Mental health is shaping up to be a priority for the Texas Legislature in 2017. The new interim report by the House Select Committee on Mental Health highlights several key issues for lawmakers to address. This blog post highlights a few of the top subjects and addressed in the report.
The Big Picture
Addressing the landscape of mental health and state policy in Texas, the report notes:
- It is important to note that while significant resources are currently being invested, the demand for services throughout the state continues to increase.
- As we head into the 85th Legislative Session, all indications are that mental/behavioral health funding for the 2018-2019 biennium budget will remain a priority.
- ...it is imperative that children and families receive expert care from the moment they present. Mental illness differs from other conditions in the sheer isolation and stress experienced by families. Screening, referral networks, specialized services, family supports, and integrated health care address many of the barriers families experience on the front lines when their child is in trouble.
- Because mental health affects so many segments of our daily lives (i.e. education, medical care, health insurance, criminal justice, homelessness, etc.), it is absolutely one of the most critical areas of concern facing Texas today.
- In short, the problems will not simply go away on their own.
Student Mental Health
The Committee report identified early intervention and prevention measures, especially among school–age children, as a priority in addressing statewide concerns related to mental health and noted how expanding innovative public school-based programs and strategies can help to close current gaps:
- …the mental health needs of a school population can have a profound effect on both the students who are receiving mental health services and those students who are not receiving services.
- The negative consequences of not addressing students' mental health are serious, including unsafe behaviors, drug and alcohol abuse, and school failure.
- More students could benefit from early intervention programs if local school districts were encouraged to create these specialized programs.
- TEA receives no direct state mental health funding.
- Many students in higher education institutions suffer from mental health illness, especially anxiety. Second only to financial constraints, mental health issues cause students to drop out of school.
Committee recommendations to address student mental health include:
- Establish and fund a Texas Center on Mental Health in Schools, similar to the Texas School Safety Center at Texas State University in San Marcos.
- Expand on best practice (school-based) programs.
- Require a PHQ9 depression screening for every student who presents to the general campus student health center to increase collaboration between health and counseling centers, as well as emphasize early intervention. If a student falls within a specified guideline on the scale, the student must then be referred to the campus counseling center for a consultation.
- Increase the one-hour suicide prevention requirement [for teachers] to 3 hours of training on mental health discussion; fund Local Mental Health Authorities (LMHAs) to provide such training at a local education service centers (ESCs).
- Expand the role and funding of the Texas Behavior Support Network within Region 4 Education Service Center (ESC) to include training and support to all school districts statewide on the effects of trauma, school-based trauma-informed practices, and integrating mental health training and services into a positive behavior interventions and supports (PBIS) framework.
- Statutorily authorize ISDs to contract with LMHAs for providing mental health services on their campuses and to contract with the MCOs to receive reimbursements from Medicaid for treatment.
Maternal Mental Health
The committee also identified gaps and opportunities in addressing women’s mental health during and after a pregnancy, which is strongly linked to their children’s physical and mental health and development, concluding:
- Increased postpartum mental health assessments are needed to permit more women to receive the assessment and treatment, including interconception care.
To address perinatal depression, the Committee recommends:
- Provide additional funding to address post-partum care.
- Increase the length of treatment to one year after the date a woman gives birth to her child.
- Consider allowing pediatric providers to conduct and bill for post-partum screenings.
CPS and Juvenile Justice
The Committee also addressed the role that behavioral health plays in the child welfare and justice systems, noting:
- Parental substance use disorders are estimated to be a contributing factor in one-third to two-thirds of CPS cases.
- Identifying and addressing mental health issues early and coordinating efforts and utilizing proven programs throughout the state, can impact children in foster care, children impacted by trauma, and may help to reduce the school-to-prison pipeline.
- Foster care children are not timely evaluated for mental health. CPS generally does not require mental health assessment until 30 days within the system.
- Approximately 50 percent of youth in the juvenile justice system have been identified with need for mental health treatment; Approximately 80 percent of state committed youth have a need for alcohol or drug use treatment.
To address these challenges, the Committee recommends:
- Provide for a continuum of mental care when the child ages out of the foster system via mental health care at LMHAs or Health Science Centers.
- Increase the use of telemedicine-psychiatry especially in rural and frontier areas, including use the school and justice settings.
The Committee notes that the report’s recommendations represent a starting point for the 85th and future legislatures to put Texas on the path to become “the country’s leader for mental and behavioral health care.” The report notes that it shouldn’t be assumed that every recommendation included is supported by each committee member without modification.
In addition to the recommendations above, we're particularly pleased to see the following recommendations included in the report:
- Require at least annual mental health screenings during Texas Healthy Steps visits.
- Develop referral networks that link non-mental health providers and parents to child mental health treatment specialists.
- Require recognition and utilization of resources available…that every county has access to a CRCG – so such resources could potentially be relied upon more for wraparound services as an example.
- Allow certified mental health peer specialists for "peer services" and "certified family partner services" to be reimbursed for services provided in a manner appropriate to the scope of their practice; define in rule the scope of peer services.
Texans Care for Children Cited in the Report
We appreciate the report including the following summation of the information we provided the Committee:
Texans Care for Children advises that there are effective interventions and services for children, but many children in need do not receive them. Thoughts on addressing mental health issues in children include: addressing maternal mental health; helping schools address the "whole child"; improving outcomes of children in foster care; improving outcomes of children in the juvenile justice system; helping bring best and promising practices, including those that are trauma informed to more programs and services through coordinated training and technical assistance; improving state and local coordination of services to children and youth with complex needs; and supporting and empowering families of children with mental illness.
Thank You to the Committee
Chairman Price, Committee Members, and Committee Staff should be commended for the thought, attention and consideration each provided during the over 40 hours of hearings on eight separate days, hearing from over 100 expert witnesses and public testimony, and multiple site visits.
We look forward to working with legislators on these critical issues!