Why you should care
Health care might be politically charged, but mental health care is more bipartisan in Texas.
Last December, 160 mental health professionals, pastors and law enforcement officials gathered in a conference room in Austin, Texas. State House Rep. Four Price, the Republican chairman of the House Select Committee on Mental Health, got up to speak. “Let’s see what we can do … at a legislative level,” he said in a noncommittal call to action that nonetheless earned applause. Price was followed by Kirk Watson, a Democrat who was not on the committee. Austin’s state senator spoke with passion and precision. “I want it to be said sometime in the near future, easily said, openly said, ‘I have a mental illness, and I’m receiving treatment in Austin, Texas.’” A few months later, Southern-accented politicians from both sides of the aisle look as though they’re going to back up their talk with legislative action.
That’s right, there’s a play for more mental health services in the Lone Star State. And for good reason: Texas ranked 48th nationally in per-capita state mental health agency spending in 2013, according to the Kaiser Family Foundation. Support for improving that poor showing is coming from the top. House Speaker Joe Straus has said mental health is a high priority in this round in the legislature, which meets for only 140 days every two years. The game plan: Flex legislative muscle on mental health care in schools and sprinkle in experimental funding for clinics that reach overlooked populations, like 18- to 25-year-olds. “Texas is doing different things, innovative things,” says Sarah Narendorf, assistant professor at the Graduate College of Social Work at the University of Houston.
Because mental health affects so many segments of our daily lives … it is absolutely one of the most critical areas of concern facing Texas today.
Interim report to the 85th Texas Legislature, House Select Committee on Mental Health
Good thing, too, in a state with a mental health care system that’s been described as decrepit. Most experts cite the need for 40 to 60 psychiatric hospital beds per 100,000 people. According to the Texas Tribune, capacity in Texas declined from 11.3 beds per 100,000 people in 2013 to 10.5 beds in 2015, putting it in a tie for 39th place in the rankings of the nonprofit Treatment Advocacy Center. The select committee’s 109-page report concluded, “Because mental health affects so many segments of our daily lives … it is absolutely one of the most critical areas of concern facing Texas today.”
All of which means that mental health in Texas “turns out to be an issue where bipartisan support is likely,” Dayna Bowen Matthew, a nonresident senior fellow at the Brookings Institution says. Especially so if federal spending is limited under a new health care law. A last-minute provision in the scuttled American Health Care Act made it optional for states to provide “essential health benefits,” which include mental health care under the definition of EHBs in the Affordable Care Act (ACA). Some experts, like Michael Cannon of the Cato Institute, favor dropping EHB mandates, claiming they decrease state “flexibility” and eliminate state “financial responsibility for unsuccessful programs.” In the end, he argues, the mandates reduce individual freedom and leave consumers worse off.
Texas can’t afford unsuccessful programs at a time when the local economy has cooled, due in part to persistently low prices in the oil and gas patch, which generates 13.5 percent of the state’s gross domestic product. Constitutionally compelled to pass balanced budgets, the legislature recently cut money from the state’s Medicaid program, the joint federal-state program for the poor and disabled. (Texas was critical of Medicaid expansion under the ACA.) However, two-year spending on behavioral health services shows a slight increase — from $2.6 billion in 2014-15 to $2.7 billion in 2016-17. The legislature may also fund improvements to the state’s 10 mental health hospitals, which are sometimes described as “crumbling.” Another bill would create a grant program for regional health departments and community mental health programs.
Fortunately for Texas, foundations and other large private institutions here have a tradition of supplementing tax dollars for state-specific work. “It’s a ‘Texas thing,’” Narendorf says. “[There are] a lot of private or private-public partnerships and foundation work that fund and fuel innovation.” Some work on helping minors transitioning out of the juvenile mental health system: Some qualify for adult services; others lose coverage, because they have a disorder that isn’t deemed serious enough. In Houston, the Hogg Foundation, which is based in Austin, has stepped in with funds for services, including work related to young people with mental health challenges.
Then there are groups in Texas who are experimenting, with the help of federal money. A clinic in Waco received a $3.4 million federal grant in September to serve those ages 18 to 22 with mental health issues. Since then, project manager Georgie Price says the clinic has added 11 young adults and two case managers to handle employment, education and mental health services for the transitioning youths. “Child [welfare] systems have no idea what to do with older teens and young adults, especially those with child-onset or emerging serious mental health conditions. And adult community mental health systems have no idea what to do with the young people coming from the child systems,” says Vanessa Klodnick, a researcher at Thresholds, a provider in Illinois of transition-age youth programs. Klodnick is helping Price’s team in Waco get off the ground and thinks these programs could end up saving the state money by preventing some participants from becoming lifelong users of the system.
Before Four Price attended the December conference in Austin, he and his committee submitted their report to the legislature. “Texas is well-positioned to be the country’s leader for mental and behavioral health care,” the committee wrote. “We have accessible world-class resources available throughout Texas.” Now the experiments are in motion.