Texas Medical Center News


Vol. 21, No. 1		January 15, 1999

Psychiatric Center Working to Ensure Continuum of Care

The Harris County Psychiatric Center (HCPC) is a 250-bed academic public mental health care facility. It is the largest psychiatric facility on the Gulf Coast. HCPC is an operating unit of The University of Texas-Houston Health Science Center and is staffed by the faculty of UT's department of psychiatry and behavioral sciences.

HCPC embraces four basic missions: to provide treatment for persons with mental illness; to serve as an educational site for professionals training in the care of the mentally ill; to participate in research into the causes, treatments and cures of mental illness; and to be involved in community education about mental illness.

HCPC opened in October 1986. It has served over 50,000 patients.

"If you don't serve the population that we do, they may well end up in jail or living under a bridge," says Dr. Robert Guynn, executive director of HCPC, and chairman of UT's department of psychiatry and behavioral sciences.

"The system has improved, compared to what it was 20 years ago," he says. "There is greater emphasis on continuity of care. Still, there is a 'disconnect' between provider groups: when someone - a providing agency - receives a patient, they start all over again. So we need to work on that. Here [at HCPC] we are moving towards more intense outpatient care, and many of our patients receive care from the Mental Sciences Institute (MSI). As we consolidate functions between HCPC and MSI, this continuum of care will become the norm, I think. And, of course, the emphasis on outpatient care will enable us to treat more patients.

"I see the development of this campus into a center for neuropsychiatric care, bringing together basic sciences and the clinical care areas. Being a part of a medical school allows us to imagine some real potential, to create a grand scheme."

In Harris County, 40,000 adults and 20,000 children suffer from some type of mental illness. Costs associated with mental illness are more than with heart disease, or cancer or AIDS.

In fiscal year 1998, there were nearly 6,000 admissions to the Harris County Psychiatric Center, four times that of the Houston-area hospital with the next most admissions. Of the 12 state psychiatric hospitals in Texas, HCPC had twice the number of admissions of the next closest facility.

About half of HCPC's patients are committed to the hospital through the court process by concerned family or friends, and the remainder referred by Mental Health and Mental Retardation Authority, Harris County Hospital District, private hospitals, the Mental Sciences Institute and police departments. In 1998, HCPC provided nearly $33 million in uncompensated care.

Importantly, the average length of stay at HCPC has decreased significantly over the last 10 years, from 21 days in 1988 to nine days in 1998.

"The reduced length of stay highlights two areas," says David R. Small, administrator of HCPC. "There are better treatment models than a decade ago, and there are better medications. So you have patients doing well in the hospital, and that's great. But if you don't have all the community supports in place when the patient is discharged, or if the discharge plan isn't in place, then the patient will probably not do very well.

"There has been tremendous emphasis these past 20 years on de-institutionalization, but the monies from state hospitals have not been sufficiently shifted to the communities," says Small. "Most of the dollars that do go to communities are for crisis intervention. Many - if not most - of our patients have complex needs. They are extremely fragile, and typically have several health care needs. If all the issues are not addressed, then the chance for long-term stabilization is far less certain."

In 1998, HCPC launched its Partial Hospitalization Program (PHP), an innovative alternative to inpatient care. Patients who are returning to the community following inpatient care or outpatients needing closer monitoring, benefit from services offered 8:30 a.m.-5 p.m. It is, at once, a structured but less restrictive environment with sessions in occupational therapy, stress management, health education, and individual and group therapy.

The PHP is designed to help patients re-enter their community and their society following their illness.

HCPC also has ongoing protocols with new medications. "New generation" antipsychotic and antidepressant medications have been studied at HCPC; the new medications have proved to be remarkably successful, especially in their lack of side effects.

"Fifty to 60 percent of our patients are dually diagnosed," says Dr. Guynn. "They may be mentally retarded and schizophrenic or, more typically, they have a severe mental illness and they are substance abusers. These are very challenging patients for us, but there has been some very good work done lately, here and at MSI, especially with substance abusers. We've made a kind of progress that was hard to imagine 30 years ago.

"When I was a resident, the thought was that any child who had been hospitalized would surely become schizophrenic. Of course we know so much more now," says Dr. Guynn. "Children are so different from adults: they may act out rather than being sullen. So it takes some very astute parents and teachers to watch for symptoms that could be serious.

"The entire system is still too fragmented, and the waiting lists are too long. There are just too many disconnected families, too many absent parents.

"Nevertheless, I am hopeful. I think the more efficient we become, the better services we offer. There is much more communication, more interaction, between agencies - us, the Mental Health and Mental Retardation Authority, the Mental Health Needs Council, law enforcement, judges."

"The costs of doing the business of treatment are higher," says Small. "We have more compliance requirements. Medication costs have risen dramatically. New technologies such as brain imaging are costly. But not providing quality patient care, education and resources will be much more costly in the long run."

"Too many people still think a person with mental illness can 'get it together' themselves," says Dr. Guynn. "That mental illness can be willed away. It's that sort of stigma which keeps four out of five people needing help from seeking it. So it's very important that we continue informing the public. And we have to make sure that if people need help, they can access it, that the system is friendly."

- Roger Widmeyer

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