TMA Testimony by Les Secrest, MD
Senate Finance Committee
Article II: Health and Human Services
Thurs., Jan. 31, 2013
Good morning Chairman Williams and members of the committee. My name is Les Secrest, MD, and I’m a psychiatrist from Dallas. I currently work at the Presbyterian Hospital of Dallas, as chair of its Department of Psychiatry. I’m also chair of the Texas Medical Association’s (TMA) Council on Legislation and today I’m speaking on behalf of 47,000 physicians and medical students.
I’m not here today to talk to you about Texas being the state with the least public mental health funding per capita; or about the 4.3 million Texans with a mental health disorder; or that for every $1 spent on mental health services, Texans would see $23 returned.
Instead, I am here to put a face on Texans with mental health disorders, the Texans who care for them, and our delivery system. We’ve heard the comment, "He just needs to reach down and pull himself up by his bootstraps." We often forget that psychiatric disorders are a product of a brain that is dysfunctional. Some of my patients don’t have the brain equivalent of bootstraps, some don’t know they have boots, and some are not concerned if they are barefoot.
No one signed up for these disorders. We work in a system that needs more care managers and more hospital resources. Lack of these resources causes all parts of the medical delivery system to become inefficient, such as our emergency rooms.
One of my patients who had a severe psychiatric disorder was responding slowly to treatment and was often in an agitated state, waited 30 days in our acute care psychiatric unit for a bed in the state hospital, which would be better to serve his needs.
Recently I asked one of my colleagues how he would use an increase in mental health funding. After a short contemplative gaze at the floor he replied, “I use to think more residential beds. Now I realize we also need more care managers.”
He then told me the following. "I go to the jail to supervise our residents and see patients. During my last visit, I saw a 40-year woman, who was manic despite treatment for bi-polar disorder. She had a history of repeated arrests but had effective mental health treatment in jail each time. When released, she is given directions to a walk-in mental health clinic. However, repeatedly before she reaches the clinic, she is without medication, craving drugs, and soon relapses on street drugs and supports herself with prostitution. Soon she is arrested for prostitution and drug possession and is back in jail — which is a very expensive setting to receive mental health care."
Ideally a care manager could begin with her while in jail, meet her upon release, and move her forward to a mental health system that can continue to address her bi-polar disorder and addiction.
These are just vignettes of what occurs every day across the state. Needless to say, all Texans will benefit from ANY increase in mental health funding.
Thank you for your time and consideration.
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