A Crisis in Care

Julie Belindo has spent much of her adult life watching her sister Angela languish in the mental health services system in Texas and other states.

Growing up in Denver, Angela blossomed into a prize-winning artist and eventually graduated from Stanford University. One of Angela’s paintings hangs in Julie’s living room in Arlington; her eyes seldom left it as she recounted her sister’s descent into depression and hallucinations.

“Angel was vivacious, beautiful, and talented,” Julie recalled. “She always had the top prize in high school competitions.”

After college, Angela moved to Santa Fe, where she did secretarial jobs and worked for a nonprofit that helped underprivileged youths. Angela’s mother Sharon Belindo said it was shortly afterward, in 1988, that her daughter began showing symptoms of mental illness. Angela was 28.

“I was a dietician in Oklahoma and invited Angel to move in with me,” she recalled. “While she was helping me at work, someone came over and said, ‘Is this your daughter? Maybe you’d better come get her.’ Angela couldn’t sit still. She seemed to have a fever or something. I took her home. She sat down on the walkway, outside. She was screaming. She was just out of it. So I finally called in a friend who said ‘We need to take her to the hospital.’ ”

That began an odyssey for all three women, through this country’s mental health services system and its shortfalls. Shortly after showing her first signs of mental illness, Angela moved to Arlington with her parents. The 10 years that followed were some of the hardest in Sharon’s life, Julie said. Sharon began attending National Alliance on Mental Illness meetings and doing her best to understand Angela’s condition.

Julie, living in Virginia at the time, recalled that Angela was regularly seeing a physician through MHMR of Tarrant County. After a decade of intermittent employment, with periods where she was more stable and less stable, Angela moved back to Santa Fe, driving a car Julie had given her.

It was during this time that Angela’s life began a precipitous decline. Away from the structure of her family, Angela began experimenting with illegal drugs, often mixing them with her prescribed medications. After being arrested for shoplifting, Angela was sent to the New Mexico Behavioral Health Institute at Las Vegas. When she was released four months later, Julie and Susan drove her back to Arlington.

Angela’s worst relapse occurred in 2011, shortly after she had moved back to Texas. At times she would babble incoherently for long periods; inevitably, such episodes intensified into uncontrollable screaming. Eventually, after several visits from the police, Julie and her mother got Angela committed to the Trinity Springs Pavilion for Psychiatric Services in the John Peter Smith hospital system.

“I researched all the places she could go,” Julie recalled. “Private clinics were never an option [because of cost]. If I was a millionaire, I’d have sent her somewhere else.”

A day after Angela was admitted, Julie got a call that floored her: JPS doctors had declared Angela stabilized — and she was being released.

When Julie went to get Angela, her sister didn’t seem stabilized, just sedated. “She smelled like urine, so I knew she had peed on herself,” Julie said. “We didn’t have a choice but to take her back. They said there was nothing they could do. They probably gave her the antidepressant Ativan. It slows you down.”

Returning from work the next day, Julie found that Angela been readmitted to JPS. To this day, Julie isn’t sure if it was Angela’s existing condition or the myriad of prescription pills that led to her deterioration around that time. Angela stopped talking altogether and became unresponsive to her sister. Infected, open sores on Angela’s ankles drew her family’s alarm. A nurse told Julie that her sister must be hitting her legs together when she slept and said they would keep her bandaged.

Repeatedly, Julie tried to find and talk to the doctor in charge of Angela’s care. Each time, she got the same reply — he wasn’t there. The only thing JPS staffers could tell Julie and her mom was that Angela had schizophrenia. Even now, Julie clearly remembers the automated way the nurses rotated around the clinic, spending little time with individual patients.

After that, JPS officials had Angela transferred to North Texas State Hospital, near Wichita Falls. To Julie, it seemed a trade of one impersonal, ineffective setting for another: Angela and the other patients were handled in a “mass cattle mode,” in the main meeting area, Julie recalled. Her sister would spend each day huddled in a corner of the room, refusing to speak to anybody. During that time, in 2012, Angela’s father John died from West Nile virus, unable to visit his daughter to say goodbye.

After a year and a half, state hospital staff members told Julie and her mother that they were unable to improve Angela’s condition and were getting ready to move her to a nursing home.

Matt Roberts, executive director at Mental Health America of Greater Dallas, said Angela’s placement in a nursing home is an example of a state system that continually fails to adequately treat patients.

“If she is in a nursing home without adequate psychiatric care, then what does that say about the care we are providing as a state?” he said. “Even people with severe mental health problems can recover and lead productive lives. Are we providing these people with the resources they need or just giving up on them?”

The sunset staff’s first recom-mendation was for Texas to deal with the crisis in its mental hospitals. Action needs to be taken immediately, they concluded, to address the “outdated condition of hospital facilities, critical shortages of clinical staff, and a lack of effective communication with the judicial system.” One result of the system’s failure to deliver adequate care: an increasing number of lawsuits against DSHS facilities, putting the agency at financial risk.

The report included recom-mendations that State Health Services immediately review its hiring practices to ensure that the hospitals are appropriately staffed and to expand the agency’s contracts with community mental health providers. And, sunset staffers concluded, DSHS should be restructured to be more responsive to such problems.

“That sums up my take on the report,” Roberts said. “We need more patient beds in local communities.”

Christine Mann, press officer for State Health Services, said her agency is beginning to address the staff shortage problem. Part of that solution involves speeding up the hiring process and increasing staff pay, which is “generally lower than the industry average,” she said.

“To help address this issue, the (recent legislative session) appropriated $14.7 million to provide a 10 percent pay increase for all psychiatric nurse assistants,” she said.

Until the problems are fixed and funding levels are increased, Mann said, State Health Services will continue to rely on contract staff and other temporary help to cover the staffing gap.

In Arlington, the news that Angela was going to be placed in a nursing home shocked Julie and her mother, but they had no recourse. They found the best nursing home they could afford. Julie’s greatest concern — that Angela would lose access to psychiatric treatment — proved true. Angela distrusts the nursing home staff and blames her family for the situation.

Julie is currently trying to find out if Medicaid will pay for in-home care, which she hopes would allow her to bring her sister home.

Neither Julie nor Sharon thinks that Angela ever received proper treatment or care at North Texas State Hospital.

“With the minimal amount of money we have, we had to settle for that minimal amount of care,” Julie said. “It’s hard to see your family go into a situation like that.”

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