In a state that already ranks 49th nationally in mental health per-capita expenditures, according to the Texas Medical Association website, proposed budget cuts by the Legislature could leave vulnerable Texans with serious mental illnesses without services.

The proposed 20 to 25 percent budget cuts may force the Pecan Valley Mental Health Mental Retardation center, which serves Johnson, Erath, Hood, Palo Pinto, Parker or Somervell counties, to discharge 500 adults and 50 children from their services in order to bridge an estimated $3 million shortfall.

“What we’re talking about here to the MHMR system in Texas is an amputation, not a scratch on the surface,” said Coke Beatty, the center’s executive director since 2006. “We’re dealing with folks who on a sliding scale typically pay nothing for their services because of their income level. We rely heavily on the general revenue service from the state.”

With a $14 million annual budget, the center’s outpatient community clinics in Cleburne, Stephenville, Granbury, Mineral Wells and Weatherford see more than 1,800 patients monthly, including 230 children, with long-term illnesses such as paranoid schizophrenia, bipolar disorder and major depression, Beatty said.

“We’re talking about counties that are growing. We have new people coming into our services all the time,” he said. “These are folks that are on psychotropic medications. The reason they’re with us anyway is because they can’t afford to pay a private psychiatrist for services and these are heavy duty medications that cost $3 or $4 dollars a pill. If they were to go out and pay for these medications on their own, they would be paying $1,000 a month just for their medications. They don’t have this kind of money.”

Beatty is concerned that those needing services the state can no longer provide could end up in costly hospital emergency rooms or in jails.

“What’s so frustrating with this too is that community services, according to the state’s own data, are much more cost effective than crisis services and institutional care,” he said. “If the state is looking at taking institutional beds offline and if they are also looking at cutting community services, where are these people going to go?”

Beatty explained that community services cost on average $11 a day, per person.

If someone needing mental health services lands in jail, he said, the cost goes up to about $47 a day and county is forced to pay the bill for expensive psychotropic medications and treatment.

“But that’s all that will be left if community services are cut. Just the most expensive services are going to be available to treat people,” he said. “We have an extensive crisis system in the community, where we have trained staff on call 24-hours a day, seven days a week. When we have an outpatient crisis, our costs are $623 per episode [according to the Department of State Health Services]. If that person goes into a state hospital, then those costs per episode are $14,436.”

The proposed cuts could also leave 30 employees out of work in the system.

Of the 200 Pecan Valley employees in the six county system, 85 work in Johnson County.

“What I’m afraid would happen is when services are cut in rural counties, they generally never get refunded, and if we lose these services, it’s high probability that these funds will never be reinstated,” he said.

More than 4.3 million Texans, including 1.2 million children, live with some form of mental health disorder, according to the Texas Medical Association. Of these, 1.5 million are unable to function at work, school, or in the community due to their illness.

The economic impact of mental illness on state and local governments is more than $1.5 billion per year. Each person repeatedly jailed, hospitalized, or admitted to a detoxification center can cost the state an estimated $55,000 per year.

Johnson County Judge Roger Harmon is not only concerned about increased mental health costs playing havoc with the county budget, but as a member of the Pecan Valley board of directors, he’s also concerned about stigmatizing and criminalizing those with mental illness.

“This would be a really tragic cut. People who are mentally ill are no different than someone who has a heart condition or a diabetes problem or any type of health problem,” Harmon said. “If you have a health problem, you need to be in some type of hospital setting. A county jail is not a hospital setting. We don’t need to be housing people who need to be in some type of mental health facility getting good mental health treatment.”

Beatty said that although they do not know how the proposed cuts would affect each specific county, they are starting to make contingency plans and will work with the board of directors to determine final decisions.

“We’re looking at all the scenarios on how we can continue to provide effective community cost-effective service and serve as many people as we can. We’re creating worst-case scenarios in-house to get ready for whatever the legislators decide on. We’re at their mercy,” Beatty said. “We’ll do what they want us to do and we’ll provide the services they want us to provide, but we see that the need is so great. We just don’t want them to cut a dollar to spend three dollars. We all have to live by a budget and we’re for accountability.”

And like many school superintendents who have been lobbying against education cuts, Beatty hopes that residents will contact their state representatives to lobby against cuts for mental health funding.

“The call to action would be to call your state legislature and let them know that cutting services to the most vulnerable Texans is unacceptable — people who can’t care for themselves and who will be left homeless, jobless and without services. Persons of mental retardation and mental illnesses are some of the most perpetrated upon people in the nation,” he said. “They are actually taken advantage of more than people realize. To de-fund services to some or our most helpless individuals and fellow Texans is unconscionable. I don’t know how to take 500 people of their medication. I just don’t know how that would work.”