Building Bridges

Strategies to Lessen the Gaps in Houston’s Mental Health Network

Adriane Barroso, Ph.D., Lumpkins Fellow in Serious Mental Illness

Hope and Healing Center & Institute – Houston, TX

2019
Building Bridges 2

ABSTRACT
Houston is known for the size and quality of its medical facilities, but America’s mental health crisis
has not spared Texas’s largest city. Community-based programs on mental health are still scarce and
underfunded in the area, despite the latest federal recommendations for expanding such initiatives.
Furthermore, misinformation makes it difficult for users and caregivers to navigate a web consisting
of multiple levels of care and different types of services. The present study assessed existing mental
health programs for adults in the Houston area and identified gaps in the local network. After
reviewing the existing literature, talking to users, caregivers, and providers, and visiting many of the
best practices in mental health nationwide, this document proposes strategies—in the form of
innovative programs and services—that would help to bridge some of Houston’s gaps in regard to
mental health services. The findings indicate that community-based practices with alternative
approaches to the traditional clinical care— like peer-run, mobile and remote services—are key to
widen the scope of our current network. As a start, the study proposes the development of three
interconnected services: a warmline, a mobile mental health care team, and a residential house.

Keywords: Mental health network, Houston, community-based services, recovery.

Building Bridges 3

SUMMARY
1. BUILDING BRIDGES: An Introduction ................................................................................................................... 6
Objective ................................................................................................................................................................................. 7
Justification and background ......................................................................................................................................... 8
Methodology ....................................................................................................................................................................... 10
a) Focus groups ........................................................................................................................................................ 10
b) Listing mental health facilities in the Houston area ............................................................................ 11
c) Online search ....................................................................................................................................................... 14
d) Contacting the programs ................................................................................................................................. 15
e) Visiting the services .......................................................................................................................................... 16
f) Visiting noteworthy practices nationwide .............................................................................................. 16
g) Practical actions: developing new services ............................................................................................. 16
2. WHAT DO WE NEED? ................................................................................................................................................. 17
A brief overview: mental illness and postmodern life in the U.S. ................................................................. 17
3. SKETCHING A PROGRAM: WHAT DO WE WANT? ......................................................................................... 25
Peer-Run Warmline ......................................................................................................................................................... 26
Mobile Mental Health Care Team ............................................................................................................................... 27
Residential service ........................................................................................................................................................... 28
REFERENCES ........................................................................................................................................................................... 29
APPENDIX A. Original lists of facilities used in the research............................................................................... 36
a) Source 1: NAMI.................................................................................................................................................... 36
b) Source 2: SAMHSA ............................................................................................................................................. 36
c) Source 3: HealthGrove...................................................................................................................................... 38
d) Source 4: Mental Health America ................................................................................................................ 38
e) Pre-final list of facilities ................................................................................................................................... 39
APPENDIX B – Facilities assessed in the Houston area ......................................................................................... 42
Baylor Psychiatry Clinic ................................................................................................................................................. 42
Behavioral Hospital of Bellaire ................................................................................................................................... 42
Behavioral Medicine of Houston ................................................................................................................................ 43
Ben Taub Hospital ............................................................................................................................................................ 44
Center for Creative Resources ..................................................................................................................................... 45
Central Care Integrated Health Services ................................................................................................................. 45
Cypress Creek Hospital .................................................................................................................................................. 46
Building Bridges 4

Denver Harbor Family Clinic ....................................................................................................................................... 46

El Centro de Corazón ....................................................................................................................................................... 47
Family Services of Greater Houston / Family Houston..................................................................................... 47
Harris Center for Mental Health and IDD (former MHMRA) .......................................................................... 48
Harris County Psychiatric Center – University of Texas................................................................................... 49
HOPE Clinic.......................................................................................................................................................................... 50
Houston Area Community Services/Avenue 360 Health and Wellness .................................................... 50
Houston Behavioral Healthcare Hospital ............................................................................................................... 50
Houston Methodist – Psychiatry Department ...................................................................................................... 51
InnerWisdom...................................................................................................................................................................... 51
Innovative Alternatives .................................................................................................................................................. 52
Interface-Samaritan Counseling Center .................................................................................................................. 52
Intracare North Hospital................................................................................................................................................ 53
Jewish Family Service ..................................................................................................................................................... 53
Krist Samaritan Center ................................................................................................................................................... 54
Legacy Community Health Services .......................................................................................................................... 55
Lone Star Behavioral Health ........................................................................................................................................ 55
Memorial Hermann Mental Health Crisis Clinic................................................................................................... 56
Menninger Clinic ............................................................................................................................................................... 56
Mental Health Co-Op ....................................................................................................................................................... 57
New Dimensions Day Treatment Center-Clear Lake ......................................................................................... 57
Post Oak Care Center ....................................................................................................................................................... 58
Saint Joseph House ........................................................................................................................................................... 58
Saint Joseph’s Medical Center – IASIS Behavioral Health ................................................................................ 59
Sun Behavioral Houston ................................................................................................................................................ 59
The Gathering Place ......................................................................................................................................................... 60
The Montrose Center....................................................................................................................................................... 60
University of Houston Clear Lake – Psychological Services Clinic ............................................................... 61
West Houston Medical Center ..................................................................................................................................... 61
West Oaks Hospital .......................................................................................................................................................... 62
APPENDIX C. FACILITIES ASSESSED NATIONWIDE ............................................................................................... 63
Afiya (Northampton, MA).............................................................................................................................................. 63
Austen Riggs Center (Stockbridge, MA) .................................................................................................................. 64
Bridges to Recovery (Los Angeles, CA) .................................................................................................................... 65
Building Bridges 5

Ellenhorn, MA (Arlington, MA) ................................................................................................................................... 65

Gnosis Retreat Center (San Francisco, CA) ............................................................................................................ 66
Gould Farm (Monterey, MA) ........................................................................................................................................ 67
Hope House (San Luis Obispo, CA) ............................................................................................................................ 68
Inner fire (Brookline, VT) .............................................................................................................................................. 69
Laurel House (Stamford, CT) ....................................................................................................................................... 69
Parachute (New York, NY – 2012-2015)................................................................................................................. 70
Safe Harbor Crisis House (Sacramento, CA) .......................................................................................................... 71
Second Story (Santa Cruz, CA)..................................................................................................................................... 71
Solara Mental Health (San Diego, CA) ...................................................................................................................... 72
Soteria (Burlington, VT)................................................................................................................................................. 73
Windhorse Integrative Mental Health (Northampton, MA) ............................................................................ 73
Building Bridges 6

1. BUILDING BRIDGES: An Introduction

According to the Mental Health Needs Council of Harris County (2015), 4.5% of the adults living in
the Houston area in 2015 had some mental illness, and 62% of this group did not have access to
treatment during that period (Mental Health Need Council of Harris County, 2015). The list of reasons
includes insufficient state funding, inefficient policies, shortage of insurance coverage, stigma, and
lack of connections between different levels of care and multiple types of services. More often than
not, users 1 and their families have the lonely task of building bridges between programs and
negotiating with various agencies and stakeholders (Evavold, 2003), as even mental health providers
have little understanding of this complex network.

When users cannot reach proper care promptly, they may end up accessing the mental health system
through its back doors. Harris County Jail is the largest mental health provider in Texas (Mental
Health Needs Council of Harris County, 2015) because many of its inmates only find assistance after
their psychiatric issues have imposed grave consequences for themselves or others. The National
Alliance on Mental Health (NAMI) estimated that “between 25 and 40 percent of all mentally ill
Americans will be jailed or incarcerated at some point in their lives” (Ford, 2015).

Other undesirable consequences of insufficient mental health treatment are homelessness—around

26% of the adults living in shelters suffer from a psychiatric disorder (Szabo, 2014)—and premature
deaths from suicide or involvement in violent situations. Thomas Insel, former director of the
National Institute of Mental Health (as cited by Szabo, 2014), explained that “People with serious
mental illness die up to 23 years sooner than other Americans, giving them a life expectancy on par
with people in Bangladesh.”

On the financial side, the amount of money paid in medical expenses for chronic mental health care
is yet lower than the indirect costs derived from inadequate treatment (Thompson, 2007). Insel
stated that the price of mental illnesses for the United States was at least $444 billion a year (as cited
by Szabo, 2014), but only a third of this amount went directly to medical care: “The bulk of the cost
to society stems from disability payments and lost productivity. That total doesn’t include caregivers’
lost earnings or the tax dollars spent to build prisons” (Insel, as cited by Szabo, 2014).

1 The term “users” was adopted in the 1970s to empower those once called “patients” in the mental health system.
Building Bridges 7

Figure 1. The cost of treating mental illness. (Szabo, 2014)

How can we increase communication between Houston’s mental health services and stakeholders,
leading to an actual network made of integrated parts? This research explored this question by
assessing Houston’s mental health care system to propose strategies that could help to develop a
continuous, recovery-oriented, and user-friendly web of services. Despite the challenges, we believe
recovery is the ultimate tool to improve users’ and families’ accomplishments and ability to make
decisions. If the latest changes in mental health policy toward recovery do not show their best effects
yet, it is because the results of the lack of adjacent support—such as homelessness and
incarceration—are still far more visible (Friedman, 2014).

Objective

The present study’s primary goal was to determine the type of mental health services that could help
lessen the gaps in Houston’s mental health network and align the area with the latest federal
recommendations on increasing the scope of recovery-oriented, community-based services. To do
so, we visited local mental health care services for adults2 and collected information and opinions

2 Mental health care for children and adolescents demand specific approaches that go beyond this study’s framework.
Building Bridges 8

from providers, users, and caregivers. We later compared this initial overview of Houston’s network
with innovative practices nationwide to design incipient solutions that could work locally.

Justification and background

The earliest institutional initiatives to treat mental illness in the United States date from the 18th
century, when Virginia built its first asylum and Pennsylvania Hospital reserved its basement to
house individuals with mental disorders (Sundararaman, 2009). Several other services were later
established, but the overall lack of quality was alarming. By the time of the Great Depression and
World War II, U.S. asylums were suffering in unsustainable conditions.

Decades later, in 1963, President Kennedy’s Mental Health Community Act was intended to align the
United States with the European deinstitutionalization movement and the underlying belief that
those with mental illness should not be confined to closed institutions. The number of psychiatric
beds was drastically reduced—from 500,000 to 150,000 in the 1970s (Drake & Latimer, 2012) and
then less than 60,000 in 1998 (Ford, 2015). In 2002, President Bush’s New Freedom Commission on
Mental Health produced the “Achieving the Promise: Transforming Mental Health Care in America”
report (Department of Health and Human Services, 2003), with measures to reinforce recovery-
oriented approaches. It defines recovery as

… The process in which people are able to live, work, learn and participate fully in their
communities. For some individuals, recovery is the ability to live a fulfilling and productive
life despite a disability. For others, recovery implies the reduction or complete remission of
symptoms. Science has shown that having hope plays an integral role in an individual’s
recovery. (Department of Health and Human Services, 2003, p. 5)

The concept of recovery goes beyond clinical care and aims at subjective aspects such as quality of
life, empowerment, and sense of hope, which has demanded the establishment of phenomenological
approaches and broader evaluation tools.

To support personal recovery, mental health systems will need to shift away from a
dominance of institutional responses, drug treatments, and coercive interventions. The focus
needs to be on fostering hope and a belief in people, supporting self-determination, ensuring
access to a broad range of community-oriented services (including housing, education,
employment, peer support, recovery education, crisis support, support in everyday living,
drug treatments, talking therapies, and advocacy), and promoting social inclusion and human
Building Bridges 9

rights. Treatment may help personal recovery, but it can also hinder it, especially if it is the
dominant response and is associated with coercive practices. (Slade et al., 2014, p. 13).

The New Freedom Commission endorsed the need to allocate funds in open-door programs and
adjacent services such as housing, rehabilitation, social welfare, criminal justice, and supported
employment, but fewer than 2% of users have access to them (Substance Abuse and Mental Health
Services Administration, 2014). “The appropriate and adequate delivery of these services requires
active and ongoing coordination that is complicated by diverse, complex, and often-inflexible funding
streams” (Mechanic & Olfson, 2016, p. 519). The lack of investments and planning turned the
deinstitutionalization movement into a quick fix for grave issues and led to “disastrous
transinstitutionalization from dreary hospitals to much worse jails and prisons” (Frances, 2014).
Myers (2015) affirmed that insufficient support has led to an impoverished and crime-ridden
underclass of users that ended up in what Szabo (2014) called “de facto” mental health institutions:
jails, streets, homeless shelters, “and the morgue, due to suicide.”

Figure 2. De facto mental health institutions in the United States (Szabo, 2014).

Evavold (2003) cited other issues derived from the attempt to reduce hospitalizations—and costs—
quickly: inadequate monitoring of new programs, untrained staff, insufficient funding, public apathy,
and the fact that “many patients found life in the community frightening, largely because of negative
community attitudes about deinstitutionalization.” Finally, there is the discontinuity of care. Because
recovery is nonlinear, services should be available to reengage with people when needed (Slade et
Building Bridges 10

al., 2014), which would require the expansion and improvement of existing facilities, not their
reduction. The states ended up sparing funds by simultaneously closing inpatient institutions and
not correctly equipping community-based programs. Short-stay psychiatric hospitals assume that
outpatient management will follow, but the shortage of support, training, and access to these
programs has led to considerable variation in adherence. For instance, Mechanic and Olfson (2016)
showed that, in 2012, only 63.6% of Medicaid health maintenance organization psychiatric inpatients
received any outpatient mental health services during the first 30 days following discharge.

In Houston, the fourth-largest city in the country (United States Census Bureau, 2016), community-
based programs feel the impact of Texas’ bad performance in mental health care: it is one of the
United States’ metropolitan areas receiving fewer tax investments in this sector (Aron, Honberg, &
Duckworth, 2009).

Methodology

The present study had three phases with distinct goals: (a) to gather information on Houston’s
mental health network, (b) to look for innovative practices on mental health care nationwide, and (c)
to propose strategies and programs that should help the Houston area to diversify its resources on
mental health and adjust its parameters to the recovery-oriented approach.

Conversations with various stakeholders guided this research: impressions collected among focus
groups with users and caregivers who were invited to talk about their experiences with Houston’s
mental health network, alongside semi-structured interviews with mental health providers working
at the inpatient and outpatient programs that we visited.

a) Focus groups
Between February 15 and February 17, 2017, we conducted three focus groups with users (3, 5, and
5 participants each—a total of 13) and two with caregivers (5 and 4 participants each—a total of 9).
We recruited the participants among support groups that took place at the Hope and Healing Center
and through an ad posted at the center’s newsletter.

Many Americans suffer from serious mental illness; the stigma associated with mental illness prevents
many from seeking the right treatment and/or care.
The Hope and Healing Center & Institute is currently looking for volunteers to participate in a new
research study focusing on facilities and institutions in the Houston area where individuals with serious
Building Bridges 11

mental illness receive treatment. The results of the study will be used to help other individuals and
families successfully locate facilities that will provide the proper treatment and care for their needs.
If you suffer from a serious mental illness or have a loved one who does, you are invited to participate in
one of our discussion groups. The group will meet for one hour to discuss the struggles associated with
mental illness, the best practices and ways to find treatment options. Your contribution to the research
study will allow the HHCI to gather information to be used to help others suffering from serious mental
illness.
If you would like to participate or have any other questions, please contact Adriane Barroso at 713-871-
1004 ext. 212 or email her at abarroso@hopeandhealingcenter.org.
If you are unable to participate by attending a group session, you can also help us by filling out an
online questionnaire at:
http://www.questionpro.com/t/AMj2DZYMbl.

Figure 3. “Volunteers needed” ad posted at the Hope and Healing Center Newsletter.

Focus groups allow contributors to define interests, clarify views, and elaborate thoughts (Kitzinger,
1995). The advantage of this method is “not simply in exploring what people have to say, but in
providing insights into the sources of complex behaviors and motivations” (Morgan, 1996, p. 139).
Morgan (1996) explained that small focus groups are appropriate for “emotionally charged” topics
that generate high levels of involvement, giving participants time, freedom, and intimacy.

During our focus groups, the conversations started with the same open-ended questions, but
participants could raise other topics, and the researcher could ask for clarifications. We recorded the
activities in audio and written notes, 3 which were later analyzed and synthesized. Our initial
questions were as follows: What are the most important aspects to consider when seeking treatment
for mental illness? What were your best and worst experiences seeking treatment for mental illness
nationwide and in the Houston area? What are the main difficulties in finding treatment for mental
illness in the Houston area? What are the best treatment programs for mental illness in Houston and
the United States?

b) Listing mental health facilities in the Houston area

Building a list of mental health services in the Houston area proved a challenging task. The directories
available online are filtered by categories, criteria, interests, or viewpoints, and most are not revised

3 Several users asked to not have their voices recorded, and, for this reason, we only took written notes of the most
noteworthy topics, phrases, and questions from the users’ focus groups. Besides the written notes, we also recorded audio
from the caregivers’ groups.
Building Bridges 12

periodically. To lessen these issues’ impact in our study, we compiled four online directories of
mental health services from different providers and settings: the National Alliance on Mental Illness
(NAMI – Gulf Coast, 2016),4 Houston’s Substance Abuse and Mental Health Administration (2014),5
Graphiq’s HealthGrove6 (Graphiq, 2016), and Mental Health America of Greater Houston’s (2017)
2016–2017 directories of nonprofit services. The services and facilities included in our final list are
located within (or close to7) the geographic boundaries of Harris County.

Figure 5. Harry County map (Maptechnica, 2016).

NAMI’s website has a tool called “Resource Listings.” Under the “Directory” file, the results are
divided into “Assistance,” “Crisis Numbers,” “Healthcare,” “Local Detention Centers,” “Organizations,”
and “Services.” Our search was restricted to the “Healthcare” section, which is subdivided into
“Mental Health Professionals,” “Personal Care and Assisted Living,” and “Hospitals and Healthcare
Centers.” We searched the section “Hospitals and Healthcare Centers,” which includes “Healthcare
Centers,” “Other Healthcare,” and “Psychiatric Hospitals.”

4 http://namigulfcoast.org/business-directory-2/wpbdp_category/hospitalshealthcarecenters/

5 https://findtreatment.samhsa.gov/

6 http://mental-health-facilities.healthgrove.com/d/l/Texas/Houston
7 Some online tools do not allow a refined geographic search, and approximations had to be used.
 Building Bridges 13

SAMHSA’s website offers the tool “Behavior Health Treatment Services Location”8 (Substance Abuse
and Mental Health Services Administration, 2016b), which filters the services according to the
location (address, city, or zip code). We selected “Houston” as our starting place and a range of 25
miles from the map’s point of departure (Bagby St., zip code 77002), including only the option
“Mental Health” in our research (and excluding the categories “Substance Abuse,” “Veterans
Affairs,” “Buprenorphine Physicians,” and “Health Care Centers”). Also, we removed one facility from
the results, “Shiloh Treatment Center,” for being out of Harris County’s boundaries. SAMHSA also
publishes an annual directory of mental health services 9 (Substance Abuse and Mental Health
Services Administration, 2016a), and we compiled its 2015 and 2016 editions.

The HealthGrove website offers the “Compare Mental Health Facilities” tool,10 which allows users to
choose a starting location and a search range. We selected Houston as the starting location and a
range of 20 miles.

Finally, Mental Health America’s website has an annual guide to nonprofit mental health services in
Harris County.11 It is subdivided in child and adolescent behavioral health, behavioral health for the
elderly, behavioral health for veterans, social and specialized services, adult and family mental
health, and adult alcohol and drug services. We focused on the section “adult and family mental health
services” and included only facilities that provide counseling and mental health support. We also
excluded adjacent services such as advocacy groups and family planning.

After compiling the four original lists, we obtained a prefinal list from which we excluded double
entries and services for children, adolescents, veterans, and substance use only. Later, we excluded
other facilities for multiple reasons (shown in Appendix A). The exclusions and additions to the
predirectory led us to the following final list of facilities and services:

Facility Name Address

1. Baylor Psychiatry Clinic 1977 Butler Blvd Ste E4.400 – 77030. 713-798-4857
2. Behavioral Hospital of Bellaire 5314 Dashwood Drive – 77081. 713-600-9500
3. Behavioral Medicine of Houston PA 7900 Westglen Drive – 77063. 713-789-5588
4. Ben Taub Hospital - Behavioral Health 1502 Taub Loop – 77030. 713-873-5143

8 https://findtreatment.samhsa.gov/

9 http://www.samhsa.gov/data/sites/default/files/2016_National_Directory_of_Mental_Health_Treatment_Facilities.pdf

10 http://mental-health-facilities.healthgrove.com/

11 http://www.mhahouston.org/media/files/files/ce74590c/The_Guide__2015-17_FINAL_PDF_Rotated.pdf
Building Bridges 14

5. Center for Creative Resources 816 Hawthorne St. – 77006. 713-461-7599

6. Central Care Integrated Health Services 8610 MLK Blvd. – 77033 - 713-734-0199
7. Cypress Creek Hospital 17750 Cali Drive – 77090. 281-586-7600
8. Denver Harbor Family Clinic 424 Hahlo St. – 77020. 674-3326
9. El Centro de Corazón 412 Telephone Rd. – 77023. 713-660-1880
10. Family Services Houston Downtown: 4625 Lillian St. – 77007. 713-861-4849.
11. Harris Center for Mental Health and IDD 9401 SW Freeway – 77074. 713-970-7000
12. Harris County Psychiatric Center – U. Texas 2800 South MacGregor Way - 77021. 713-741-5000
13. Hope Clinic 7001 Corporate Drive, Ste 120 – 77036. 713-773-0803
14. Houston Area Community Services/Avenue 360 2150 West 18th St. – 77008. 713-426-0027
15. Houston Behavioral Healthcare Hospital 2801 Gessner Rd – 77080. 832- 834-7710
16. Houston Methodist – Psychiatric Department 6565 Fannin St, Houston, TX 77030 – 713-790-331112
17. Innerwisdom Inc 10777 Stella Link Road – 77025. 713-592-9292
18. Innovative Alternatives 1335 Regents Park Dr., 240 – 77058. 832-864-6000
19. Interface-Samaritan Counseling Center 4803 San Felipe St. – 77056. 713-626-7990
20. Intracare North Hospital 1120 Cypress Station Drive – 77090. 281-893-7200
21. Jewish Family Service 4131 South Braeswood Blvd. – 77025. 713-667-9336
22. Krist Samaritan Center 17555 El Camino Real – 77058. 281-480-7554
23. Legacy Community Health Services 1415 California St. – 77006. 832-548-5100
24. Lone Star Behavioral Health Cypress 16303 Grant Road – 77429. 281-516-6200
25. Memorial Hermann Mental Health Crisis Clinic 10780 Westview Dr. Suite C – 77043. 713-338-6422
26. Menninger Clinic 12301 S. Main – 77035. 713-275-5000
27. Mental Health Co-Op 503 Sul Ross St, Houston, TX 77006 - 713-524-8705
28. New Dimensions Day Treatment Centers 1345 Space Park Drive – 77058. 281-333-2284
29. Post Oak Care Center 2020 North Loop West – 77018. 713-960-0344
30. Saint Joseph House 3307 Austin St. – 77004. 713-523-5958
31. Saint Joseph Medical Center - Center for BH 1404 Saint Joseph Parkway – 77002. 713-757-7512
32. Sun Behavioral Houston13 7601 Fannin St. – 77054. 713-790-0949
33. The Gathering Place 5310 South Willow Dr. – 77035. 713-729-3499
34. The Montrose Center 401 Branard St., 2nd Floor – 77006. 713-529-0037
35. University of Houston Clear Lake - Psychological Services 2700 Bay Area Blvd., Box 83 – 77058. 281-283-3330
36. West Houston Medical Center 12141 Richmond Avenue – 77082. 281-588-8320
37. West Oaks Hospital and Outpatient Clinic 6500 Hornwood – 77074. 713-995-0909
Table 1. Final list of facilities included in the research

c) Online search
Before contacting the services from our final list of programs, we performed a detailed online search
on each one of them to see how they present themselves and what information they are willing to
provide beforehand. This step also helped us to retrace their history: innovations, expansions, frauds,
inspections, honors, and changes in administration.

12 Not on the primary lists; cited at least twice during the focus groups with consumers and caregivers.

13Not on the primary lists; currently operating at the same building as Cambridge Hospital and Intracare Medical Center,
now closed.
Building Bridges 15

Mental health facilities tend to open, close, and relocate several times in the Houston area. Many
services are still listed under the wrong address, no longer exist, or simply do not provide any online
information about themselves. This reality offers a portrait of Houston’s mental health network, the
misinformation that surrounds it, and the difficulty in keeping services open and running.

The amount of information available varies from facility to facility. Moreover, the data provided differ
considerably in quality and accuracy: although some services offer only basic information, others
present mental health facts, lists of services, articles, and research findings. In general, outpatient
programs tend to display fewer data on their websites, whereas inpatient facilities have a more
established presence online.

d) Contacting the programs

We initially contacted the services we assessed via email. Our message asked for a visit, introduced
the Hope and Healing Center & Institute, and attached a research outline containing introduction,
objectives, and methodology. Most requests sent to the services’ general email addresses were
ignored, and we started to contact email directors and managers directly to schedule visits.

Dear. [Representative],

We know how hard you work to improve Houston’s mental health network. We do too. That is why we are asking for your
participation in our research: “Serious mental illness: Developing a ‘roadmap’ for individuals and families seeking mental
health services in Houston.” Our goal is to build an online database with qualitative information about the mental health
facilities in the area. Furthermore, this material will be used as the foundation of a program to orient patients searching for
treatment in Houston and its surrounding communities. Please find attached a document outlining the research project so
that you might learn more about the study and our Center & Institute.

It would be very helpful if you could grant us a visit to [facility]. It should not take more than one hour, and we would use
this time to observe how the facility works. Our intent is not to rank the services, but to learn how to make better referrals,
connecting patients with serious mental illness to the right places for their clinical, social and economic needs.

We also have a few simple questions about your service, which can be answered in less than five minutes through this link:
http://www.questionpro.com/t/AMj2DZYCQ1

Please help us make our mental health network better. We care as much as you do.

Sincerely,

Adriane Barroso, Ph.D. – Lumpkins’ Fellow in Serious Mental Illness

Matthew Stanford, Ph.D. – CEO

THE HOPE AND HEALING CENTER & INSTITUTE

Figure 4. Visit request sent to the facilities’ representatives via email

Building Bridges 16

e) Visiting the services

While visiting the services that agreed to meet us in person, we observed programs, infrastructure,
providers, and other resources. Through semistructured interviews with their representatives, we
also gathered information on each service’s history, population, demands, and goals, in addition to
the following information: (a) number of beds/participants; (b) year of foundation; (c) average
length of stay; (d) waiting time for admission; (e) specialties and programs available; (f)
professionals available; (g) outcomes, facts, and advantages that may be noteworthy; (h) payment
methods and cost of the programs; (i) major challenges; (j) mental health programs that respondents
would recommend in Houston and nationwide; and (k) referrals and follow-up procedures after
discharge.

Many of our phone calls and email messages were left unanswered; pictures of some facilities could
not be taken even from the outside; staff members refused to answer basic questions about their
programs. In brief, services that should be transparent and ready to welcome users seemed a
concealed business, which explains why this study ended up not visit all the facilities on our final list.

f) Visiting noteworthy practices nationwide

We asked users, caregivers, and providers to mention outstanding practices on mental health
nationwide. This material, alongside a broad literature review of best practices in the U.S. mental
health system, helped us to define what services and facilities to visit in other states. For the sake of
time and financial resources, we chose two major regions for our visits: the New York area and the
state of California.

This step gave us access to programs with positive outcomes and innovative models of care. It also
showed that community-based, nonclinical experiences have been widening the scope of long-term
care and support for severe mental illness.

g) Practical actions: developing new services

With the knowledge gathered during the focus groups, semistructured interviews, and visits to
mental health facilities in Houston and other states, we proposed new services for serious mental
illness in the Houston area. This study focused primarily on solutions that represent not only a bridge
between existing programs but also an alignment with the latest federal concerns on recovery and
community-oriented services.
Building Bridges 17

2. WHAT DO WE NEED?
This chapter presents the topics discussed during the focus groups held with users and caregivers as
part of our study, alongside opinions and viewpoints from semistructured interviews with
representatives of the facilities visited during the research. These conversations with different
stakeholders helped us to build a sketch of Houston’s mental health network and identify what is
missing and what should be improved. They also emphasized the importance of fostering
communication and dialogue between the players in this system.

A brief overview: mental illness and postmodern life in the U.S.

In the 18th century, the modern era changed the Western world, and reason replaced religion as the
primary tool to achieve the truth (Bauman, 2000). That time was the apogee of the so-called total
institutions (Goffman, 1961), places where a significant number of people in similar conditions was
enclosed and cut off from the community, living a formally administered life that focused on
efficiency and control. Psychiatric hospitals were born in that context, relying on the medical-
scientific discourse to manage the mentally ill. Their regulatory role was even more significant than
their therapeutic function.

The vertical, structured configuration of modern society lost strength after World War II. In our
postmodern world, which philosopher Bauman (2000) referred to as “liquid modernity,” the control
once derived from the institutional power was weakened by the rise of individual aspirations. In the
mental health field, such institutional “liquefaction” resulted in the deinstitutionalization movement,
after which long-term patients of psychiatric hospitals were discharged, and the policy of segregation
resulting from stigma had to turn into a coexistence with one’s fellow citizens.

We live in a world of loneliness. Grave depression is a consequence of isolation and stigma.

(User)14.

14 Allexcerpts presented in this chapter were extracted from our audio records and written notes on the focus groups and
the semi-structured interviews.
Building Bridges 18

For the fundamentalists, we are the devil. Have you heard of Legion? (User)15.

Several focus group participants emphasized the challenges of living with a mental health diagnosis.
Stigma is one of the reasons for users and caregivers to delay the search for appropriate care and,
more than often, to accept wrongful health, social, and religious diagnoses. Fear and misinformation
are, at once, cause and consequence of the aura of secrecy that surrounds serious mental illness,
feeding a vicious circle that turns it into an unspoken issue, a family secret, an internal problem.

Dissemination of information is a precious thing, and something is very wrong with the
dissemination of information. (Caregiver).

You hit so many dead ends before you find the right care. […] It's a secret, you have to find
the door inside, but you keep hitting on these walls. (Caregiver).

The more you educate yourself, it becomes a little bit easier to navigate and to remain calm
and to know the things that you need to pursue. (User).

It was seen as ADHD, not schizophrenia. We wasted four years treating the wrong problem.
Schools are not ready to deal with mental issues. (Caregiver).

I thought it was a spiritual issue, but [a pastor] advised me to look for a psychiatrist. (User)

Segregation is worsened by the fact that many crisis episodes can also turn into a legal matter. Harris
County Jail is the largest health care provider in the Houston area, but research shows that users of
mental health services are more often victims than perpetrators. Choe, Teplin, and Abraham (200816,
as cited by Myers, 2015) affirmed that about 25% of this group suffered some type of violent attack
in the 1-year period of their study, “a rate more than eleven times higher than the general population
even after controlling for demographic differences.”

In Harris County jail, people with serious mental illness or intoxication just started being
separated from the rapist, the bank robbers. That is a baby step. (User).

15 Accordingto the Bible, a possessed man met Jesus, who ordered his demons to emerge, calling them "Legion”. Afraid of
being driven to the abyss, Legion begs to be sent into a herd of pigs, which later rushed into the lake and drowned.

16 Choe, J., Teplin, L., & Abram, K. (2008). Perpetration of violence, violent victimization, and severe mental illness: Balancing

public health concerns. Psychiatry Services, 59(2), 153–164.

Building Bridges 19

My son is sick, he's not a criminal, and so often they are put in the judicial system. Our society
has taken mental health from the healthcare industry. They had the asylums, now they have
the judicial system, which is so wrong. This person is not a criminal; they have to go to the
hospital. It is not a crime; it is a breakdown. (Caregiver).

Jail is the worst treatment center in Houston. I have been there. […] The inmates will not take
their medication; they save it and exchange it for things. (User).

By crisis—called “breakdown,” “earthquake,” “mess,” and “manic episode” during the focus groups—
users and caregivers mean a brutal disruption in life. Aggressions, incapacitation, and sudden
behavior changes were the most cited symptoms of crises, which also involved relationship problems
caused by behaviors considered unacceptable (Myers, 2015), in addition to other coexistent issues17.
Although most caregivers mention long-term, structured clinical care as the key to success when
facing a serious mental illness, most users in the focus groups see strong personal connections as the
crucial tool for recovery, alongside being seen as a person, a whole individual.

Mental health is not merely medication. It is about being human. […] Resiliency is the key, but
isolation is terrible for mental illness. We have to bond. (User).

Contentiousness: do what you need to do. Be in recovery; don’t be a patient. I’m on a journey.
[…] Am I a lifelong patient? I try not to be defined by it. (User).

“I am… I said.” Neil Diamond. “I got an emptiness deep inside / and I’ve tried / but it won’t let
me go… I never cared for the sound of being alone.” (User).’

Being stable is not having severe ups and downs. […] I got stable, but I also got flat. I could
not feel anything. Once we are out of inpatient care, we need to wake up again. (User).

After stabilization, users often struggle to have their basic needs met. Studies have shown that only
one in five people diagnosed with schizophrenia find competitive full-time employment, and less
than 50% work at all (Gioia & Brekke, 2003). Providers interviewed for the present research cited

17 Meyers (2015) demonstrated that around 50% of people diagnosed with schizophrenia have a diagnosis of substance use

at some point. Bibliography: (a) Bellack, A., & DiClemente, C. (1999). Treating substance abuse among patients with
schizophrenia. Psychiatric services, 50, 75–80. (b) Mueser, K., Bennett, M., & Kushner, M. (1995). Epidemiology of substance
use disorders among persons with chronic mental illness. In A. Lehman & L. Dixon (Eds), Double jeopardy. Newark, NJ:
Harwood Academic. (c) Liberman, R., & Kopelowicz, A. (2002). Recovery from schizophrenia: A challenge for the 21st
century. International Review of Psychiatry, 14(4), 245–255.
Building Bridges 20

housing as one of Houston’s major flaws when it comes to adjacent support—public programs are
scarce, paid housing services are expensive, and shelters offer less than what is needed for human
dignity.

Once you find your way and have a diagnosis and the person is on the right medication… from
that point in time, the problem is employment, keeping a job, having a life. (User).

We have been trying to educate the community, but only a few places will hire a person with
chronic mental illness. People think they are not reliable. We want to get people out in the
workforce. (Provider).

[At the shelters] They steal your things; you are not able to sleep because you have to watch
your stuff. (User).

The current medical discourse determines chemical and neurological causes to the whole spectrum
of mental illness (Bassols, 2015), decreasing the role of social connections in explaining and treating
it. For most users and caregivers in the focus groups, clinical services for mental health care rarely
means compassionate support. Many participants talked about how warm, truthful personal
connections are rare but, when found, had changed their journeys. They also acknowledge their
“trust issues” as much as providers’ and facilities’.

One of the most frustrating things for us is that no one would ever explain to me "this is going
to be a world of discovery.” […] It was misery on top of misery. And being told that your child
has a serious mental illness is a scary thing. I wish somebody had given me more kindness
and information, "listen, you and your family need to understand this is going to be a road
until we discover the right combination or the right medication to help your son, so that he is
able to receive good help.” (Caregiver).

Let’s not only build buildings! […]. (User).

I want to find a doctor who cares about me, not about my bipolar disorder. Most doctors don’t
care about you and don’t treat you as a person […]. (User).

What has worked is having him in the facility he goes to and then seeing the same physician
once outside that facility. Continuity of care, having good relationships, building long-term
relationships. (Caregiver).
Building Bridges 21

We repeat a formula that does not work because we feel more comfortable being doctors than
human beings. (Provider).

Our big problem is the lack of connections, exchange, and trust. We can’t seem to find a way
to fix this. We should be working closely together. (Provider).

Texan providers do not trust each other. (Provider).

They say, “Everything is in your head.” You can’t complain. I never thought a doctor would
believe me. They have trust issues, and we have trust issues. Let’s put it this way: it’s not a
smooth relationship. (User).

It’s all about saving their time and protecting themselves [the providers]. (User).

Mental health providers are seen as authorities in the structure of care, but they are also subject to
the insurance companies, whose demands usually supplant users’ and providers’. Despite that, not
having insurance and not being able to pay for treatment reduces even further the number of options
available in terms of care. To avoid relying on state-funded programs, many families give up on their
financial plans to support the treatment of their loved ones. Additionally, political changes and
inefficient policies are an extra barrier to ongoing care: by the time of our visits, President Donald
Trump had just been elected with the promise to review 2010’s Affordable Care Act and 2008’s
Mental Health Parity and Addiction Equity Act.

Liability. Doctors are more likely to face legal problems if they are open to non-traditional
approaches. […] We have good ideas, but insurance companies determine what can be done.
They don’t want good ideas; they want fast results. (Provider).

A long time ago, we would have 30 days to do what we are supposed to do in 8 days now. …
20 years ago, the average length of stay at an inpatient treatment facility would be 20 days;
now it’s 3 days. (Provider).

Their [insurance companies’] first question is: when is he [user] leaving? Insurance
companies are the major barrier to good quality of care. (Provider).

I have funded his life and his medical treatment because, not having insurance, you are
thrown into County care, and you don’t want that. (Caregiver).
Building Bridges 22

Obamacare needs improvement, but I think it could lead us to a solution, eventually. It could
be a way to get there, but it will not survive this new administration. Tough times are coming.
[…] Medicare, as it is today, does not take mental health care seriously enough, but I don’t see
a better horizon. (Provider).

We need someone to fight for this cause in the political sphere. We need political power,
which we don’t have. I think it will get worse. (Provider).

Harris County is the third most populous county in the United States and has the second highest rate
of uninsured citizens in Texas: around 25% (Ben Taub Hospital, 2017). Harris Health System is the
number one provider of mental health services for adults in the area, followed by Harris Center for
Mental Health and IDD (former MHMRA). Most users, caregivers, and providers interviewed for this
study consider their services outstanding, alongside those of UT Health Harris County Psychiatric
Center. Even so, most families fear to have to rely on public systems because of administrative
barriers. Houston’s outpatient facilities to the low-income public also face issues of financial and
political instability. Many have a history of high staff turnover because of low salaries and have
changed location multiple times in an attempt to beat high costs. On the opposite end, the city saw an
increase in the number of self-paid inpatient and outpatient facilities for severe mental illness.

There is no lack of private beds in general, but a considerable gap regarding public treatment.
Care for children is even scarcer because of bad legislation to protect children’s mental health
care. (Provider).

They do their best with what they have. Some public hospitals do not get any mental health
money but treat mental health, and do a great job. […] The faculty is the same in expensive
facilities, but here they provide care to everybody. They are not fancy, you might have to wait
longer, but it is worth it. (Provider).

Public care… you never know what to expect. There are good days and terrible days. I would
rather pay for care and make decisions that I cannot make in state hospitals. (User).

We work to convert nickels and dimes to dollars every single day. (Provider).

We struggle to provide good care to people who cannot pay. Medicare is supposed to cover
80% of our costs, but how are indigent individuals expected to pay the other 20%? (Provider).
Building Bridges 23

We don’t provide care in line with insurance reimbursement. We’ve been working on studies
to demonstrate our efficacy to the insurance companies… outcomes research to demonstrate
it. It is one of our greatest challenges. (Provider).

The large mental health corporations ruined Houston’s mental health network and
community treatment. Those facilities are not worried about developing relationships with
the community. (Provider).

Some of the most interesting solutions in Houston’s mental health network come from less traditional
models, such as clubhouses and peer respites. Their atmosphere is friendly and warm, but they also
face challenges, including lack of transportation, homelessness, substance use, incapacity, stigma,
underfunding, and policy barriers.

Most come with a substance use issue. We are learning where to refer our people in case of
substance use. (Provider).

We deal with low staffing, we do not have money to fund everything, and we have many other
challenges. However, the outcomes are good! We work for rich and poor people; they only
have to show up. (Provider).

It’s a system. If one part does not function properly, we are in trouble. The whole system has
problems. Some individuals can’t come every day because they have to take three buses. We
try to help, but we can’t help them all. (Provider).

They spend the night walking around the city. By the morning, they are tired. They just want
a place to stay for a couple of hours; they are not able to work or to engage in an activity.
(Provider).

Because of the financial, political, clinical, and social issues presented so far and discussed in the focus
groups and the semistructured interviews that are part of this research, most users experience
discontinuities in mental health care. Rhodes (1991) highlighted the curious need for changes and
movement, rather than a tendency to recovery and rest, in the U.S. mental health system, which is
based on crisis and successive hospitalizations, resulting in disconnected actions. More often than
not, inpatient care does not evolve into a plan that contemplates after-crisis, having become “a place
where someone must go when hopes for recovery are failing and it was often seen as a return to
square one” (Myers, 2015).
Building Bridges 24

They make you leave as soon as possible, and you end up back in the hospital. (Caregiver).

The system itself is in crisis because it is a crisis-oriented system. (Provider).

The best inpatient psychiatric treatment is the one closest to your house. I don’t believe that
any of them offer something groundbreaking. Personal support and having your family
around is more important than the facility itself. (Provider).
Building Bridges 25

3. SKETCHING A PROGRAM: WHAT DO WE WANT?

The deinstitutionalization movement in the United States should have resulted in a more horizontal
and decentralized network of services, but the American mental health system ended up facing
another type of vertical power: the market’s demand for productivity and reduced costs. “Crafted
means of healthcare were replaced by large-scale production of health services in huge hospitals with
streamlined specialization” (Seikkula, Arnkil, & Eriksson, 2003, p. 187).

As a reaction to this reality, new humanistic approaches emerged, focusing on personal narratives
and demands such as “empowerment, voice, choice” for users (Substance Abuse and Mental Health
Services Administration, 2014). For example, people with lived experience in mental issues began to
be trained to act as a workforce in the field. The so-called peer movement is now considered a best
practice 18 by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is
available—and Medicaid reimbursable—in most U.S. states.

Peers are not specialists in any condition but “experts in themselves,” spokespersons for their
personal solutions in their pathways to recovery. They are witnesses to the challenges and setbacks
on the way to recovery but also living proof of its feasibility. Moreover, they rely on knowledge that
is reachable, understandable, and not overly technical, which helps to disperse the common paranoid
effects caused by medical knowledge and vertical organizations (Zenoni, 2000). Each user is
responsible for building their own history with the support of peer staff. According to Viganò (2000,
p. 30), “It’s not the subject that must respect the institutions; institutions will be respected if they
wish to give the subjects a representation, a place in the social tissue.”

Widening the scope of peer-run programs in Houston would help reduce the number of untreated
cases by providing users with more options. Our conversations with providers, users, and caregivers
show that Houston’s major problem regarding mental health care does not relate to quality but to

18 Some studies on peer support outcomes: (a) Cook, J. et al. (2010). Developing the evidence base for peer-led services.
Psychiatric Rehabilitation Journal, 34(2), 113–120; (b) Bologna, M., & Pulice, R. (2011). Evaluation of a peer-run hospital
diversion program. American Journal of Psychiatric Rehabilitation, 14(4), 272–286; (c) Chinman, M. et al. (2014). Peer
support services for individuals with serious mental illness: Assessing the evidence. Psychiatric services in advance. Retrieved
from http://www.rand.org/pubs/external_publications/EP51719.html; (d) Davidson, L. et al. (2012). Peer support among
persons with severe mental illnesses: A review of evidence and experience. World Psychiatry, 11(2), 123–128; (e) Simpson,
A. (2013). Collaborators, not competitors: Peer workers and professionals, Journal of Psychosocial Nursing and Mental
Health Services, 51(10), 3–4; (f) Walker, G., & Bryant, W. (2013). Peer support in adult mental health services. Psychiatric
Rehabilitation Journal, 36(1): 28–34.
Building Bridges 26

the lack of accessibility and diversity. Building mobile, fluid bridges between services would grant
access to multiple types of care, building an interconnected, decentralized mental health system.

Peer-Run Warmline

A peer-run warmline is a phone number that users can call if they want to talk to peers, and acts as
an addition to traditional psychiatric hotlines (National Empowerment Center; National Mental
Health Consumers’ Self-Help Clearinghouse, 2013). Warmline calls are not emergency in nature and
are supposed to take place before a crisis, helping to prevent hospitalizations and the use of more
expensive and traumatic resources. They are also an excellent source of case management and
connection between users and existing services. In brief, they are an alternative to the medical model
but can also help users make the best use of traditional services.

Establishing a warmline is a feasible way to encompass critical elements observed in the

conversations that were part of this study and some of the best practices it assessed—flexibility,
affordability, peer workforce, case management, and accessibility. Houston offers good crisis lines to
its users, but the only warmline in Texas is Mental Health America’s Warmline of Greater Tarrant
County.19

Very few studies have examined warmlines and their impact; however, Stefan (2006) suggested that
“in a system with adequate case management, hot and warm lines, respite care, and well-trained,
flexible community providers, use of ED (Emergency Departments) by people in psychiatric crisis
could be expected to drop substantially” (p. 112). Moreover, Dalgin et al. (2017) stated that warmline
callers report a reduction in the use of crisis services and in feelings of isolation, indicating this
service can fill a void in the mental health network.

Because the entire community benefits from crisis prevention services, Houston’s warmline should
be built with strong, diverse collaborations among various stakeholders. The program would be a
pilot for further research on peer-run, community-based services in Texas; therefore, record keeping
should be a primary concern.

19 Available at 817-546-7806, from 2 p.m. to 6 p.m., Monday–Friday.

Building Bridges 27

The warmline should act as an initial seed that, in the near future, would develop into a set of
interconnected mental health services following the same premises of affordability, accessibility,
flexibility, and community-based programs.

Mobile Mental Health Care Team

The concept of mobile teams on mental health is not new; for instance, the Program for Assertive
Community Treatment (PACT) was created to support users outside of closed facilities and within
the community. However, they have been used as a step-down from hospitalizations and are strongly
based on traditional psychiatric care.

The central idea of assertive community treatment was that a community-based team would
provide a full range of medical, psychosocial, and rehabilitative services, analogous to care in
a hospital, to prevent hospitalization of clients. (Drake; Burns, 1995, p. 667).

What we envision is a crisis-prevention team that would provide long-term support using multiple
approaches, including non-psychiatric models. Users would be allowed to choose the providers they
want to see, and the team should be able to adapt to these needs. Flexibility, alongside the ability to
collaborate with several resources other than psychiatric facilities, would help the team to reach a
population that currently refuses the type of care that PACT provides and, as a result, significantly
raise its dropout rates.

A study conducted by several authors comments on the fact that clients "referred from
community mental health centers were more successfully engaged, while clients referred
from shelters and hospitals were less successfully engaged" (Herinckx, Kinney, Clarke &
Paulson, 1997, p.1298)20. Apparently, some clients, no matter who attempted to "treat" them,
were making it clear through their actions, that they would rather be left alone.(Spindel;
Nugent, 1999).

Parachute NY, one of the best practices assessed during this study, was the first of its kind to have
peers and clinicians working together, both trained in trauma-informed approaches: intentional peer

20 Herinckx,
H. et al.(1997). Assertive Community Treatment Versus Usual Care in Engaging and Retaining Clients With
Severe Mental Illness. Psychiatric Services, 48(10), 1297 - 1306.
Building Bridges 28

support and need-adapted treatment. 21 The collaboration proved challenging but also promising
(Pope, Cubellis, & Hopper, 2016), and should be further studied in populations as vast and diverse as
Houston’s.

Residential service

A residential program is crucial to the set of interconnected services suggested as the result of this
research, as it provides a long-term type of care that is much needed in the Houston area. Like the
other programs previously suggested – a warmline and a mobile team –, the residential facility should
not be run exclusively by clinicians, but by a wide array of professionals with various approaches,
provided according to each user’s needs and beliefs.

Among the best practices visited during this study, there are two noteworthy models of residential
care: Soteria and Gnosis. Both programs propose a house-like environment with an open setting that
allows the experience of communal living for an extended period of time. The idea behind these
programs is to support users while they make their way into living independently in the community.

Community is actually a main value in these residential services, especially peer-run houses. They
are not intended to fix adjacent problems like housing and long-term care, but to create an
environment that enables users establish a safety net that would lessen the effects of eventual crises
and distresses.

These services are based on a recovery model, with a set of elements that includes non-medical staff,
users’ empowerment, social networks, individual and communal responsibilities and subjective
experience. Outcomes (Toresini, 2007; Calton; Ferriter; Huband; Spandler, 2008) show that
residential houses can be useful both as a prevention service and during acute mental distress, acting
as a gentler alternative to hospitalization.

21The model focuses on the users’ network and close relationships to find pathways to recovery. Therapists are not
considered experts, and families and users have an active role in the treatment plan.
Building Bridges 29

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Building Bridges 32

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Building Bridges 33

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Building Bridges 35

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 Building Bridges 36

APPENDIX A. Original lists of facilities used in the research

a) Source 1: NAMI
In November 2016, we obtained the following results:

Facility Name Address

1) Baylor Psychiatry Clinic 1977 Butler Blvd Ste E4.400 – 77030 – 713-798-4857
2) Devereux Texas Treatment Network 1150 Devereux Dr. – League City – 77573 – 281-335-1000
3) Houston Behavioral Healthcare Hospital 2801 Gessner Rd – 77080 – 832-834-7710
4) New Dimensions 1345 Space Park Dr. Ste. C – 77058 – 281-333-2284
5) Saint Joseph’s Medical Hospital 1919 La Branch – 77002 – 713-657-7300
6) The Excel Center 111 E Edgewood Dr. – 77546 –281-648-1200
7) The Menninger Clinic 12301 S. Main – 77035 – 713-275-5000
8) West Oak Hospital 6500 Hornwood – 77074 – 713-995-0909
Table 1. NAMI list – facilities included in the research

b) Source 2: SAMHSA
The results displayed in November 2016 using both SAMHSA’s list and 2015-2016 directory were:

Facility Name Address

1) Behavioral Hospital of Bellaire 5314 Dashwood Drive – 77081 – 713-600-9500
2) Behavioral Hospital of Bellaire - Outpatient Center 6550 Mappleridge St. – 77081 – 713-662-2957
3) Ben Taub Hospital - Behavioral Health 1502 Taub Loop – 77030 – 713-873-5143
4) Center for Success and Independence 3722 Pinemont Drive – 77018 – 713-426-4545
5) Cypress Creek Hospital 17750 Cali Drive – 77090 – 281-586-7600
6) Daybreak Rehabilitation Center 5331 West Orem Drive – Houston, 77045 – 713-433-0528
7) DePelchin Children's Center - Main Campus 4950 Memorial Drive – 77007 – 713-730-2335
8) Devereux Foundation 1150 Devereux Drive – League City, 77573 – 281-335-1000
9) Excel Center at Friendswood 111 East Edgewood Drive – 77546 – 281-648-1200
10) Family Houston - Bay Area District Office 1300 Bay Area Boulevard – 77058 – 281-282-6045
11) Family Houston - Baytown District Office 1300 Rollingbrook Drive – Baytown – 77521 – 281-424-0314
12) Family Services of Greater Houston 4625 Lillian Street – 77007 – 713-861-4849
13) Fort Bend District Office 12300 Parc Crest Dr – Stafford – 77477 – 713-861-4849
14) Guardian Angels I Residential Treatment Center 9530 West Montgomery Rd. – 77088 – 281-447-1812
15) Harris Center for Mental Health and IDD 9401 SW Freeway – 77074 – 713-970-7000
16) Harris Center for Mental Health and Safe Havens 1215 Dennis Street – 77004 – 713-658-0972
17) Harris Center for Mental Health and IDD TCOOMMI 2525 Murworth Drive – 77054 – 713-394-4494
18) Harris Center for Mental Health and IDD Bristow Center 2627 Caroline Street – 77004 – 713-970-7413
19) Harris Center - Southeast Community Service Center 5901 Long Drive – 77087 – 713-970-4300
20) Harris County Hospital District 2525 Holly Hall Street – 77054 – 713-566-6403
21) Harris County Psychiatric Center - University of Texas 2800 South MacGregor Way – 77021 – 713-741-5000
22) Hope Bridge Hospital 5556 Gasmer Drive – 77035 – 713-422-2650
23) Houston Serenity Place Inc 6509 Morrow Street – 77091 – 713-691-5453
24) Houston Wee Care Shelter Inc 28915 South Plum Creek Drive – 77386 – 281-363-4020
25) Innerwisdom Inc 10777 Stella Link Road – 77025 – 713-592-9292
26) Intracare North Hospital 1120 Cypress Station Drive – 77090 – 281-893-7200
 Building Bridges
27) Jewish Family Service
28) MH/MR Authority of Harris County - Northwest Clinic
29) Michael E DeBakey VAMC - Mental Hygiene (116A)
30) New Dimensions Day Treatment Centers
31) Post Oak Care Center
32) Saint Joseph Medical Center - Center for BH
33) Unity Children's Home
34) Unity Children's Home - Trickey Road Location
35) West Houston Medical Center
36) West Oaks Hospital
37) West Oaks Hospital - Outpatient Clinic
Table 2. SAMHSA’s list – facilities included in the research
Facility Name
1) Behavioral Hospital of Bellaire
2) Ben Taub General Hospital – Behavioral Health
3) Center for Success and Independence
4) Cypress Creek Hospital
5) DayBreak Rehabilitation Center
6) DePelchin Children's Center - Main Campus
7) DePelchin Children’s Center – Clear Lake
8) Devereux Foundation
9) Excel Center at Friendswood
10) Family Services of Greater Houston
11) Family Services of Greater Houston – Bay Area District Office
12) Guardian Angels Residential Treatment Center
13) Harris Center for Mental Health and IDD
14) Harris County Hospital District
15) Harris County Psychiatric Center - University of Texas
16) HopeBridge Hospital
17) Houston Serenity Place Inc.
18) Innerwisdom Inc
19) Intracare North Hospital
20) Jewish Family Service
21) Legacy Recovery Health Center
22) Lone Star Behavioral Health Cypress
23) MH/MR Authority of Harris County - Northwest Clinic
24) MH/MR Authority of Harris County - Bristow Center
25) MH/MR Authority of Harris County - Emergency Service
26) MH/MR Authority of Harris County - Safe Havens
27) MH/MR Authority of Harris County - SE Comm. Serv. Center
28) MH/MR Authority of Harris County TCOOMMI Juvenile
29) Michael E DeBakey VAMC Mental Hygiene (116A)
30) New Dimensions Day Treatment Center
31) Post Oak Care Center
32) Saint Joseph Medical Center - Center for BH at Saint Joseph MC
33) Unity Children’s Home – Tricky Road Location
34) West Houston Medical Center
35) West Oaks Hospital
Table 3. SAMHSA’s 2015-2016 directories – facilities included in the research
37
4131 South Braeswood Boulevard – 77025 - 713-667-9336
3737 Dacoma Street – 77092 – 713-970-8400
2002 Holcombe Boulevard – 77030 – 713-791-1414-28907
1345 Space Park Drive – 77058 – 281-333-2284
2020 North Loop West – 77018 – 713-960-0344
1404 Saint Joseph Parkway – 77002 – 713-757-7512
2111 River Valley Drive – Spring, 77373 – 281-355-0905
11805 Trickey Road – 77067 – 281-537-6148
12141 Richmond Avenue – 77082 – 281-588-8320
6500 Hornwood Drive – 77074 – 713-995-0909
6612 Hornwood Drive – 77074 – 713-774-0606
Address
5314 Dashwood Drive – 77081 – 713-600-9500
Behavioral Health 1502 Taub Loop – 77030 – 713-873-4900
3722 Pinemont Drive – 77018 – 713-426-4545
17750 Cali Drive – 77090 – 281-586-7600
5331 West Orem Drive, Suite 400 – 77045 – 713-433-0528
4950 Memorial Drive – 77007 – 713-730-2335
1300 Bay Area Boulevard, Suite A – 77058 – 281-282-6062
1150 Devereux Drive – 77573 – 281-335-1000
111 East Edgewood Drive – 77546 – 281-648-1200
4625 Lillian Street – 77007 – 713-861-4849
1300 Bay Area Boulevard, 240A – 77058 – 281-282-6045
9530 West Montgomery Road – 77048 – 281-447-1812
9401 SW Freeway – 77074 – 713-970-7000
2525 Holly Hall Street – 77054 – 713-566-6403
2800 South MacGregor Way – 77021 - 713-741-5000
5556 Gasmer Drive – 77035 – 713-422-2650
6509 Morrow Street – 77091 – 713-691-5453
10777 Stella Link Road - 77025 – 713-592-9292
1120 Cypress Station Drive – 77090 – 281-893-7200
4131 South Braeswood Boulevard – 77025 – 713-667-9336
388 West Little York Road – 77076 – 713-636-9264
16303 Grant Road – 77429 – 281-516-6200
3737 Dacoma Street – 77092 – 713-970-8400
2627 Caroline Street – 77004 – 713-970-7413
1502 Taub Loop – 77030 – 713-970-7000
1215 Dennis Street – 77004 - 713-658-0972
5901 Long Drive – 77087 – 713-970-4300
2525 Murworth Drive – 77054 – 713-394-4494
2002 Holcombe Boulevard – 77030 – 713-791-1414
1345 Space Park Drive, Suite C – 77058 – 281-333-2284
2020 North Loop West, Suite 150 – 77018 – 713-960-0344
1404 Saint Joseph Parkway – 77002 – 713-757-7512
11805 Trickey Road – 77067 – (281) 537-6148
12141 Richmond Avenue – 77082 – 281-588-8320
6500 Hornwood Drive – 77074 – 713-995-0909
 Building Bridges 38

c) Source 3: HealthGrove
In November 2016, the facilities presented were:

Facility Name Address

1) Behavioral Hospital of Bellaire - Outpatient Center 6550 Mappleridge St. – 77081 – 713-662-2957
2) Behavioral Medicine of Houston PA 7900 Westglen Drive – 77063 – 713-789-5588
3) Ben Taub Hospital - Behavioral Health 1502 Taub Loop – 77030 – 713-873-5143
4) Clinic Resources Management 1320 Quitman St. – 77009 – 713-227-8246
5) Dapa Family Recovery 5500 Guhn Road – 77040 – 713-783-8889
6) Daybreak Rehabilitation Center 5331 West Orem Drive – Houston, 77045 – 713-433-0528
7) DePelchin Children's Center - Clear Lake Center 1300 Bay Area Boulevard - # A – 77058 – 281-282-6062
8) DePelchin Children's Center - Main Campus 4950 Memorial Dr – 77007 – 713-730-2335
9) Family Services of Greater Houston 4625 Lillian Street – 77007 – 713-861-4849
10) Harris County Hospital District 2525 Holly Hall Street – 77054 – 713-566-6403
11) Harris County Psychiatric Center - University of Texas 2800 South MacGregor Way – 77021 – 713-741-5000
12) Houston Methodist – Psychiatry Department 6565 Fannin St., Houston, TX, 77030. 713- 790-3599
13) Intracare Medical Center Hospital - Behavioral Health 7601 Fannin St. – 77054 – 713-790-0949
14) Intracare North Hospital 1120 Cypress Station Drive – 77090 – 281-893-7200
15) Menninger Clinic 12301 S. Main – 77035 – 713-275-5000
16) Mental Health Co-op 503 Sul Ross St., Houston, TX 77006. 713-524-8705.
17) MH/MR Authority of Harris County - Administration Office 7011 SW Freeway – 77074 – 713-970-7000
18) MH/MR Authority of Harris County - Bristow Center 2627 Caroline Street – 77004 – 713-970-7413
19) MH/MR Authority of Harris County - New Start 7200 North Loop East – 77028 – 713-970-8625
20) MH/MR Authority of Harris County - Adults/ACT Program 3737 Dacoma St. – 77092 – 713-970-8400
21) MH/MR Authority of Harris County - Emergency Services 1502 Taub Loop – 77030 – 713-970-7000
22) MH/MR Authority of Harris County - Ripley Clinic 4414 Navigation Boulevard – 77011 – 713-970-8100
23) MH/MR Authority of Harris County - Safe Havens 1215 Dennis Street – 77004 – 713-658-0972
24) MH/MR Authority of Harris County - Southeast Comm. Service 5901 Long Drive – 77087 – 713-970-4300
25) MH/MR Authority of Harris County - TCOOMMI Juvenile 2525 Murworth Drive – 77054 – 713-394-4494
26) MH/MR Authority of Harris County - TRIAD MH 6300 Chimney Rock Road – 77081 – 713-970-7000
27) Michael E DeBakey VAMC - Mental Hygiene (116A) 2002 Holcombe Boulevard - 77030 – 713-791-1414
28) Post Oak Care Center 2020 North Loop West – 77018 – 713-960-0344
29) Restoration Odyssey Inc. 2814 Aldine Bender Road – 77032 – 281-442-4900
30) West Houston Medical Center 12141 Richmond Avenue – 77082 – 281-588-8320
31) West Oaks Hospital 6500 Hornwood Drive – 77074 – 713-995-0909
Table 4. HealthGrove’s list – facilities included in the research

d) Source 4: Mental Health America

In January 2017, the results were:

Facility Name Address

1) Baylor Psychiatry Clinic 1977 Butler Blvd., Ste. E4.400 – 77030 – 713-798-4857
2) Catholic Charities of the Archdiocese of Galveston-Houston 2615 Fannin St – 77002 – 713-526-4611
3) Center for Creative Resources 816 Hawthorne St. – 77006 – 713-461-7599
4) Central Care Integrated Health Services 8610 MLK Blvd. – 77033 – 713-734-0199
5) Denver Harbor Family Clinic 424 Hahlo St. – 77020 – 674-3326
6) El Centro de Corazón 412 Telephone Rd. – 77023 – 713-660-1880
7) Family Services of Greater Houston 4625 Lillian St. – 77007 – 713-861-4894
 Building Bridges 39

8) Ben Taub Hospital 1504 Taub Loop – 77030 – 713-873-2000

9) Hope Clinic 7001 Corporate Drive, Ste 120 – 77036 – 713-773-0803
10) Hope and Healing Center 717 Sage Rd. – 77056 – 713-871-1004
11) Houston Area Community Services 2150 West 18th St. – 77008 – 713-426-0027
12) Innovative Alternatives 1335 Regents Park Dr., Ste. 240 – 77058 – 832-864-6000
13) Interface-Samaritan Counseling Center 4803 San Felipe St. – 77056 – 713-626-7990
14) Jewish Family Service 4131 South Braeswood Blvd. – 77025 – 713-667-9336
15) Krist Samaritan Center 17555 El Camino Real – 77058 – 281-480-7554
16) Legacy Community Health Services 1415 California St. – 77006 – 832-548-5100
17) The Harris Center for Mental Health and IDD 3630 West Dallas St. – 77019 – 713-970-4444
18) Memorial Hermann Mental Health Crisis Clinic 9813 Memorial Blvd., Ste A – 77338 – 713-338-6422
19) Saint Joseph House 3307 Austin St. – 77004 – 713-523-5958
20) The Gathering Place 5310 South Willow Dr. – 77035 – 713-729-3499
21) The Montrose Center 401 Branard St., 2nd Floor – 77006 – 713-529-0037
22) UH-Clear Lake Psychology Services Clinic 2700 Bay Area Blvd., Box 83 – 77058 – 281-283-3330
Table 5. Mental Health America’s list – facilities included in the research

e) Pre-final list of facilities

The compilation of our four original lists resulted in the following directory of facilities, from where
double entries and services for children, adolescents, veterans, and substance abuse only were
excluded. Several other facilities were also excluded in a second moment for multiple reasons
(explained in the “Situation” column below). Services with various locations were merged into a
single item and shown under their current name. After these adjustments, the pre-final list below
generated the final list of facilities used in this research.

Facility Name Situation

1. Baylor Psychiatry Clinic Included in the research.
2. Behavioral Hospital of Bellaire Included in the research.
3. Behavioral Hospital of Bellaire Merged with Behavioral Hospital of Bellaire.
4. Behavioral Medicine of Houston Included in the research
5. Ben Taub Behavioral Health Included in the research.
Excluded: website says, “Cambridge Hospital is closed.” Phone out of
6. Cambridge Hospital in Houston
service22. Visited Jan. 24, 2017.
7. Catholic Charities of Galveston-Houston Excluded: does not treat severe mental illness23.
8. Center for Creative Resources Included in the research
Excluded: adolescents only (residential and intensive outpatient
9. Center for Success and Independence
care). Visited on Jan. 31, 2017.
10. Houston Methodist Psychiatry Department Included in the research
11. Mental Health Co-Op Included in the research

http://www.cambridgehospitalhouston.com/. Online newspapers (Deam, 2015; Pulsinelli, 2015) show that Intracare
22

Medical Center was closed in 2012 and replaced by Cambridge Hospital, also closed in 2015 due to financial issues.

23An email from Ernesto Lopez (elopez@catholiccharities.org), received on April 25, 2017 in response to our visit request,
stated that Catholic Charities do not offer treatment for serious mental illness.
Building Bridges 40

12. Central Care Integrated Health Services Included in the research.

Excluded: phone disconnected. No website available. Visited on Jan.
13. Clinic Resources Management
21, 2017. The building is closed.
14. Cypress Creek Hospital Included in the research.
Excluded: substance use only. Currently under “Dapa Psychiatric and
15. Dapa Family Recovery
Substance Abuse programs.”24.
16. Daybreak Rehabilitation Center Excluded: phone disconnected. Visited on Jan. 24, 2017: closed.25
17. Denver Harbor Family Clinic Included in the research.
Excluded: children only. Main campus visited on Feb. 02, 2017.
18. DePelchin Children's Center
Counseling for children and families.
Excluded: children and adolescents (residential services and foster
19. Devereux Texas Treatment Network
care). Visited on Feb. 03, 2017.
20. El Centro de Corazón Included in the research
21. Excel Center at Friendswood Excluded: merged with West Oaks Hospital.
22. Family Services Houston Included in the research.
Excluded: children only (residential treatment center). Visited on
23. Guardian Angels Residential Center
Jan. 31, 2017.
24. Harris Center for Mental Health and IDD Included in the research.
25. Harris County Hospital District Excluded: now Harris Health System/Ben Taub Hospital
26. Harris County Psychiatric Center – UT Included in the research.
27. Hope and Healing Center Excluded to avoid any possible conflicts of interest.
28. Hope Bridge Hospital Excluded: closed in 2017 26.
29. Hope Clinic Included in the research
30. Houston Area Community Services Included in the research
31. Houston Behavioral Healthcare Hospital Included in the research.
Excluded: children only (Child Protective Services). Visited on Jan.
32. Houston Serenity Place Inc
31, 2017. Currently open.
Excluded: children and adolescents only (residential treatment
33. Houston Wee Care Shelter
center). Visited on Feb. 1, 2017.
34. Innerwisdom Inc Included in the research.
35. Innovative Alternatives Included in the research
36. Interface-Samaritan Counseling Center Included in the research
Excluded: closed in 2012. Substituted by Cambridge Hospital – also
37. Intracare Medical Center - Behavioral Health
closed. Now Houston Sun Behavioral.
38. Intracare North Hospital Included in the research.
39. Jewish Family Service Included in the research.
40. Krist Samaritan Center Included in the research.
41. Legacy Community Health Services Included in the research.
42. Legacy Recovery Health Center Excluded: substance use only. Recently closed, building for lease.
43. Lone Star Behavioral Health Cypress Included in the research
44. Memorial Hermann Crisis Clinic Included in the research

24 Dapa is at the same building as Intracare North Hospital Partial Hospital. The facilities work closely but are independent.

25The phone number 713-433-0528, painted on the property’s wall, is disconnected. The website shows another address
under the same name in Missouri City. According to a newspaper article (Wukman, 2016), and a release from the United
States Attorney’s Office (2016), the facility was being investigated on Medicare fraud.

26Online news (Wetzel, 2017) shows that HopeBridge Hospital was closed on May, 2017 after failing to meet accreditation
standards for Medicare and Medicaid. In 2015, it appeared on a list of 758 American hospitals penalized by the Federal
government for high rates of patient safety incidents in the year that ended in September, 2016 (Kaiser Health News, 2015).
Building Bridges 41

45. Menninger Clinic Included in the research.

46. MH/MR Authority of Harris County Excluded: now Harris Center for MH and IDD.
47. New Dimensions Day Treatment Centers Included in the research.
48. Post Oak Care Center Included in the research.
Excluded: adolescents/substance use only. Closed at this address.
49. Restoration Odyssey Inc.
Phone calls not answered. Visited on Feb. 13, 2017.
50. Saint Joseph House Included in the research
51. Saint Joseph Behavioral Health Included in the research.
52. The Excel Center Excluded: added to the West Oaks Hospital.
53. The Gathering Place Included in the research
54. The Montrose Center Included in the research
55. Univ. of Houston Clear Lake Clinic Included in the research
56. Unity Children's Home Excluded: children and adolescents only (residential treatment
center). Visited on Jan. 31, 2017.
57. West Houston Medical Center Included in the research.
58. West Oaks Hospital and Outpatient Clinic Included in the research.
Table 6. Pre-final list of facilities included in the research
Building Bridges 42

APPENDIX B – Facilities assessed in the Houston area

Baylor Psychiatry Clinic

Visited on Apr. 27, 2017. Address: 1977 Butler Boulevard, Suite E4.100, Houston, TX 77030. Phone:
713-798-4857. Website: https://www.bcm.edu/healthcare/care-centers/psychiatry. Email:
psychiatry@bcm.edu. Representative: Bella Schanzer (Medical director; vice chair for clinical affairs
for the Menninger Department of Psychiatry at Baylor). Payment method: Medicare, a few private
insurance companies, out-of-pocket. Waitlist: depends on the provider; longer for insurance
coverage. Specialties: mood, anxiety, and personality disorders; eating disorders; psychiatric
disorders related to women’s reproductive events; marital, family, and relationship conflicts;
evaluation and treatment of organ transplant donors and recipients; work-related problems; brain
injury-related problems; sexual abuse treatment (Baylor College of Medicine, 2016a).

The Menninger group operates the Psychiatry Clinic at Baylor College of Medicine, offering
assessment, treatment, and educational programs. The service does not include intensive care, case
management, or social work. Appointments and payments can be made online or over the phone. The
evaluation process consists of an initial assessment over the phone, a psychiatric interview, and
psychological testing. The wait list management takes these results into consideration.

The facility’s website offers a “For patients” section (Baylor College of Medicine, 2016a), with
information on appointments, forms, consumers’ rights and responsibilities, payments, and billings.
It is part of Baylor College of Medicine’s portal, which delivers news and articles on multiple mental
health issues.

Behavioral Hospital of Bellaire

Visit requests were not responded. Inpatient and outpatient care. Address: 5314 Dashwood Drive,
Suite 200, Houston, TX 77081. Phone: 713-600-9500. Website: http://bhbhospital.com/. Email:
info@bhbhospital.com. Representative: Coleby Wright (CEO). Specialties: depression; psychotic,
mood, and anxiety disorders; drug and alcohol rehabilitation; chronic suicidal ideation;
family/interpersonal conflict; postpartum depression/psychosis (Behavioral Hospital of Bellaire,
2016). Programs: Exclusively Women; Senior Mental Health and Substance Abuse Treatment
Program. Number of beds: 122. Payment method: Medicare/Medicaid; private insurance; out-of-
pocket.
Building Bridges 43

Behavioral Hospital of Bellaire provides substance use and mental health care for adults, adolescents,
and children. Free assessments are available 24 hours a day. Outpatient services have two levels of
care: partial hospitalization (for patients on the cusp of an inpatient admission or recently
discharged), and intensive outpatient (for those who have already reached some stability). The
facility’s website offers detailed information on both.

We called the facility on January 10, 2017, and were told that any visit should be pre-approved; the
call was transferred to the CEO’s secretary, we left a voice message, but it was never responded. Three
visit requests were sent to its general email (info@bhbhospital.com) (January 17, March 8, April 25,
2017).

In 2015, Universal Health Services (UHS), which manages Houston’s Behavioral Hospital of Bellaire,
Cypress Creek, and West Oaks Hospital went through a criminal investigation by the U.S. Department
of Justice, due to “… alleged fraudulent billing practices to Medicare and Medicaid” (Morse, 2015).
BuzzFeed News (Adams, 2016) wrote an extensive article about UHS, and the company created a
website with its version of the facts27, stressing that it has not been charged with any wrongdoing.
None of the three facilities investigated answered to our visit requests.

Behavioral Medicine of Houston

Visited on Jan. 25, 2017. Outpatient care. Address: 7900 Westglen Drive, Houston, TX 77063
(previous address revised during the visit). Phone: 713-789-5588; 713-850-1190 (provided in the
visit). Website: not available. Email: rmgservicesr@gmail.com (provided in the visit). Representative:
Paulo Bettega (owner). Specialties: outpatient services to children and adults; emergency care;
partial hospitalization (PHP); inpatient referral; placement services; clinical assessment for mental
health warrants; intensive outpatient services (information provided during the visit). Payment
method: Medicare/Medicaid; out-of-pocket (sliding scale).

Our online search showed very little and outdated information on Behavioral Medicine of Houston
PA. Our calls did not receive responses, there were no email addresses available online, and its
physical location is listed as “permanently closed” on Google Maps.28 A newspaper article from 2013

27 http://www.uhsthefacts.com/

28 www.google.com/maps
Building Bridges 44

cites the facility among those of Texas’ community mental health services that is being investigated
for excessive Medicare billing (Langford, 2013).

We visited the facility on January 25, 2017, and found it was being operated in a building close to the
original location (7830 Westglen Dr.) that had a “for lease” sign and an “emergency number” (713-
785-1987) written on its wall; our calls to this number were not answered. The new building’s main
door was open. We met some users walking around, and a staff member asked us to email our
questions to rmgservicesr@gmail.com; however, we received an “undeliverable”29 automatic reply
after trying to contact it.

Ben Taub Hospital

Visited on Apr. 25, 2017. Inpatient and outpatient care. Address: 1502 Taub Loop, Houston, TX
77030. Phone: 713-873-2000. Website: https://www.bcm.edu/healthcare/care-
centers/psychiatry/clinics/ben-taub-harris-health-system. Email: aashah@bcm.edu.
Representative: Asim A. Shah (chief of psychiatry). Specialties: post-traumatic stress disorders;
forensic issues; anxiety and personality disorders; depression; psychiatric disorders caused by
general medical conditions (Ben Taub Hospital, 2017). Number of beds available: 20. Average length
of stay: 6-7 days. Waiting list: no. Payment method: Medicare/Medicaid; private insurance; out-of-
pocket.

Ben Taub is a large acute care facility and trauma center staffed by faculty and residents from the
Baylor College of Medicine. It offers services for children, adolescents, and adults in several medical
specialties, including psychiatry (inpatient, outpatient, and emergency care). The facility is part of
the Harris Health System, the main health provider in the area. Its inpatient unit offers voluntary and
involuntary treatment and is “the only facility capable of providing care for indigent individuals
needing psychiatric hospitalization who have concomitant medical conditions” (Ben Taub Hospital,
2017). The Emergency Center, which coordinates psychiatric, medical, and surgical treatments, is
open 24 hours a day, and sees approximately 10,000 consumers a year. Because substance use is a

29 “Deliveryhas failed to these recipients or groups: rmgservicesr@gmail.com. The email address you entered couldn’t be
found. Please check the recipient’s email address and try to resend the message. If the problem continues, please contact
your helpdesk. The following organization rejected your message: gmail-smtp-in.l.google.com.”
Building Bridges 45

primary factor in emergency care, the service has a licensed chemical dependency counselor. Clients
in the high-risk group have follow-ups with social workers after discharge.

Ben Taub is also the largest outpatient mental health care provider in the area. The Outpatient
Psychiatry Clinic offers services for adults with concomitant medical and psychiatric illnesses and
individuals discharged from other facilities. The intensive outpatient program serves nonpsychotic
individuals incapable of independent community living, and the community behavioral health
program focuses on mental health care, education, and research. The hospital has a mood disorder
clinic and a survivors of torture clinic.

The facility’s website is hosted by the Baylor College of Medicine’s portal and has detailed
information about its treatments.

Center for Creative Resources

Visit requests were not responded. Outpatient care. Address: 816 Hawthorne St., Houston, TX 77006.
Phone: 713-461-7599. Website: http://www.therapyhouston.org. Email: not available.
Representative: Dr. Jyl Scott-Reagan (executive director). Specialties: counseling services.

The Center for Creative Resources is a nonprofit organization that has provided individual, couples,
groups, and family therapy to children, adolescents, and adults since 1968. Some of its therapists
work with sliding scale fees at its low-cost clinic. Its website offers scarce information.

We tried to visit the facility on May 17, 2017, but it was closed; our research material and business
cards were left in the mailbox, but we did not receive any response.

Central Care Integrated Health Services

Visit requests were not responded. Outpatient care. Address: 8610 Martin Luther King Blvd.,
Houston, TX 77033 (several locations). Phone: 713-734-0199. Website:
http://www.centralcarechc.org. Email: admin@centralcarechc.org. Representative: La Toya Darden
(CEO). Specialties: individual, group, and family therapy; medication evaluation and maintenance;
social work; stress management; treatment planning; support services.

With six different locations in Houston, Central Care Integrated Health Services (2017) can serve
more than 30,000 low-income and uninsured individuals in preventative medical, dental, and
Building Bridges 46

behavioral health services. Its website offers scarce information on the services provided. According
to it, its behavioral health program offers initial identification, referrals to other services, and With
six different locations in Houston, Central Care Integrated Health Services (2017) can serve more
than 30,000 low-income and uninsured individuals in preventative medical, dental, and behavioral
health services. Its website offers scarce information on the services provided, but it does mention
that its behavioral health program offers initial identification, referrals to other services, and
counseling to “all patients, regardless of insurance coverage, citizenship status or level of income”
(Central Care Integrated Health Services, 2017).

Our calls and emails to the facility were left unanswered.

Cypress Creek Hospital

Visit request were not responded. Inpatient and outpatient care. Address: 17750 Cali Drive, Houston,
TX 77090. Phone: 281-586-7600. Website: http://www.cypresscreekhospital.com. Email: not found.
Representative: Brian J. Brooker (CEO). Specialties: chemical dependency; electroconvulsive therapy
(ECT); 12 steps immersion program (Cypress Creek Hospital, 2016). Number of beds available: 96.
Payment method: Medicare/Medicaid; private insurance; out-of-pocket.

Cypress Creek is over twenty years old and treats adolescents and adults’ behavioral health issues,
including substance use. It offers inpatient care, day treatment, and intensive outpatient services. Its
official website provides an online payment tool, information about the programs available, a virtual
tour, and data on clients’ medical records. The facility’s representative answered to one of our emails
Cypress Creek is over 20 years old and treats adolescents and adults’ behavioral health issues,
including substance use. It offers inpatient care, day treatment, and intensive outpatient services.
Its official website provides an online payment tool, information about the programs available, a
virtual tour, and data on clients’ medical records. The facility’s representative answered one of our
emails but cut off communication with us when we tried to schedule a visit.

Denver Harbor Family Clinic

Visited on May 22, 2017. Outpatient care. Address: 424 Hahlo St., Houston, TX 77020. Phone: 713-
674-3326. Website: http://www.denverharborclinic.org. Email: not available. Representative:
Daniel Montez (CEO). Specialties: bilingual counseling services to adults, adolescents, and children.
Building Bridges 47

Payment method: Medicare/Medicaid; private insurance; out-of-pocket (sliding scale). Waitlist:

depends on the service; counseling may take six to eight weeks (information provided during the
visit).

The Vecino Organization was created in 2001 to offer medical, dental, and mental health services.
Denver Harbor Family Clinic is part of this group and delivers counseling, psychiatric services, and
education to the low-income public through both patient fees and federal funds. Most users are
Hispanic and on the Children’s Health Insurance Plan or Medicaid. The Family Assistance Program
covers a portion of the medical costs for those who are eligible. The clinic has been planning an
expansion to double its capacity over the next 5 years (Martin, 2016). Its website offers an overview
of the services provided but no further details.

El Centro de Corazón

Visited on May 22, 2017. Outpatient care. Address: 412 Telephone Rd., Houston, TX 77023 (several
locations). Phone: 713-660-1880. Website: www.elcentrodecorazon.org/. Email: not available.
Representative: Marcie Mir (CEO). Specialties: primary care to adults and children, women’s health
services, dental care, behavioral health services. Payment method: Medicare/Medicaid; private
insurance; out-of-pocket (sliding scale). Waitlist: depends on the service; psychiatric consultations
may take up to six months.

El Centro de Corazón was founded in 1994 as a social service organization focused on early childhood
development (El Centro de Corazón, 2017). Over the years, it became a designated Federally Qualified
Health Center, with three health centers that offer pediatric and adult primary, dental, and behavioral
care. More than 80% of its patients are Hispanic. Its website provides information on how to make
appointments and gives an overview of the facility, its history, and its programs. The services include
individual, couples, and family therapy, psychiatric evaluation and medication management,
psychological testing, and assessments in English and Spanish. The facility welcomes consumers with
chronic mental illness, but there is only one psychiatrist available and a long wait list.

Family Services of Greater Houston / Family Houston

Visited on Apr. 4, 2017. Outpatient care. Address: 4625 Lillian St., Houston, TX 77007 (several
locations). Phone: 713-861-4849. Website: http://familyhouston.org/counseling. Email:
family@familyhouston.org. Representative: Jessica Cisneros (vice-president of behavioral health
Building Bridges 48

services). Specialties: cognitive behavioral therapy, trauma-based cognitive behavioral therapy, play
therapy, parent-child interactive therapy, adjacent services (case management, financial coaching,
employment services, etc.). Number of participants: more than 2,000 per year. Average length of
treatment: 5 sessions. Waitlist: depends on location and payment method. Payment methods:
Medicare/Medicaid, private insurance, out-of-pocket (sliding scale).

Family Services of Greater Houston was founded in 1904 and is one of the most traditional nonprofit
organizations in the area. It was conceived as a “flexible social service agency, ready to quickly offer
help to those in need” (Family Services of Greater Houston, 2016), with low-cost programs in several
areas, including counseling. Its website has little information about the services provided. The facility
offers adjacent programs in addition to mental health counseling and case management for basic
needs, parent education, financial coaching, employment, and veterans’ support. It also provides
parenting and life skills classes, substance abuse prevention programs, and school-based activities.

Harris Center for Mental Health and IDD (former MHMRA)

Visited on Apr. 28, 2017. Inpatient and outpatient care. Address: 9401 Southwest Freeway, Houston,
TX 77074 (several locations). Phone: 713-970-7000 (Helpline). Website:
http://www.mhmraharris.org. Email: not available. Representative: Sylvia Muzquiz-Drummond, MD
(medical director of the mental health division). Specialties: psychiatric emergency unit; Helpline;
outpatient programs; services for intellectual and developmental disabilities; forensic services.
Waitlist: may take weeks or even years, depending on the program. No wait list or eligibility
procedures in cases of emergency. Payment methods: Medicare/Medicaid; private insurance; out-of-
pocket. Financial criteria for outpatient services.

The Harris Center for Mental Health and IDD (former Mental Health and Mental Retardation
Authority of Harris County - MHMRA) is a non-profit, governmental entity established in 1964. It is
the largest mental health authority of Harris County, responsible for the coordination and
development of community-based programs for mental illness, intellectual and developmental
disabilities, forensic services and psychiatric emergency care to children, adolescents, and adults
(Harris Center for Mental Health and IDD, 2016). The psychiatric emergency services include crisis
stabilization and residential units, a mobile crisis outreach team, a post-hospital crisis unit, and an
intervention response team. Through its Helpline, people can get support in their search for adequate
The Harris Center for Mental Health and IDD (former Mental Health and Mental Retardation
Building Bridges 49

Authority of Harris County – MHMRA) is a nonprofit governmental entity established in 1964. It

is the largest mental health authority in Harris County and is responsible for the coordination and
development of community-based programs for mental illness, intellectual and developmental
disabilities, forensic services, and psychiatric emergency care to children, adolescents, and adults
(Harris Center for Mental Health and IDD, 2016). The psychiatric emergency services include
crisis stabilization and residential units, a mobile crisis outreach team, a post-hospital crisis unit,
and an intervention response team. Through its Helpline, people can get support in their search for
adequate mental health treatment. The official website contains little data about the programs
offered. The easiest way to obtain information about it is by calling the Helpline.

Harris County Psychiatric Center – University of Texas

Visited on June 7, 2017. Inpatient care. Address: 2800 South MacGregor Way, Houston, TX 7721.
Phone: 713-741-5000. Website: https://hcpc.uth.edu/pages/index.htm. Email:
LaVonne.Carlson@uth.tmc.edu. Representative: Jair C. Soares (executive director); Stephen Glazier
(COO). Average length of stay: 7 to 10 work days. Number of beds available: 276 (inpatient). Waitlist:
around 40 new patients for intake each day. Specialties: legal issues; mental health care for adults,
children, and adolescents; dual diagnosis unit; early onset program (up to 90 days to prevent further
hospitalization). Payment methods: Medicare/Medicaid; private insurance; out-of-pocket.

UTHealth Harris County Psychiatric Center is the only public psychiatric hospital and the largest
provider of inpatient care for children, adolescents, and adults in Houston. It is the teaching hospital
of McGovern Medical School at the University of Texas Health Center (UTHealth, 2016). Most
admissions are involuntary, and typical consumers are of limited means—more than 80% do not
have health insurance, and about a third is later discharged to a homeless shelter (Zaveri, 2016).
Additionally, 12 patient units (recently renovated) host 276 beds. The facility owns the
Electroconvulsive Therapy Clinic and other outpatient services staffed by the UTHealth Medical
School Department of Psychiatry and Behavioral Sciences. Its website provides information on
mental illness, national programs, and personal care homes in the Houston area; it also has an
impressive list of local resources for mental health.
Building Bridges 50

HOPE Clinic

Visited on May 18, 2017. Outpatient care. Address: 7001 Corporate Drive, Ste 120, Houston, TX
77036. Phone: 713-773-0803. Website: http://hopechc.org. Email: information@hopechc.org.
Representative: Rodolfo Orna (director of behavioral health). Payment methods:
Medicare/Medicaid; private insurance; out-of-pocket (sliding scale). Waiting list: Around two
months for psychiatric services; mental health care is provided to internal clients with medical
referrals only.

The Asian American Health Coalition opened the HOPE Clinic in 2002 as a 4-hr-a-month, volunteer-
run, nonprofit service for Houston’s Asian communities with limited English proficiency (Hope Clinic,
2017). The facility offers services in 14 different languages, including Mandarin, Cantonese,
Vietnamese, Korean, Burmese, Arabic, and Spanish. The Mental Health Care Department is not open
to the public, only to current clients with a previous medical condition.

Houston Area Community Services/Avenue 360 Health and Wellness

Visit requests not responded. Outpatient care. Address: 2150 West 18th St, Houston, TX 77008
(several locations). Phone: 713-426-0027. Website: https://avenue360.org/. Email: not available.
Representative: Joe C. Fuentes (CEO). Specialties: medical care, housing, behavioral health.

In 1998, Houston Area Community Services started to provide care for individuals with HIV/AIDS:
medical, behavioral, and living services. In 2016, the facility merged with Bering Omega under the
name Avenue 360 Health & Wellness (Avenue 360, 2017). Its Behavioral Health Department includes
substance use treatment and therapy for adults and adolescents. Social workers provide case
management, referrals, and follow-ups.

Our calls were not answered; we contacted the facility via social media (Facebook) on May 22, 2017,
and were asked to wait for the representative’s response but did not hear back from them.

Houston Behavioral Healthcare Hospital

Visit requests were not responded. Inpatient and outpatient care. Address: 2801 Gessner Rd,
Houston, TX 77080. Phone: 832-834-7710. Website: http://www.houstonbehavioralhealth.com/.
Email: alexandra.grebens@houstonbehavioralhealth.com (obtained via phone). Representative: Roy
Building Bridges 51

Hollis (CEO); John Marcellus, MD (medical director). Specialties: Detox Plus – chemical dependency
program; partial hospital program; intensive outpatient program; electroconvulsive therapy
(Houston Behavioral Healthcare Hospital, 2016).

Houston Behavioral Healthcare Hospital opened in 2014 and is managed by Signature Behavioral
Health Care, which has hospitals in California, Illinois, Nevada, Arizona, and Texas. Its programs are
briefly presented on the official website.

Despite our efforts to contact the facility, our calls and emails were not returned.

Houston Methodist – Psychiatry Department

Visited on May 18, 2017. Inpatient and outpatient care. Address: 6565 Fannin St., Houston, TX, 77030.
Phone: 713- 790-3599. Website: http://www.houstonmethodist.org/psychiatry/. Email: not
available. Representative: not available. Specialties: depression and mood disorders; anxiety
disorders; schizophrenia; substance abuse; mental disorders related to physical conditions; eating
disorders; personality disorders; geriatric conditions. Number of beds available: 31 private and semi-
private rooms. Average length of stay: 7-8 days

Houston Methodist offers a variety of psychiatric services in both inpatient and outpatient settings.
It includes medical management of alcohol and chemical dependency detoxification. The staff are
affiliated with the Baylor College of Medicine and works to ensure individualized care. “A system
approach to treatment is in place incorporating family members and/or significant friends of the
patient” (Baylor College of Medicine, 2016b). The hospital accepts voluntary and involuntary adult
clients to its inpatient and partial hospitalization programs. The official website has comprehensive
information about the services and a tool to find doctors by name or specialty and to schedule
appointments online.

InnerWisdom

Visited on Jan. 26, 2017. Outpatient care. Address: 10777 Stella Link Rd., Houston, TX 77025. Phone:
713-592-9292. Website: http://www.innerwisdom.com/index.htm. Email: info@innerwisdom.com.
Representative: Joanne Mandel (CEO) - jmandel@innerwisdom.com. Specialties: partial and
intensive hospitalization outpatient programs; mental health services for adults; substance use
programs. Programs: Elders Day Program; Wellness Day Program; Skill Building Day Program;
Building Bridges 52

family, group and individual therapy. Year of foundation: 1988. Waitlist: no (information provided in
the visit). Payment methods: Medicaid/Medicare; private insurance, out-of-pocket (sliding scale).

InnerWisdom was founded in 1988 to provide mental health services to HIV consumers. A holistic
approach remains at its base, seeking to bring “long-term improvement to clients by combining the
traditional and widely used methods of mental health care with those methods that may be less
widely used, but are nonetheless greatly effective” (InnerWisdom, 2016). The facility went through
many location changes to overcome Houston’s high rental costs. In 2012, it acquired its current
building. InnerWisdom emphasizes its TJC (The Joint Commission) accreditation, one of the largest
standards-setting and accrediting bodies in health care in the United States. It offers individual,
family, and couples’ therapy, addictions counseling, and vocational evaluation.

Innovative Alternatives

Visited on May 11, 2017. Outpatient care. Address: 1335 Regents Park Dr, Suite 240, Houston, TX
77058. Phone: 832-864-6000. Website: http://innovativealternatives.org. Email:
aia@innovativealternatives.org. Representative: Sharon Bayus (CEO). Payment methods:
Medicare/Medicaid, private insurance, out-of-pocket (sliding scale). Specialties: mediation;
counseling; Victim Assistance Program; stress management to companies, families, and individuals.
Waitlist: depends on the provider; consumers can be seen as soon as the next day depending on the
urgency.

Innovative Alternatives is a nonprofit that started 28 years ago and offers counseling, mediation, and
training programs to companies, families, and individuals. The facility has a Victim Assistance
Program that provides eight free individual sessions for eligible clients, in addition to treatment for
PTSD, stress management, play therapy, and counseling (including faith-based services). Some of the
staff also speak Spanish and French. The service went through a massive expansion in 2016 to include
providers who treat acute mental illness, but psychiatric services are not available onsite. The
website does not provide details about specialties and procedures.

Interface-Samaritan Counseling Center

Visited on May 25, 2017. Outpatient care. Address: 4803 San Felipe St, Houston, TX 77056 (several
locations). Phone: 713-626-7990 Website: http://houstonsamaritan.org/. Email:
inquiries@houstonsamaritan.org. Representative: Steve Duson (executive director). Payment
Building Bridges 53

methods: Medicare, private insurance, out-of-pocket (sliding scale). Average length of treatment:
Five sessions, long-term counseling available if needed. Waitlist: depends on the provider.

Interface has over 20 licensed therapists and offers counseling to individuals, families, groups,
children, adolescents, and adults in three different locations. Counselors have a Christian approach
but are open to all faith backgrounds. Its holistic model of “prevention and healing” (Interface-
Samaritan Counseling Services, 2017) includes yoga programs, marriage/premarital classes, and
educational tools for caregivers. Psychiatric services are offered to current clients but are not open
to the public. Interface’s website explains its programs and offers answers to common questions on
mental health. It also provides an online library with links to facilities and news on mental health
topics.

Intracare North Hospital

Visit requests were not responded. Inpatient and outpatient care. Address: 1120 Cypress Station,
Houston, TX 77090 (inpatient). 5500 Guhn Road, Houston, TX 77040 (outpatient). Phone: 281-893-
7200. Website: http://www.intracarehospital.com/. Email: not available. Representative: Terry
Scovill (CEO). Specialties: psychiatric care; substance use. Payment methods: Medicare/Medicaid;
private insurance; out-of-pocket.

Intracare Medical Center, a former major mental health hospital in Houston, closed in 2012 after
losing its Medicare and Medicaid contracts. Management efforts then shifted to expanding its North
Houston premise, “which is separately certified and not part of the termination at the Astrodome
location [Medical Center]” (Ackerman, 2012). The Cambridge Hospital then operated the former
building for a period of time but was also closed. Intracare North Hospital offers treatment to
children, adolescents, and adults: intensive psychiatric care, inpatient units, chemical dependency
services, and outpatient programs: partial hospitalization (5 days a week); and intensive outpatient
programs (3 days a week). The information available on the website is outdated and barely adapted
to the changes that occurred in 2012. Our emails and calls to the facility were not answered.

Jewish Family Service

Visited on Mar. 17, 2017. Outpatient care. Address: 4131 S. Braeswood, Houston, TX 77025. Phone:
713-667-9336. Website: http://www.jfshouston.org/contactus.php. Email: info@jfshouston.org.
Representative: Linda Burger (CEO). Specialties: severe and persistent mental illness; adjacent
Building Bridges 54

services (employment and financial assistance, etc.). Payment methods: Medicare/Medicaid; private
insurance; out-of-pocket (sliding scale). Waiting list: average wait of three weeks to counseling –
meanwhile, the facility assesses direct clients for psychosocial assistance and other services.

Jewish Family Services is a nonprofit agency founded in 1913 that offers services to members of the
Jewish community in the Houston area. All fees are based on a flexible scale: “no client is ever refused
quality care due to an inability to pay” (Jewish Family Services, 2016). The Houston unit has seven
departments and licensed multilingual staff, interns, and volunteers. It offers counseling, disability,
senior and case management programs; employment, financial, and disaster support; medication
management; and other specialties. One of their new services is the suicide prevention program, a
response to the high suicide rates among young people in the community. Jewish Family Service is
also an educational institution, working closely with the University of Houston to provide internships
and supervision to clinical specialties.

The official website gives an overview of the institution. Its impact goes beyond direct clients because
it is a reference to the Jewish neighborhood. During Houston’s massive floods, it usually makes
headlines because of the support provided to the community (Jewish Telegraphic Agency, 2016).

Krist Samaritan Center

Visited on Apr. 12, 2017. Outpatient care. Address: 17555 El Camino Real, Cypress, TX 77058 (several
locations). Phone: 281-480-7554 Website: www.samaritanhouston.org. Email:
info@samaritanhouston.org . Representative: Kelley Williams (Clinical Director). Specialties:
individual and family counseling for children, adolescents, and adults; anger management; parent
coaching; family/divorce mediation; For Kids’ Sake program; early screenings; faith-based
counseling. Payment methods: Medicare/Medicaid; private insurance; out-of-pocket (sliding scale).
Wait time: a few weeks, depending on the provider; longer for testing. Average time of treatment: 7
sessions.

Krist Samaritan Center is a nonprofit center with several locations all over the Houston area. Grant-
funded services allow its providers to see low-income users on a sliding scale. Some units are heavily
Medicare/Medicaid funded, whereas most rely on private insurance payments. Currently, it houses
more than 30 clinicians and interns, and it just added a psychiatrist to the staff. Providers see clients
with chronic mental illness, but the psychiatric services are still incipient and do not include case
management. Individuals from all spiritual backgrounds are welcome.
Building Bridges 55

The service started a new phase with the retirement of its former CEO in 2016, after 29 years. It now
operates in a new building and has plans to expand its activities and locations. The official website
shows all the services offered.

Legacy Community Health Services

Visited on June 9, 2017. Outpatient care. Address: 1415 California St., Houston, TX 77006 (several
locations). Phone: 832-548-5100. Website: http://www.legacycommunityhealth.org/. Email: not
available. Representative: Chad Lemaire (psychiatrist). Specialties: primary, dental, and vision care;
behavioral health; LGBT services; HIV/STD screening and treatment. Payment methods:
Medicare/Medicaid; private insurance; out-of-pocket (sliding scale). Waitlist: depends on the
service; testing has a long wait list.

Legacy started in 2005 because of the merger of two leading community organizations: Montrose
Clinic and Assistance Fund. Currently, it has 14 locations and school-based services. The Behavioral
Health Department offers assessment, medication management, therapy, and psychological testing.
It also provides social work, including resource linkage, school advocacy, and connection to
immigration and legal services. Legacy offers psychiatric treatment for internal patients but may
accept some specific external demands. Several staff members are bilingual. Legacy’s website
provides comprehensive information not only about its services but also health and social issues,
with an archive of articles and news.

Lone Star Behavioral Health

Visit requests were not responded. Inpatient and outpatient care. Address: 16303 Grant Road,
Cypress, TX 77429 (several locations). Phone: 281-516-6200. Website:
http://www.lonestarbehavioralhealth.com/. Email: not available. Representative: Nathan Ingram
(CEO). Specialties: depression treatment; substance abuse treatment; inpatient and outpatient
mental health services; equine therapy (Lone Star Behavioral Health, 2016). Number of beds: 24.

Lone Star Behavioral Health has facilities in Tomball (167-acre outpatient service) and Cypress (24-
bed inpatient hospital), both in rural settings, with inpatient and partial hospitalization/outpatient
programs. Its website presents only a brief overview of the facility, focusing on its history and its
founder. Our emails and calls were not answered.
Building Bridges 56

Memorial Hermann Mental Health Crisis Clinic

Visited on May 24, 2017. Outpatient care. Address: 10780 Westview Dr., Suite C, Houston, TX 77043
(several locations). Phone: 713-338-6422 Website: http://www.memorialhermann.org/mental-
health/. Email: not available. Representative: Manish A. Pandya (director). Specialties: psychosocial
assessments; emergency medication administration; short-term prescriptions; referrals to a medical
home or outpatient treatment; social services; brief crisis counseling; short-term follow-ups.
Payment methods: Medicare/Medicaid; private insurance; out-of-pocket.

Memorial Hermann Mental Health Crisis Clinic serves individuals who are in a mental health crisis,
are unable to follow up with other outpatient providers, or both (Memorial Hermann, 2017). It also
helps connect users with permanent ongoing medical and behavioral health homes and intends to be
an entry point to structured care. The case management services are structured but not open to the
public and are offered only to Memorial Hermann clients. The facility’s hours of operation are
expanded to include late evenings and early mornings, and it provides telemedicine services to
expand its reach even more. The website provides a brief history and overview of the institution.

Menninger Clinic

Visited on Feb. 9, 2017. Inpatient and outpatient care. Address: 12301 S. Main St., Houston, TX 77035.
Phone: 713-275-5140. Website: http://www.menningerclinic.com/patient-care/admissions. Email:
alupton@menninger.edu. Representative: C. Edward Coffey (CEO). Number of beds: 120
(information provided during the visit). Average length of stay: 6-8 weeks. Wait time: no waitlist
(information provided during the tour). Specialties and programs: Psychiatric assessment service;
Hope Program for Adults; Pain Management Program; Professionals in Crisis; Adolescent Treatment;
Compass Program for Young Adults; outpatient therapy and psychiatric services; electroconvulsive
therapy; Pathfinder community program. Payment methods: out-of-pocket.

The Menninger Clinic was founded in 1925 in Topeka, Kansas. In 2002, it announced its affiliation
with Baylor College of Medicine and Methodist Hospital in Houston, moving to Texas in 2013. It is
one of the most respected mental health institutions in the United States. The inpatient programs
offer family orientation and a broad set of assessment tools, whereas the outpatient services focus
on socialization. Menninger is engaged in a variety of research on mental health (Menninger Clinic,
2016) and focuses on consumers who have not been successful in previous treatments.
Building Bridges 57

The facility offers free care to a small group of individuals who qualify for financial assistance as a
counterpart to its “nonprofit” status. Criteria are available on the website, which also provides
information on mental health topics, a virtual tour, and extensive data about the assessments and the
admissions processes.

Mental Health Co-Op

Visited on Feb. 9, 2017. Inpatient and outpatient care. Address: 503 Sul Ross St., Houston, TX 77006.
Phone: 713-524-8705. Website: http://www.thementalhealthco-op.com/. Email: not available.
Representative: Dewey Paris (Clinical Director). Specialties: Cognitive Enhancement Therapy (CET);
life skills services; adults in transition; independent living; cooperative house; Fulshear farm
program. Payment methods: Out-of-pocket.

Mental Health Co-op is a communal living space for adults with chronic mental illness, with 16
units—apartments or shared housing. Treatment plans include psychotherapy, daily groups, and
cognitive classes, among other options. Cognitive enhancement therapy is designed to help
consumers “improve brain and cognitive development, social cognition, and increase vocational
capabilities” (Mental Health Co-op, 2017). The facility’s website has plenty of information on its
programs and services.

New Dimensions Day Treatment Center-Clear Lake

Visited on May 24, 2017. Outpatient care. Address: 1345 Space Park Dr., Ste. C, Houston, TX 77058
(several locations). Phone: 281-333-2284. Website: http://www.newdimensionsdayhospital.com.
Email: not available. Representative: Randy Brazzel (CEO). Specialties: adolescents’ mental health;
behavioral health; dual diagnosis; chemical dependency. Waitlist: no. Average length of treatment:
30 days. Payment methods: private insurance; out-of-pocket.

New Dimensions provides partial and intensive outpatient mental health treatment to adults and
adolescents, besides chemical dependency programs. Its users attend therapy groups and are
provided case management and medication as needed (New Dimensions Day Treatment Center,
2016). The adults are seen during the day, the adolescents come after school, and substance use
programs occur in the evenings. Most of its users are professionally active. Aftercare programs are
offered as a follow-up procedure after discharge.
Building Bridges 58

The institution has compiled an impressive resource book of mental health providers by area (Clear
Lake, Woodlands, Katy). Its website also contains information on mental illness and topics related to
this subject.

Post Oak Care Center

Visit requests not responded. Outpatient care. Address: 2020 North Loop West #150, Houston, TX
77018. Phone: 713-960-0344. Website: http://www.postoakscarecenter.com. Email:
postoakscarecenter@gmail.com. Representative: Manjeshwar Prabhu (director). Specialties: partial
hospitalization program; suboxone treatment (opioid dependence treatment). Payment methods:
Medicare/Medicaid; private insurance; out-of-pocket.

Post Oak Care Center defines its partial hospitalization program as a step-down from hospitalization
and a way to prevent a crisis (Post Oak Care Center, 2016). The facility’s website is outdated; further
information must be requested by email or phone, but our calls were never answered.

Saint Joseph House

Visited on May 17, 2017. Outpatient care. Address: 3307 Austin St., Houston, TX, 77004. Phone: 713-
523-5958. Website: http://www.stjosephhouse.org/. Email: info@stjosephhouse.org.
Representative: Luke Stuckey (director). Payment methods: free membership. Waitlist: no.

In 1971, Magnificat Houses, Inc. purchased the Saint Joseph House’s building and later acquired
Clubhouse International accreditation. Today, Saint Joseph supports over 40 members daily and has
around 300 active members. Most users were recently released from psychiatric hospitals, are
homeless, or deal with substance use; for many, the facility is their only resource. Its goal is to engage
users in a productive and independent life: “Work areas include culinary, arts, clerical, hospitality,
horticulture, and housekeeping” (Saint Joseph House, 2017). Members can come and go, and
membership is free. Any adult with a documented history of mental illness is eligible to affiliate.
Services include social work, advocacy support, transportation to appointments, employment
assistance, computer education, GED preparation, and budget management assistance.
Building Bridges 59

Saint Joseph’s Medical Center – IASIS Behavioral Health

Visited on May 10, 2017. Inpatient and outpatient care. Address: 1404 Saint Joseph Parkway,
Houston, TX, 77002. Phone: 713-757-1000. Website: http://www.sjmctx.com/services/behavioral-
health/. Email: info@sjmctx.com. Representative: Richard Kuehn (clinical program director) -
Richard.Kuehn@sjmctx.com. Number of beds available: 106 inpatient, 40 outpatient. Average length
of stay: 7 days (information provided during the visit). Payment methods: Medicare/Medicaid;
private insurance; out-of-pocket. Waitlist: no.

St. Joseph Medical Center is over 125 years old and was Houston’s first general acute care hospital
(Saint Joseph Medical Center, 2016). The Center for Behavioral Health offers inpatient and
outpatient/partial hospitalization programs in addition to an emergency room; however, the hospital
was severely criticized in 2015 when a police officer shot a patient inside its premises (Rosenthal,
2016). Since then, several professionals were replaced and retrained, and new policies were adopted.
The hospital does not have consistent follow-up procedures, but several users have remained in its
outpatient programs after discharge.

Sun Behavioral Houston

Visit requests not responded. Inpatient and outpatient care. Address: 7601 Fannin St., Houston, TX
77054. Phone: 713-796-2273. Website: http://www.sunhouston.com. Email: info@sunhouston.com.
Representative: Rick Harding (CEO); Vernon Walling MD (chief medical officer). Number of beds
available: 148. Specialties: children, adolescents, and adults’ mental health programs; women’s
program; substance use program. Payment method: private insurance; out-of-pocket.

Sun Behavioral Health’s building was renovated in January 2016, promising high-quality care and
accommodations. The facility offers mental health services to adults, adolescents, and children in
addition to programs for substance use and co-occurring disorders, partial hospitalization, and
intensive outpatient programs. Women have a gender-specific program for issues related to trauma
and acute or chronic mental issues. Admissions staff are available 24 hours a day and provide free
evaluation services. The facility’s website offers information on each program and continuing
education services. In addition, the website provides a list of “community resources” in the Houston
area.
Building Bridges 60

The Gathering Place

Visited on Feb. 23, 2017. Outpatient care. Address: 5310 South Willow Dr., Houston, TX, 77035.
Phone: 713-729-3499. Website: http://www.menningerclinic.com/patient-care/outpatient-
services/the-gathering-place. Email: not available. Representative: Shalla Parker -
sparker@menninger.edu. Payment method: free membership.

The Gathering Place is a psychosocial service in the clubhouse format that offers free rehabilitative
services for more than 300 members with persistent mental illness, with a daily attendance of about
50 users. Support is provided through vocational skills training, employment assistance, and
recreational and social activities. To become a member, adult individuals must have a psychiatric
diagnosis, follow a treatment plan, and represent no danger to themselves or others. The place is
funded by the Menninger Clinic, and further information about it can be found at Menninger’s
website.

The Montrose Center

Visited on May 22, 2017. Outpatient care. Address: 401 Branard St., 2nd floor, Houston, TX 77006.
Phone: 713-529-0037. Website: http://www.montrosecenter.org/hub/. Email:
info@montrosecenter.org. Representative: Ann J. Robison (executive director). Specialties:
counseling; addiction/recovery services; HIV/AIDS-related services; senior, transgender, and youth
programs. Waitlist: longer for mornings and evening appointments; immediate help for crisis and
substance use issues. Payment methods: Medicare/Medicaid; private insurance; out-of-pocket
(sliding scale).

The Montrose Center is an essential mental health care provider for the LGBT community in the
United States (The Montrose Center, 2017). The facility offers licensed therapists to all individuals,
but adjacent services focus on the LGBT public. Some providers are bilingual. The center does triage
for crisis and substance use and offers a walk-in assessment service and a hotline. It currently sees
around 1,500 consumers yearly in its Behavioral Health Department. Its website details all the
programs available.
Building Bridges 61

University of Houston Clear Lake – Psychological Services Clinic

Visited on May 4, 2017. Outpatient care. Address: 2700 Bay Area Blvd, box 83, Houston, TX 77058.
Phone: 281-283-3330. Website: http://www.uhcl.edu/psychological-services-clinic. Email: not
available. Representative: Julia Englund Strait (director). Specialties: individual therapy for children,
adolescents, and adults; couple’s and family therapy; school-based assessments; Center for Autism
and Developmental Disabilities. Payment methods: out-of-pocket (sliding scale). Waitlist: depends
on the clinical case.

The University of Houston Clear Lake – Psychological Services Clinic is a training and research clinic
where “graduate students trained in evidence-based assessment and therapy deliver most of the
services under the direct supervision of professionally licensed and/or Ph.D.-level supervisors”
(University of Houston Clear Lake, 2017). It encompasses the Center for Autism and Developmental
Disabilities and testing and counseling services for children and adults. Doctorate students see more
complex issues on a case-by-case basis, but the clinic does not offer psychiatric care. Therapists
continuously change because of the students’ rotation, but cases remain under the supervision of the
same professor. Sessions can be recorded and used as educational material. Professors and students
manage the waitlist according to their needs and possibilities; therefore, the wait times vary. The
facility’s website does not offer further information on the services provided.

West Houston Medical Center

Visit requests were not responded. Inpatient and outpatient care. Address: 12141 Richmond Avenue,
Houston, TX 77082. Phone: 281-558-3444. Website:
http://westhoustonmedical.com/service/behavioral-health. Email: not available. Representative:
Erik Levinson (director of behavioral health). Specialties: Senior Program for Behavioral Health
(inpatient program for 55-years and older individuals).

West Houston Medical Center’s website (2016) offers information regarding the most common
psychiatric disorders but no specific data on its services.

Our emails and phone calls to the facility were not answered.
Building Bridges 62

West Oaks Hospital

Visit canceled. Inpatient and outpatient care. Address: 6500 Hornwood, TX, 77074. Phone: 713-995-
0909. Website: http://www.westoakshospital.com/. Email: not available. Representative: Colleen
Paxton (Director of Inpatient). Specialties: chemical dependency (inpatient and residential);
outpatient clinic; Second Chances Program, Excel Center (Friendswood, TX). Beds available: 144 for
acute care and 16 for chemical dependency care.

In addition to its inpatient psychiatric care, West Oaks offers a partial hospital program and an
intensive outpatient service for adolescents and adults. It also provides an outpatient evidence-based
social learning program called “Second Chances,” which focuses on users who have had several
hospitalizations but made little progress. “Most of the clients are unemployed or disabled, are living
in personal care homes, or have become too much for their families to manage” (West Oaks Hospital,
2016).

The Excel Center (Friendswood, TX) is one of West Oaks Hospital’s outpatient branches, specializing
in group therapy for severe mental illness and chemical dependency. The Hornwood Clinic offers
group therapy, relapse prevention, family support, and education for mental health users and
chemical dependents.

We scheduled a visit on September 15, 2017, but no representatives were available to talk to us at
the time of our visit. We left, and our emails and calls were not answered.
Building Bridges 63

APPENDIX C. FACILITIES ASSESSED NATIONWIDE

We visited each facility presented in this section on one of two different occasions: during a field trip
to New York/Massachusetts/Connecticut/Vermont in August 2017 and during a field trip to
California in September 2018. Users, caregivers, and providers who participated in our focus groups
and interviews recommended the services assessed as outstanding or innovative. Although other
services were cited, we reduced our visits to these two geographic areas for economic and time
reasons.

Afiya (Northampton, MA)

Address: 256 Jackson Street, Northampton, MA. Phone: 413-570-2990. Website:

http://www.westernmassrlc.org/afiya. Email: n/a. Representative: Dan Scott (director). Number of
beds: 3. Waitlist: restricted to three individuals. Payment methods: free (state funded). Average
length of stay: 1-7 days.

Everyone who works at the space (including all leadership) identifies as having some variety
of ‘lived experience.’ And, varied experience it is! Some who work with us have been
homeless, addicted to different substances, have withdrawn off of psych drugs, been
mistreated by the mental health industry, experienced trauma, struggled with suicidal
thoughts, and any number of other struggles life has to offer. This having “been there” seems
to create more potential for a truly open and genuine dynamic to form between people
staying and people working. (Scott, 2015).

Afiya is part of the Western Mass Recovery Learning Center, an organization that promotes
alternative practices and advocacy on mental health. It is the first peer-led respite in Massachusetts,
and one of about three dozen in the country. Guests can come and go as they please, have access to
one-on-one peer support, and manage their medication, as the house does not provide clinical care.
It has about 10 staff members (Afiya, 2017).

The facility made the news in 2014 when a guest stabbed a peer (Crowley, 2014). Part of the
community questioned the program, but the house treated it as an isolated case—the only violence
issue since its opening.
Building Bridges 64

Afiya’s 2016 annual report (Western Mass Recovery Learning Community, 2017) is based on a survey
with former guests. The outcomes are very positive and are backed up by a broader study on peer-
run respites (Croft & Isvan, 2015) that demonstrates that guests are 70% less likely to use inpatient
or emergency services. In contrast, a small number of beds remain as a barrier to avoid
hospitalization.

In the past year, the vast majority of people (80%) who were willing to state where they were
headed upon departure returned to their own home […] and two went to the hospital (one
for strictly medical reasons, and another for psychiatric reasons). (Western Mass Recovery
Learning Community, 2017)

As noted in the feedback we received on our surveys, it is hard to get into the house. There
are nine psychiatric units based in Western Massachusetts with dozens of ‘beds’ in between
them, but only three bedrooms at Afiya (open not only to Western Mass, but also Central). As
aforementioned, this makes it extremely difficult to fully realize the space’s potential to act
as a diversion for those who are trying to avoid more invasive (and costly) measures.
(Western Mass Recovery Learning Community, 2017).

Austen Riggs Center (Stockbridge, MA)

Address: 25 Main Street, Stockbridge, MA. Phone: 1-800-51-74447. Website:

http://www.austenriggs.org/. Email: not available. Representative: Andrew Gerber (CEO).
Specialties: “treatment-resistant” adults with severe mental illness. Number of participants: 65.
Payment method: out-of-pocket. Average length of stay: five months; minimum of six weeks.

Austen Riggs Center is a residential treatment facility and center for education and research on
severe mental illness. It offers long-term treatment for adults, focusing on intensive psychodynamic
psychotherapy (Austen Riggs Center, 2016). The institution specializes in so-called “treatment-
resistant” individuals. Users’ freedom to come and go is one of its central aspects, but the campus
offers plenty of activities, such as work and education programs. Because of this open structure,
individuals must be minimally stable and out of acute crisis to join it.

The Erikson Institute is the center’s educational branch and promotes conferences, lectures, and
clinical studies. Research and treatment are interconnected: fellows with various psychoanalytical
approaches are an active part of the facility’s routine.
Building Bridges 65

The Austen Riggs building is located in the heart of a charming town, facilitating guests’ circulation
in the community; however, as with most traditional mental health facilities, advocacy and social
outreach are not a central part of the program. The psychoanalytic approach adds an important
subjective component to the program, and 92% of the facility’s participants see individual
psychotherapy as its most essential element, according to outcomes (Austen Riggs Center, 2015).

Bridges to Recovery (Los Angeles, CA)

Address: 10201 Charing Cross Rd, Los Angeles, CA. Phone: (888) 907-4794. Website:
https://www.bridgestorecovery.com/. Email: vemelife@constellationbh.com. Representative:
Trevor Small (Clinical Director) Specialties: mood disorder, anxiety, trauma, borderline disorder,
psychotic disorder. Number of beds: 8. Payment method: out-of-pocket. Average length of stay: 90
days.

Bridges to Recovery is located in Los Angeles and San Diego and intends to provide an alternative to
psychiatric hospitalization. The facilities are luxurious and well-structured.

The program relies on extensive psychiatric and clinical assessments to shape each user’s treatment
and define their group and individual sessions. Among the daily activities offered, participants can
join multiple classes such as yoga, meditation, community meetings, and drumming.

Bridges to Recovery is known among users of mental health services for its experienced and well-
trained clinical team. All staff are licensed, and most professionals have been working at the program
for many years. The atmosphere is very friendly and calm.

Ellenhorn, MA (Arlington, MA)

Address: 406 Massachusetts Ave., Arlington, MA. Phone: 617-491-2070. Website:

http://ellenhorn.com. Email: info@ellenhorn.com. Representative: Ross Ellenhorn (CEO).
Specialties: psychosocial rehabilitation; co-occurring addiction; psychiatric issues. Number of
participants: around 40. Payment method: out-of-pocket.
Building Bridges 66

Founded by a sociologist and a psychiatrist, Ellenhorn focuses on “psychosocial rehabilitation and

recovery, recreational and group experiences, vocational/educational counseling and best-practice
approaches” (Ellenhorn, 2017).

... That means we put a lot of energy into issues other than a client’s purely psychiatric
symptoms, working with clients in the community and with their families, attempting to
strengthen social connections and to enhance our clients’ integration in the world. (Ross
Ellenhorn, personal communication, July 15, 2017).

The facility offers transitional housing—staffed apartments and a shared house—but the goal is to
help users to live independently. Most clinical services are offered at their houses or in public spaces.
Treatment plans are designed in the first months and involve particular arrangements depending on
the level of care needed.

Teams treat users in an approach inspired by PACT (Program of Assertive Community Treatment).
PACT has four unique linked components: a single-source, multidisciplinary approach; highly flexible
and personalized treatment planning; mobile services delivered to users in the community; and
assertive help that guides people to use community resources in their recovery (Ross Ellenhorn,
personal communication, July 15, 2017). The Open Dialogue approach is another inspiration for the
program. The model was born in Finland in the 1980s and has resulted in impressive outcomes
throughout the years. “In practice, this involves joint meetings including the client, mobile crisis
intervention teams, and members of the clients’ social networks” (Gromer, 2012, p. 164).

Clinical practice at Ellenhorn is heavily based on PACT, a biomedical model that has significant
differences with the Open Dialogue approach. This helps explain why we do not see many aspects of
the latter being practiced in the program, although some of its elements are still applied during
assessments that involve the user in decisions and goals. Overall, the staff members work in a
traditional framework, but the open setting forces the team to be creative.

Gnosis Retreat Center (San Francisco, CA)

Address: no current address. Phone: no current phone. Website: http://www.austenriggs.org/.

Email: http://www.gnosisretreatcenter.org/. Representative: Michael Guy Thompson (Executive
Director). Specialties: serious mental illness. Number of participants: 10. Payment method: out-of-
pocket. Average length of stay: one year.
Building Bridges 67

Gnosis Retreat Center, an alternative to conventional psychiatric treatment, is still a project looking
for funding. We talked to their directors, and they explained that it proposes a residential community
of about 10 residents living in a household that allows them to learn new ways of coping with distress.
After about a year of such a respite experience, they should be able to return to their regular lives
and become independent. Those experiencing a crisis may also benefit from a relatively short-term
stay until they feel able to return home. Additionally, Gnosis will offer a team of experienced
therapists who provide in-home support.

Residents will be able to participate in individual psychotherapy, family therapy, and other health
care practices off premises. Meditation, yoga, mindfulness exercises, and a healthy diet will be
provided onsite. An individual coaching life plan will be crafted for each resident, and staff will work
closely with families to facilitate optimal communication.

To start Gnosis Retreat Center, the directors are seeking funds to rent a house and provide services
for the first 12 months.

Gould Farm (Monterey, MA)

Address: 100 Gould Road - Monterey, MA. Phone: 413-528-1804. Website:

http://www.gouldfarm.org/. Email: admissions@gouldfarm.org. Representative: Lisanne Finston
(executive director). Number of beds: 40.

Founded in 1913, Gould Farm was the first farm-based residential treatment program for adults with
serious mental illness in the United States. It revolves around work, community, and therapy
(Huberman, 2015). Guests are divided into teams (garden, farm, forestry and grounds, maintenance,
harvest barn, or the Roadside cafe) and work 5 days a week, living alongside staff members on a 630-
acre property and receiving individual and group therapy.

There is a vast amount of literature on the value of meaningful work and its effect on mental health.30
Gould Farm has also been measuring its impact since 1998, using standard psychiatric tools to gather
information on residents for a period of up to 36 months after discharge. The outcomes indicate
improvement in social functioning and community integration, including securing employment,

30 Harvey,S. et al (2013). Severe mental illness and work: What can we do to maximize the employment opportunities for
individuals with psychosis? Australian and New Zealand Journal of Psychiatry, 47(5), 421–424.
Building Bridges 68

advancing education, and forming new social relationships (Gould Farm, 2017). Huberman’s (2015)
study on guests’ satisfaction has backed up these positive impacts:

… Clients engaged in the therapeutic milieu at Gould Farm consistently report an increase in
subjective satisfaction across seven measured areas, including mental health, community
support, daily structure, physical health, relationships with family members, social
relationships, and independent living skills. (Huberman, 2015, p. 45).

Medicare and Medicaid cover the program, and income-eligible applicants can discuss their
contribution rate. Over 50% of Gould Farm’s guests receive financial assistance.

Gould Farm was using elements of the recovery-oriented approach, especially community support,
even before the recovery model was defined. Most staff members and volunteers receive on-site
housing and move to the farm’s premises with their families. A large number of employees are
professionally trained not as mental health workers, but in farming, gardening, maintenance, cooking
and baking, activities planning, maple syrup production, and forestry (Huberman, 2015). This reality
makes the atmosphere familiar and vibrant, despite its calmness. The closest urban center is located
many miles away, which might make it more difficult for users to readapt to “real life” after discharge.

Hope House (San Luis Obispo, CA)

Address: 1306 Nipomo St., San Luis Obispo, CA. Phone: 805-541-6813. Website: https://www.t-
mha.org/. Email: jbaker@t-mha.org. Representative: Julie Baker (Center Supervisor). Specialties:
support groups; wellness activities for serious mental illness. Payment methods: free. Waitlist: no.

Transitions – Mental Health Association is a nonprofit organization that serves San Luis Obispo and
Santa Barbara, California. Its mission is to eliminate stigma and to promote recovery and wellness by
providing multiple adjacent services such as housing, family support, and employment programs, in
addition to intensive mental health services.

Hope House is one of Transitions’s wellness centers, and it creates a home-like environment suitable
for different age groups. It focuses on community connection, wellness, advocacy, and independence.
Every month, the Hope House develops a calendar of events that include classes, social hours, support
groups, and activities such as music, meditation, and discussions.
Building Bridges 69

Inner fire (Brookline, VT)

Address: 26 Parker Road, Brookline, VT. 05345. Phone: 802.221.8051. Website: http://innerfire.us.
Email: info@innerfire.us. Representative: Beatrice Birch (founder). Specialties: medication
withdrawal; farm-based work therapy; alternative therapies; mentoring, peer, and life coaching.
Payment method: out-of-pocket. Number of participants: 6. Average length of stay: one year.

Inner Fire is a “proactive healing community offering a choice for adults to recover from debilitating
and traumatic life challenges without the use of psychotropic medications” (Inner Fire, 2017). It
welcomed its first six guests (called “seekers”) in September 2016, offering a 1-year treatment plan
that relies on alternative and nonmedical therapies.

Inner Fire is in a beautiful and quiet valley. Seekers live in two rentals nearby. During the mornings,
they work in the gardens, woods, kitchen, or household; in the afternoons, they engage in supportive
group sessions and alternative therapies such as art, music, spatial dynamics, massages, and
counseling (Inner Fire, 2017). Evenings and weekends are filled with activities such as drumming
and singing, hikes, and cultural events.

During Inner Fire’s first year, all but one of the six participants tapered off psychiatric medication
(Inner Fire, 2017), although coming off it is not required. A psychiatrist orients the process, and
seekers meet a homeopath, a naturopath, and an anthroposophical MD to receive alternative types
of care. Research regarding psychiatric medication withdrawal has increased in the last years,
partially because of recovery-oriented approaches that rely on alternatives to medical care.31

Laurel House (Stamford, CT)

Address: 1616 Washington Blvd. Stamford, CT. Phone: 203-324-1816. Website:

https://www.laurelhouse.net. Email: contact@laurelhouse.net. Representative: Linda Autore (CEO).

31 Wunderink et al. (2013) reported on a 7-year follow-up of 103 people with first-episode schizophrenia and related
disorders; patients with 6 months of remission following treatment were randomly assigned to either maintenance on
antipsychotic treatment or tapering-off and drug discontinuation. The second group experienced twice the relapse rates in
the early follow-up phase, but, after 7 years, the discontinuation group had achieved twice the functional recovery rate,
taking little or no medication. Additionally, relevant longitudinal 15-year follow-up research from Harrow and Jobe (2007)
identified a subgroup who does not immediately relapse while off antipsychotics and experience intervals of recovery. The
data suggested that more favorable outcomes are associated with personal characteristics and attitudinal approaches
(Harrow & Jobe, 2007), not with medication.
Building Bridges 70

Laurel House was founded in 1984, initially following the nonclinical clubhouse format. Over the last
8 years, it identified new needs among users and decided to adopt a clinical approach, waiving its
Clubhouse certification. Now, Laurel House combines community integration with best practices on
mental health, providing workshops, life skills coaching, supported employment and education, and
adjacent services, advocacy, and mutual support.

One of Laurel House’s primary services is the “Thinking Well” program, a cognitive remediation
therapy plan to help users with chronic mental illness in daily functioning and thinking skills. Staff
were trained by Dr. Alice Medalia, a prominent expert in cognitive remediation and are faithful to the
original program. The process involves two parts: a computer-based session and a closing session to
analyze the former.

Parachute (New York, NY – 2012-2015)

Parachute NY, which closed in 2015, was one of the most innovative mental health programs in the
United States.32 In 2012, the Fund for Public Health in NY was awarded US$17.6 million from the
Center for Medicare & Medicaid Innovation. Parachute was then created, consisting of four mobile
crisis teams staffed by clinicians and peer specialists who provided long-term (at least 1 year) care
for users and families, four crisis respite centers that offered short-term (up to 2 weeks) residential
alternatives in home-like settings, and a peer-run warmline to provide support and referral services.

The staff were cross-trained in two complementary approaches, the need-adapted treatment model33
and the intentional peer support, which became the single most extensive effort to integrate peers
into a public mental health system.

Between January 2013 and April 2015, Parachute mobile crisis teams enrolled 614 unique clients
and conducted 5,316 face-to-face meetings. The warmline fielded 23,501 calls during that time (Pope
et al., 2016). Outcomes were extremely positive, but many issues were related to “demanding
pragmatics of implementing so radical a departure from mental health business as usual” (Pope et

32 Mostdata on Parachute was provided by Steve Coe during an interview. Coe participated in planning and implementing
the program and is the CEO of Community Access, a NY pioneer in social services and mental health advocacy.

33 Theneed-adapted treatment model prioritizes the engagement of consumers’ social network, advocating for the minimal
use of neuroleptic medication. Follow-up studies show its efficacy in avoiding hospitalizations, lessening psychotic
symptoms, and increasing employment rates among users (Alakare et al., 2003; Alanen et al., 1991).
Building Bridges 71

al., 2016. The mobile structure required improvisation in addition to training, and the staff had to
build a new crisis response culture.

A vast majority of consumers surveyed felt positive about their experience with Parachute:
84% said they would re-enroll in the program if they were to experience a crisis again, and
92% stated that they would refer a friend. Even so, “in exit surveys, many respondents voiced
confusion or disappointment after being discharged with little pre-planning or overlap with
linked providers. (Pope et al., 2016)

Safe Harbor Crisis House (Sacramento, CA)

Address: 584 Kentucky Ave. Sacramento, CA. Phone: 530-661-3213. Website:

http://y3c.org/safe_harbor1.aspx. Email: dyoon@y3c.org. Representative: Dahyoung Yoon
(Program Assistant). Payment methods: free. Average length of stay: up to 13 days. Waitlist: no.

Safe Harbor Crisis House is coordinated by Yolo Community Care Continuum, a nonprofit that intends
to provide direct services, advocacy, education, and volunteer efforts to users with serious mental
illness. Safe Harbor offers short-term residential treatment for adults experiencing a psychiatric
crisis and acts as an intermediate step between a hospital stay and returning home or a more
structured setting to prevent hospitalization. Admission is voluntary, and users actively participate
in developing their treatment plan.

The services provided focus on defining and limiting the crisis, planning for the future, and mobilizing
community and personal resources. Users have group and individual therapy sessions in addition to
everyday activities such as preparing meals, cleaning the house, and maintaining the grounds.
Continuity of treatment is one of Safe Harbor’s main goals. Users are linked with services and
supports in the community, including financial, educational, social, medical, and mental health
resources.

Second Story (Santa Cruz, CA)

Address: 2884 Estates Dr., Santa Cruz, CA. Phone: 831-466-0967. Website:
https://www.encompasscs.org/second_story. Email: adrian.bernard@encompasscs.org.
Representative: Adrian Bernard. Payment methods: free. Average length of stay: up to 13 days.
Waitlist: no.
Building Bridges 72

Second Story is a six-bed peer respite located in a wealthy neighborhood in Santa Cruz, California. It
offers a maximum stay of 13 days for guests to find their way to recovery. Second Story was the first
entirely peer-run respite house in California and became a flagship program among peer services in
the United States.

Former guests are offered ongoing telephone support and are welcome to visit when they need
encouragement from peers and staff. Participants also have opportunities to enroll in Intentional
Peer Support training to become peer supporters themselves.

A 2010 Federal Transformation award funded the program’s startup. Since then, Second Story went
through multiple financial and social challenges—including stigma and lack of funding—to stay
operational. After the county’s decision to close the program in November 2018, the largest donation
in the organization’s history paid off the house where it is located, ensuring the program’s continued
operation and giving it time to develop a sustainability plan for the future.

Solara Mental Health (San Diego, CA)

Address: 1321 Garnet Ave. San Diego, CA. Phone: 844-600-9747. Website:
www.solaramentalehalth.com. Email: knovak@solaramentalhealth.com. Representative: Kimberly
Novak (Director of Admissions). Specialties: eating disorders, medical detoxification, personality
disorders. Payment methods: out-of-pocket. Average length of stay: 90 days. Waitlist: no.

Solara Mental Health is a deluxe, laidback, in-residence psychiatric facility founded in San Diego in
2004. It offers progressive psychotherapy associated with holistic practices. Its first program focused
on eating disorders and gave birth to other programs and multiple facilities in California.

Services include in-residence and transitional programs, assessments, and individual and family
therapy. A full pharmacological assessment determines if detoxification is indicated in the case of
conflicting prescribed medications or substance abuse. Individual psychotherapy is the cornerstone
of Solara’s treatment program, and its intensive format seeks results that could not be recreated in
an outpatient setting. Multiple therapy sessions per week foster a strong bond between clients and
therapists. Clinicians integrate a variety of modalities, such as psychoanalysis, DBT, and CBT, to shape
individual treatment plans for each user.
Building Bridges 73

Soteria (Burlington, VT)

Address: 125 College Street, Floor 2, Burlington, VT 05401. Phone: 888-492-8218. Website:
http://www.pathwaysvermont.org. Email: not available. Representative: Hilary Melton (executive
director). Average length of stay: 3-6 months. Payment method: free (state funded).

Pathways Vermont has supported programs and advocacy on mental health since 2009. The
institution offers “immediate access to non-judgmental, compassionate support for Vermonters who
have experienced trauma and mental health crisis” (Pathways Vermont, 2017b).

This philosophy is the central pillar of Soteria, a peer-run house sponsored by the institution since
2015. It started to take shape in 2011, when Tropical Storm Irene flooded Vermont’s psychiatric
hospital and illustrated the need for new mental health care options. Soteria is now a robust program
that relies on peer support and has become a symbol for mental health advocates and users: “I don’t
think it is hugely important in terms of reducing hospitalization, but it is saying there are other modes
of treatment,” says Rep. Anne Donahue (R-Northfield), a mental health advocate in the area (Remsen,
2015).

Many countries have a Soteria house. The first one was built in California in 1971 as part of a social
experiment that intended to prove that residents would recover better than a control group in the
psychiatric hospital. The project closed 11 years later, but its outcomes inspired a new generation:
only 31% of users treated without drugs relapsed over the next 2 years (Matthews et al., 1979).
Soteria Vermont has on-site psychiatry and nurse consultants but “treats psychiatric medication as a
personal choice and offers alternative modalities, including dreamwork, breathwork, herbalism, and
meditation” (Pathways Vermont, 2017a).

Windhorse Integrative Mental Health (Northampton, MA)

Address: 211 North St #1, Northampton, MA. Phone: 413-586-0207. Website:

https://www.windhorseimh.org. Email: info@windhorseimh.org. Representative: Eric Friedland-
Kays (admissions manager). Specialties: serious mental illness; dual diagnosis; eating challenges;
anxiety. Payment methods: out-of-pocket. Average length of stay: 18 to 30 months.

Windhorse began in 1993 as a coalition of parents, professionals, and peer advocates, providing
treatment to “the whole person, going beyond diagnostic labels and history of mental illness to
recognize each person’s strengths and history of sanity” (Windhorse Integrative Mental Health,
Building Bridges 74

2017). It is a step-down from psychiatric settings and may be used to help users change, reduce, or
come off medications through alternative methods.

The Windhorse model is a thoughtful, environmental approach to support individuals in

extreme mental states. Counseling is supported by contemplative practices, like meditation,
inviting consumers to synchronize mind, body, and environment. “Recovery, then, at
Windhorse, is not a matter of people who are ‘well’ helping someone who is ‘sick,’ but a
journey of mutual learning and mutual recovery” (Rosenberg; Rosenberg, 2018, p. 27).

A team of various providers, including a therapeutic housemate, a therapist, a wellness nurse, a

leader who coordinates care, and counselors or peers work together to deliver the so-called “basic
attendance.” Counseling sessions are 3 hours long, giving users and counselors the opportunity to
meet and relate. The facility is not licensed to provide clinical care but provides support for
individuals’ independence and self-knowledge. Users are offered housing options, and care is
provided in the community and parallel to daily activities.