Lawmakers to take comprehensive look at Texas' mental health needs

AUSTIN - Texas spends less per capita on mental health care than all but a couple states in the nation. Seventy percent of the counties here do not have a single practicing psychiatrist. Forty percent of children experiencing emotional, developmental or behavioral problems do not get any help. And the state's biggest provider of treatment is the Harris County Jail.

Now, lawmakers are making their most deliberate effort in two decades to address the problems.

House Speaker Joe Straus on Monday formed a special committee to "take a wide-ranging look at the state's behavioral health system for children and adults."

The House Select Committee on Mental Health, the first such panel since 1995, will study mental health care, as well as substance abuse treatment, recommend ways to improve early identification and treatment, and increase collaboration and measurement of outcomes. It will pay particular attention to services in rural parts of the state and for veterans and the homeless.

"We owe it to taxpayers to make sure the system is as effective and efficient as possible," Straus, R-San Antonio, said in a statement announcing the committee.

Republican Four Price of Amarillo will chair the committee, with Democrat Joe Moody of El Paso as the vice chair. Republican Sarah Davis and Democrats Garnet Coleman and Senfronia Thompson of Houston will be among the 13 members.

The announcement came as welcome news to mental health advocates and providers, many of whom expressed optimism while also noting the long way the state has to go.

49th in spending

Sue Adams, a spokeswoman for the Tarrant County branch of the National Alliance on Mental Illness, summed up the state of Texas mental health care in one word: "Terrible."

First, there is the issue of state spending. Texas spends about $900 million annually on mental health. The state placed 49th in per capita mental health spending in the most recent ranking by the national nonprofit Kaiser Family Foundation. That was based on 2010 funding, but a Houston Chronicle analysis last year found that the latest numbers would only slightly improve the state's ranking.

The consequences include fewer community programs to identify and treat those suffering from mental illness, less money available for training of psychiatric professionals and others such as public school teachers, lower reimbursement rates for potential Medicaid providers - which lowers the number of providers willing to accept Medicaid – and fewer state hospital beds for those in crisis.

The Chronicle has reported that by some estimates, Harris County should have one-third more psychiatric beds, and one of the county's biggest psychiatric hospitals closed suddenly in July.

Texas also has the highest rate of residents without health insurance in the nation, reducing the number of those who can seek help before reaching a crisis.

There also are not enough providers to help those that can seek out help, especially in rural areas. About 200 of the 254 counties in the state are federally designated as Mental Health Professional Shortage Areas, which means there are more than 30,000 people per psychiatric professional, a ratio experts say is problematic.

According to the advocacy group Mental Health America, just 36 percent of Texas adults with mental illness receive help - 44th in the nation. For kids, the estimate of 40 percent is from Kaiser.

As a result of all that, the state's criminal justice system has become the biggest provider of psychiatric treatment. Around 76,000 people with mental illness were arrested in Texas for minor crimes last year, according to the Texas Department of State Health Services.

Innovation can be found

There are some bright spots: Texas has launched several innovative pilot programs aimed at providing wraparound treatment and reducing incarceration rates for those with mental illness. The Assertive Community Treatment team in Travis County is especially well-regarded, as is a special court for residents with mental illness in Bexar County and one for veterans in Harris County.

Lawmakers also have increased spending on mental health by about $200 million annually over the past few years, drastically reducing waiting lists for services, among other moves. This year, the extra funding targeted access by increasing medical student residency slots in Texas and paying off student loans for psychiatric professionals who choose to practice in under-served areas.

John Hawkins, a lobbyist for the Texas Hospital Association, said officials have recognized that "behavioral health care is not a political issue."

The membership of the new panel also sparked optimism for advocates, such as Bill Kelly of the Houston chapter of Mental Health America, who noted that key budget-writers such as Price and Davis were included alongside policy experts such as Coleman and Thompson.

"That's the A team," Kelly said.

Coleman said that he expected the committee to make a difference, including by finding innovative ways to improve care without huge costs.

"Mental health crosses into so many areas of public policy, whether it's criminal justice, juvenile justice, education or health care in general and this is the best way to look at it, by bringing together people who are familiar with the different areas," he said. "This is a great thing."