San Antonio Express-News (Sunday)
Mom wants to know why homeless son not helped
“The era of forcing people with (severe mental illness) into hospitals solely because it may be in their best interest is long past.” Probate judges Guy Herman and Dan Prashner
Frances Musgrove bundles against the chill and drives around Austin every few days, searching for her son under highway overpasses and alongside busy thoroughfares.
She doesn’t always find him. There are a few spots he frequents, where he knows he can get meth, but he’s not always there.
It’s often a multihour drive, Musgrove holding her breath every time she sees a man of his build; a man with his blanket; a man who seems out of his mind.
She can’t believe it’s come to this.
Justin Brodmann, 40, was supposed to be getting help through a program called Assisted Outpatient Treatment, which would provide court-ordered care in the community for his debilitating bipolar disorder. The federally funded program, operated by Integral Care — the local mental health authority in Austin — is specifically for individuals like Brodmann who have been hospitalized, arrested and/or homeless numerous times because of their mental illness.
But Integral Care has stopped helping Brodmann and left him on the streets, Musgrove alleges in a complaint she filed last week with the U.S. Department of Health Human Services Office for Civil Rights.
“Discrimination has been ongoing and constant,” Musgrove, who lives in Austin and is retired, wrote in her complaint. “The first two weeks of this homelessness, (Integral Care) did not even engage with him, and when I went looking for him I found him without much difficulty, digging through a trash can to find something to eat.”
Integral Care declined to comment on the complaint, citing privacy concerns.
“The existence of a court order, along with consistent messages from the judge and treatment team that they care about the participant’s success in the community, are often enough to motivate participants to follow their treatment plans,” Anne Nagelkirk, spokeswoman for the mental health authority, wrote in a statement. “The primary goal of AOT is to encourage the development of an ongoing, positive relationship between the treatment team and the participant so that in time, the person voluntarily engages
in treatment.”
Brodmann, who has been hospitalized for his mental illness more than 70 times in his life, was featured in Hearst Newspapers’ investigation, In Crisis, published last year. The investigation found that there aren’t nearly enough beds — private or state-funded — to help everyone in need, forcing mentally ill Texans to seek out crisis care through emergency rooms and, often, the criminal justice system. Though the state has tried in recent years to fund the addition of hundreds of psychiatric beds to lighten the load, there still were about 1,800 people waiting to get into a state-run hospital as of October.
In summer 2020, Integral Care was awarded federal funds for the Assisted Outpatient Treatment program, with a goal to “bridge the gap between inpatient and outpatient mental health services, improve treatment outcomes and reduce incidence of inpatient psychiatric and reduce criminal justice involvement.”
Through the Substance Abuse and Mental Health Services Administration grant, the mental
health authority receives $1 million of funding each year for four years. During the program’s first year, from July 2020 to July 2021, 38 individuals were approved for AOT. Only 22 were enrolled in services.
During the first five months of the program’s second year, which runs from July 2021 to July 2022, Integral Care’s AOT program has served 26 individuals.
Brodmann was placed in the program in January 2021, court documents show, and his treatment plan specifically states that he could go back to a mental hospital “if you do not follow your treatment plan; if your doctor and case manager believe you are getting sick again and you could be a danger to yourself or others.”
But by March, Musgrove received an email from Integral Care’s ombudsman, Phyllis Wolf, saying his order for treatment was suspended.
“Since Justin wasn’t motivated to participate by the court order and isn’t taking meds, the Judge isn’t willing to extend the order and is letting it expire,” Wolf wrote. “We have been attempting to meet with Justin … 3 times per week for safety reasons (with us cabbing him there and back) but he has declined.”
She continued that the plan was to “attempt to collaborate with him” to establish goals and the service package he would like to use moving forward.
Nagelkirk wrote in her statement that: “Because AOT is a civil court process, a judge can order a person to follow a treatment plan, but the person cannot be placed in jail for not adhering to a courtordered treatment plan. The court can order a person to adhere to an outpatient treatment plan but may not compel performance.”
Brodmann was placed under another outpatient treatment order in September, court documents show.
Two months later, he had left his supportive housing and began wandering the streets, Musgrove said.
She was infuriated. She felt like Integral Care wasn’t being communicative with her or implementing the program appropriately.
In December, she emailed the mental health authority asking why he hadn’t been committed to a mental hospital yet.
“The judge requires that the same criteria be met (imminent danger) to send a person back to the State Hospital,” Wolf wrote. “I was confused by that too and she went on to relay that the judge sees AOT as incentive-based not punitive.”
Under Texas law, failing to comply with AOT is not grounds for inpatient commitment, said Greg Hansch, executive director for the National Alliance on Mental Illness Texas. However, Integral Care could file a petition for inpatient commitment or the probate court judge could order commitment if a patient meets the criteria. Texas requires a person be a danger to themselves or others or is suffering severe mental, emotional or physical distress and therefore cannot provide for their own basic needs or make rational decisions about whether they need treatment.
The law doesn’t include psychiatric deterioration, or harm without further treatment, as a separate type of danger to self — something advocates tried and failed to address during last year’s legislative session.
Integral Care “has failed to report to the judge overseeing his outpatient commitment that Justin has deteriorated to the point where he should be re-hospitalized for supervised treatment,” Musgrove wrote in her complaint. “They continue to ignore that deterioration is a separate standard for commitment in Texas from harm to self/others.”
Musgrove is at a loss for what to do. This month, she fired off a letter to advocates and officials begging for help — asking that her son be committed to a mental hospital again.
Travis County Probate Court judges Guy Herman and Dan Prashner responded in kind, saying they have “nothing but sympathy for a mother’s pain for her son suffering from” severe mental illness. Both judges were involved in Brodmann’s AOT orders.
“But what she wants a court to do cannot be done under the law that governs outpatient mental health programs, because even people with (severe mental illness) have rights that courts are required to respect,” they wrote. “The era of forcing people with (severe mental illness) into hospitals solely because it may be in their best interest is long past.”
They noted that the court cannot order someone be hospitalized unless they meet the dangerousness criteria for inpatient care.
Musgrove doesn’t understand why living under a highway doesn’t meet the dangerousness criteria under Texas law. She’s considered moving to a state with more stringent commitment standards to get her son help.
But how would she get him in a car? And would it be safe?
So, she brings him food when she can. She gets him to change his shirt when she can.
But often, he thinks he’s in Iraq even though he never served in the military. Often, he’s aggressive.
All she can do now is wait. Wait for him to want help.
Wait for him to walk into traffic. Wait for him to overdose.
Wait for him to die.