Lisa Settles has spent years watching Denton County MHMR struggle to address increasing mental health needs in a growing county.
As the former director of behavioral health services for MHMR, Settles said the agency’s staff turnover rate isn’t unusual for employees such as case managers because they earn a low hourly wage with 300-plus caseloads. That kind of turnover has led some clients, she said, to go through as many as eight case managers in a year.
But Settles, who retired in February, said what was unusual is a high turnover rate among leadership; she said she went through 13 supervisors in her decade at MHMR.
“That’s a lot and doesn’t make sense,” she said. “Every time I got a supervisor, I had to teach them what I do.”
In the past two years, Settles said Denton County’s mental health agency has had a massive turnover of leadership under Executive Director Pam Gutierrez. There have been allegations of a hostile and toxic work environment that the MHMR board declined to investigate in June 2022.
More than a dozen directors, senior directors, program managers and team leaders have left since April 2023, according to several former employees, some of whom couldn’t speak on the record because they said they had signed nondisclosure agreements.
“There is not enough staff and case managers to meet the need for the clients to be served in the county,” Settles said.
Settles claimed the high turnover rate has impacted the lack of MHMR services along the U.S. Highway 380 corridor east of Denton where there’s no satellite office for areas such as Little Elm, Frisco and part of Plano.
“My issue is client concern,” Settles said. “There has been an increase in suicides down that 380 corridor. We can put out great reports and data. We have an office in Denton and in Flower Mound and Lewisville. Why are we not down in Aubrey and Pilot Point?”
In 2023, 112 suicides were reported in Denton County, and while that number was a 10.5% decrease from 2022, Aubrey, Lewisville, Carrollton, Northlake, Justin and Highland Village are all experiencing an increase of deaths by suicide, according to the 2023 annual report by Denton County’s LOSS Team (Local Outreach to Suicide Survivors). Denton County MHMR’s volunteer program serves people affected by suicide.
So far this year, 38 suicides have been reported in Denton County, with nine in April alone, as the LOSS Team reported in a May 23 update presentation.
In a May 23 email, Gutierrez said additional public funding would be needed from the Legislature to extend services into those areas. She mentioned they are seeking grant opportunities to address the need and offered several ways that MHMR has been trying to raise awareness of suicide prevention through more community outreach.
One way they’ve done so is by establishing a Zero Suicide Task Force that aims to engage not only center staff but the entire community via schools and universities, as well as providing training to local law enforcement, Gutierrez said.
Since January 2024, Gutierrez said the center has provided training to 610 community members in mental health first aid, applied suicide intervention skills training (ASIST) and About Suicide to Save a Life (AS+K).
“Please further note there is no correlation between the rate of suicide and services that the Center or other providers make available,” wrote Gutierrez, who declined to discuss former employees’ allegations.
A correlation
The lack of mental health providers, however, does correlate with mental health outcomes.
In August 2018, Sonia Redwine, director of health and mental health initiatives for the United Way of Denton County, said a lack of mental health providers is directly correlated with the increase in inmates with mental health issues at the Denton County Jail.
Lack of services not only leads to an increase in inmates with mental health issues but also contributes to a rise in homelessness and leads to people relying on jails or emergency rooms to provide needed mental health services.
Denton County’s latest point-in-time survey reported a 20% increase in people experiencing homelessness, from 431 in January 2023 to 518 individuals in 2024.
Since the 1990s, suicide rates have been on the rise nationwide in nearly every age, race and ethnic group. They reached their highest point recorded in 2022 with nearly 50,000 suicide deaths, 13.2 million people having considered suicide and 1.6 million people having attempted it, according to the 2024 National Strategy for Suicide Prevention by the U.S. Department of Health and Human Services.
Between 2012 and 2022, HHS found suicide rates increased by 12.7%.
The National Alliance on Mental Illness found that 46% of people who die by suicide had a known mental health condition.
Athena Trentin, the executive director of National Alliance on Mental Illness (NAMI) North Texas, said it’s “safe to assume” that a correlation does exist between suicide and the lack of services. She also stressed that many factors exist that could influence someone’s access to mental health care and that mental illness is a very individualized recovery process.
“I think Texas has a long way to go in general,” Trentin said. “We are ranked last in the country [in mental health care], and we have the highest number of uninsured individuals. It makes it very difficult. Even if you want treatment and want help, it’s difficult to get it.”
In early May, The Texas Tribune reported that 60% of rural Texas counties were designated as provider shortage areas.
Whitney Redden, NAMI chapter president for Cooke, Grayson and Fannin counties, pointed out it doesn’t help that state funding is based on an outdated methodology from the 1970s despite the growth affecting the area. She called the Texoma Community Center in Sherman, formerly known as MHMR Services of Texoma, one of the lowest funded in the state compared to Denton County MHMR, which she said is one of the highest, despite Sherman experiencing explosive growth similar to Denton.
“We certainly have a lack of providers,” Redden said. “... We have a serious lack of transportation, too. Typically, even the hospital in Fannin County will make them drive to Denton or Grayson for services.”
The ignition
The lack of providers for the U.S. 380 corridor east of Denton is part of the reason Settles has been attending board meetings since late 2022. She had also been hearing about unfair practices from the “gossip mill” and wanted to see for herself what was happening.
Jada Pearson, a former program manager for MHMR’s First Episode Psychosis program, began attending with Settles, who was her supervisor at the time. Pearson said she wanted to attend for similar reasons because she had heard the board had done nothing to address employee concerns.
A few months before, in late June 2022, Doug Reuter, a board appointee for Denton County Commissioner Ryan Williams, resigned after the board declined to place Gutierrez on paid leave with benefits for four to six weeks to investigate employee allegations.
Reuter was qualified to serve, given his more than 25 years working in human resources and retirement as an HR director for a large company. A former Minnesota legislator in the 1990s, he also worked to help change several mental health laws in Washington, D.C., after his son was shot and killed by Seattle police in 2013 during a mental health crisis.
“When that went down, the board is the group that holds the executive director responsible for the proper execution of her duties and managing the employees,” Reuter said. “I, as a board member, was not about to be sued by an employee, past or present, because the board did not do their due diligence into investigating these serious allegations and numerous complaints.”
In December 2022, Gutierrez addressed the board and again denied the allegations. She claimed some from the executive management team and a board member were spreading rumors and encouraging discord behind her back. She admonished those who were doing it for not coming to her first and claimed they were slandering her.
“If you are the honest and true leaders of the Center, you would depict the leaders that you are, you would never do anything that could ever jeopardize any relationships that the Center has built on honesty and trust,” Gutierrez said, according to the meeting minutes.
“Yet members of the board and EMT have done exactly that and continuously defamed me.”
The response
Nearly two years after Reuter’s resignation, several changes have taken place at MHMR to address the low hourly wages, high caseloads, employee allegations and suicide awareness. The leadership team was also restructured.
Gutierrez said case managers were given a raise to $21 per hour and a stipend beginning in June. Their caseloads have also been shifted to 150 spread evenly among them.
Some of the other changes included extending intake service hours from 8 a.m. to 8:30 p.m. with virtual intakes from 5 to 8:30 p.m. Monday through Friday. A virtual psychiatric clinic on Saturdays, 8:30 a.m. to 4:30 p.m., was also added.
Several new positions have also been added, including hospital liaison ($22 per hour), jail outreach ($24.50 per hour) and peer support ($15 per hour), according to the late October 2023 minutes.
Team leads, managers, supervisors, program managers and directors were also required to sign an update to their job descriptions to ensure “loyalty, honesty and integrity” and a “confidential approach to the release or distribution of information from the executive staff as appropriate,” according to a Jan. 23, 2023, email from the human resources department to MHMR’s executive management team.
In a May 30 email to the Denton Record-Chronicle, Linda Holloway, who’s served on the MHMR board for three years, said the board has investigated every employee allegation.
“As I’m sure you are aware, we are not at liberty to discuss any specific personnel issues,” Holloway wrote. “Most of the staff that I have interacted with seem very content. It’s disheartening that a few disgruntled employees can make such an issue that detracts from the good work that the Center is doing.”
Both Pearson and Settles claimed they left their positions on good terms, have no animosity toward Gutierrez and that their interactions with her have been pleasant and respectful.
Pearson, who left MHMR in June 2023, said she hasn’t been contacted by anyone investigating employee allegations — nor have the former employees whose allegations she said she referenced during her public comments to the board in July, October and December 2023. Now, she is demanding a complete investigation.
Settles said her main concerns were the lack of the satellite locations or hubs in numerous areas of the county and hopes that county commissioners will “promote a board that represents the entire county and is truly aware of the county needs regarding MHMR.
“Some have been on the board for 30 years and appear to lack insight or ambition to expand services throughout a growing county, such as Denton,” Settles said.
The meeting
In early February, Pearson and Settles met with Commissioner Williams to address their concerns. Pearson pointed out those concerns in a February email to the Record-Chronicle:
- Mass exit of long-term employees after complaints brought up against the executive director.
- Possible retaliation against employees from supervisors after concerns were brought to the board of trustees’ attention.
- Board of trustees not investigating retaliation concerns against the executive director.
- Program closures and low pay for hourly employees, however, above-average salary for the executive director and lack of growth of the company compared to other counties such as Collin County.
- Lack of plan to address U.S. 380 corridor.
- Some members of the board sitting on the board for over 20 years.
In a May 23 email to the Record-Chronicle, Williams said he has known about the issues since May 2022 and that county leaders have been working to improve the services MHMR provides.
“I found it ironic that after these allegations came up,” Williams wrote in his May 23 email, “the Director had the following approved in the board bylaws: ‘as the staff do not report to the board, at no time will any board member communicate with Center staff about any personnel issues or additional Center issues unless the Executive Director has given authorization for a Center staff to talk to a board member about an issue and with full Executive Director knowledge.’”
Williams claimed that it was inappropriate for employees not to be allowed to go directly to the board with their concerns about a director.
“When you have that much turnover in such a short period of time, my experience says it should be investigated,” Williams continued. “I am not saying the allegations are all true, but we do not know because, to my knowledge, an investigation was never done.”
Williams hopes MHMR will also work on adding services along with additional beds and a jail diversion program for county residents.
“I feel that it is imperative to have a well-run MHMR with full transparency and a successful work environment,” Williams wrote in the email. “I want the Board to continue to work toward these goals.”
Suicide Awareness Training is available for community members, contact Michelle Foster, Michellef@dentonmhmr.org, to obtain any information regarding any of the trainings.