible for VA healthcare benefits, treatment is available at the Houston Veterans Affairs Medical Center, 2002 Holcombe Boulevard.

Follow these guidelines to determine which hospitals accept Medicare, Medicaid or Medicaid-HMO:

* If the hospital is a full-service medical hospital with a psychiatric unit, Medicaid, Medicaid- HMO or Medicare may be accepted.
* If the hospital only provides psychiatric services, Medicaid-HMO may be accepted for adults. Medicaid and Medicaid-HMO may be accepted for children.

It is suggested that you contact the hospital of your choice to determine which method(s) of payment they accept. It is recommended that families determine which hospitals cover treatment costs under the insurance plan of their ill relative in order to make the selection of a hospital prior to a crisis.

Voluntary or Elective Treatment

MHMRA
After a psychiatric evaluation, MHMRA determines who has priority for inpatient or outpatient treatment. When there is a huge demand for public psychiatric services, clinic appointments for ongoing services may not be readily available. However, crisis services can be accessed through the NeuroPsychiatric Center.

Adult Services
Persons seeking psychiatric treatment may request an appointment at MHMRA by calling 713-970-7070. Based on symptom descriptions, an appointment may be scheduled with a clinical evaluation specialist to determine eligibility for services. If eligible, an appointment is scheduled with an MHMRA psychiatrist for further evaluation and treatment.

Persons eligible for Harris County Hospital District services may ask their primary physician in the community health clinic to make a referral to the Ben Taub General Hospital for psychiatric outpatient services.

Anyone in a psychiatric crisis may go to the NeuroPsychiatric Center at 1502 Taub Loop, 713-970-7070; or Ben Taub General Hospital at 1504 Taub Loop, 713-793-2000.

Chemical Dependency Services
MHMRA does not provide services for people with a single diagnosis of chemical dependency. Contact MHMRA's Access Center at 713-970-7070 to obtain referrals to the appropriate treatment facility; or, check the telephone numbers at the end of this pamphlet for referral to agencies providing treatment for substance and alcohol dependency.

Child and Adolescent Services
Persons seeking psychiatric treatment for children and adolescents may request an appointment at MHMRA by calling 713-970-7070. Based on symptom descriptions, an appointment may be scheduled with a clinical evaluation specialist to determine eligibility for services. If eligible, an appointment is scheduled with an MHMRA psychiatrist for further evaluation and treatment.

Court-Ordered and Involuntary Mental Health Services

Arrangements to obtain a court order for mental health services may be made through the Mental Health Division of the Harris County Clerk's Office. The Mental Health Division is located at UTHCPC, 2800 South MacGregor Way, and open from 8 a.m. to 4 p.m., Monday through Friday, except holidays. The telephone number is 713-741-6024.

Anyone over the age of 18 who has personal knowledge of someone they believe poses a danger to him or herself or to others may request a mental health warrant.

Involuntary Commitment Process for Adults

1. To begin the involuntary commitment process, the applicant (person who is filing for commitment) requests and completes an application for a warrant from the Mental Health Division of Harris County Clerk's Office at UTHCPC.
2. MHMRA staff at UTHCPC screen applicants once a bed is available.
3. A warrant may then be issued by the Harris County Clerk's Office. The whereabouts of the person must be known so that a Harris County Deputy Constable may take the person to UTHCPC.
4. The UTHCPC physician must provide a medical certificate within 24 hours of the patient's admission in order for the court to determine if it is necessary to issue an order of protective custody (OPC). Once the OPC is issued, an attorney is appointed to the case. Probate Courts #3 and 4 are located at UTHCPC, 2800 South MacGregor Way, and may be contacted by calling 713-741-6020.
5. Within 72 hours of the issuance of the OPC, the probable cause hearing is held in which the judge determines whether to hold the person at UTHCPC until the mental health hearing. The applicant does not have to be present at this hearing.
6. The mental health hearing must occur within two weeks of detention. In Harris County, this final hearing is usually within eight days. During the mental health hearing, the court determines the appropriate treatment based on testimony provided by the applicant (usually a family member or friend), medical experts and the patient. The result of the hearing may be:

* Dismissal
* A court order for outpatient treatment
* Inpatient hospitalization

Involuntary Commitment Process for Children and Adolescents
Call MHMRA at 713-970-7070 for an appointment for a psychiatric assessment at one of their clinics. An MHMRA psychiatrist will provide an evaluation of the child or adolescent and make the necessary referral for outpatient or inpatient treatment. In a crisis, go to the NeuroPsychiatric Center, 1502 Taub Loop.

How To Access Treatment at the University of Texas Harris County Psychiatric Center
There are four direct ways to access public psychiatric hospitalization at the University of Texas Harris County Psychiatric Center (UTHCPC). They are:

1. Through court-ordered, involuntary mental health services in which an application is filed with the Mental Health Division of the Harris County Clerk’s Office (see court-ordered admission section)
2. Transfer from another hospital or treatment center. Transferring staff must obtain administrative and medical clearances prior to patient transport and admission to UTHCPC
3. Direct admit or walk-in patients may come on their own or through thier private physicians referral.
4. Patients may voluntarily walk into UTHCPC for screening by an MD to determine criteria for admission. This is not the preferred route to gain access. If the hospital is at maximum capacity, these patients will be referred to the MHMRA Neuropsychiatric Center

FOR ADMISSION INFORMATION, CALL 713-741-3883

Confidentiality Guidelines

The federal government and the State of Texas have established statutes and regulations governing disclosure of information pertaining to a person's mental health care. Additionally, the codes of ethics for all mental health providers (psychiatrists, social workers, substance abuse counselors, psychologists, nurses, etc.) address the protection of the person's right to privacy.

Confidentiality concerns the clinician's obligation not to reveal information to others without the patient's specific written consent. Treatment facilities have a circle of confidentiality within which the sharing of information does not require the patient's permission. Included within this circle are all members of the treatment team, supervisors and consultants within the agency or treatment facility.

There are several exceptions to the confidentiality rules. They include:

Emergencies
In bona fide emergencies, information may be released for the sake of emergency interventions, but efforts should be made to obtain the patient's permission. The need to obtain a history, information on current behavior/treatment and medications/significant incidents, takes precedence during emergency situations.

Reportable Conditions
Child abuse must be reported to Children's Protective Services. Certain communicable diseases require mandatory reporting to government agencies. Additionally, threats made against the U.S. president require reporting to the U.S. Secret Service and gunshot wounds must be reported to the local police department. A reasonable belief of abuse of the elderly or the disabled adult must be reported to Adult Protective Services.

Duty To Inform Third Parties
Since the 1976 court decision on Tarasoff vs. the Regents of the University of California, it is generally thought advisable for mental health professionals to warn or to take reasonable steps to protect endangered third parties under the following conditions:

* When a patient makes a threat to harm a specific person
* When there is clear and present danger

However, a Texas Supreme Court decision (Thapar vs. Zezulka) determined that a mental health professional has no legal duty to warn a third party of a patient's threat to harm. The mental health professional however may contact the appropriate officials in the event that the professional has determined there is a probability of imminent injury by the patient to himself or herself or to others, or mental or emotional injury to the patient.

Section 611.004 of the Texas Health and Safety code does allow disclosure of confidential information "to medical or law enforcement personnel, if the professional determines that there is a probability of imminent physical injury by the patient to the patient or others or there is the probability of immediate mental or emotional injury to the patient." The code allows disclosure of confidential information to a governmental agency if the disclosure is required or authorized by law.

Mental health professionals generally understand the frustration confidentiality rules may cause to families, friends and significant others. At times, distinctions may be made between internal processes that are private and behaviors that can be considered public. At all times, the care of the patient and the protection of the patient's rights must be sustained.