Q&A: NAMI Texas executive director Greg Hansch on mental health advocacy

Although mental health awareness month is coming to an end, Texans need mental and behavioral health support year-round. Greg Hansch, executive director of the National Alliance for Mental Health (NAMI) Texas, has led numerous policy advocacy initiatives and outreach efforts at NAMI Texas since his start in 2012. 

In this Q&A, Hansch talks to State of Reform about the continuous need for mental health funding, policy progress this session (and the lack thereof), the significance of audio-only mental health service coverage and other pertinent topics in Texas’s mental health space.

 

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Eli Kirshbaum: Texas is likely to expand telehealth services, assuming Gov. Greg Abbott signs HB 4. How will the permanent expansion of telehealth transform the delivery of mental health services?

Greg Hansch: “HB 4 significantly increases access to telehealth services. Most notably, from our perspective, part of the bill that allows for ongoing reimbursement for audio-only telehealth services. People can receive great benefit by receiving services over the phone, and given that there are broadband access issues in the state, having reimbursement for telephonic services is really important.”

EK: The legislative session ends this week. Is NAMI satisfied with the progress made on the mental health front? What were the wins and losses there?

GH: “There were mixed results this legislative session. We’re encouraged by ongoing attention to the cost of mental health, and significant progress was made, but there were a lot of issues that were left on the table that need to be addressed in the next legislative session. 

This session, beyond the telehealth bill that we spoke about earlier, we’re very encouraged by the Legislature passing a bill that provides Medicaid reimbursement for collaborative care management services. This bill helps to integrate mental health services into the primary care system. That’s SB 672. Adding a new Medicaid benefit is always a steep climb in this state and we’re thrilled by the Legislature’s decision to turn on that billing code in the Medicaid system.

The Legislature also passed bills that strengthen the state’s approach to mental health parity, helping to ensure that insurance companies are covering mental health equally when you do the comparison of how they cover other health services. So that’s HB 2595 that passed the Senate this morning.

Finally, we’re thrilled by the Legislature’s decision to limit the application of prior authorization protocols for mental health medications in the Medicaid system. By reducing these barriers, more people will get access to the right item at the right time.

The last item I want to mention is just on the state appropriations budget bill. The Legislature appears committed to continuing to fund transformation of the state mental health hospital system, and [it’s also] increasing its investment in community private psychiatric beds. This investment is sorely needed, and because Texas is behind where it needs to be on access to in-patient care, mental health is more criminalized in our state than it needs to be and people are waiting in jail right now for access to mental health services. So the Legislature’s investment should and will help in that regard.

On the other side of things, you had asked about things that didn’t make it through that we’ll continue to push for. One of those is the creation of the Texas brain health research initiative, HB 15. Brain health research is sorely needed, and progress on brain health initiatives has been lagging behind brain health research in other areas, and HB 15 would have addressed this by creating a Texas Brain Health Research Institute.

We’re also disappointed that the bill that would have extended Medicaid continuous eligibility for youth under 19 years [of age] from six months to one year — that bill didn’t make it. Ensuring that youth are able to continue to stay on Medicaid if they’re eligible for it is a common sense measure, and it’s very disappointing that it didn’t pass.”

EK: According to Steve Love, president and CEO of the Dallas Fort-Worth Hospital Council, 70% of Texas counties don’t have a psychiatrist. Why is this, and what can the state do to increase the availability of these mental health professionals?

GH: “Well, this is a very vexing issue. I think our Legislature has taken steps that have helped with this problem, including increasing its investment in graduate medical education and also expediting licensure for out-of-state psychiatrists coming to Texas. 

But one policy solution that would help is increasing Medicaid reimbursement rates. I think a lot of people are hesitant to enter the field of mental health in the first place because they know that mental health services are underfunded and undervalued. But I also think that, to a certain extent, Texas will never have the ideal number of psychiatrists. t’s important to keep in mind that there are other providers who can and do provide valuable care outside of physicians who specialize in mental health. 

So we have advocated for legislation that would give advanced practice registered nurses [APRNs] more independent authority and that would increase access to mental health here, especially for people in rural areas that don’t have a psychiatrists. That bill unfortunately didn’t make it through, and many other states allow that full practice authority for APRNS.

Telehealth is another area that needs continued attention. Integrating mental health services into the primary care system, like the collaborative care bill that I spoke to. If people can receive meaningful mental health care in the primary care setting, it reduces the negative impact of there not being enough psychiatrists in the state.”

EK: NAMI conducted the “My Story” campaign this session to gather stories from constituents about their mental health issues and give them to legislators. What do you think this campaign accomplished?

GH: “The ‘My Story’ campaign exists for — more broadly than just policy — raising awareness about the impact of mental illness on people’s lives in Texas. We intentionally train people in ways that give them the ability to share their story to policymakers. And that has a really significant impact when we get one of our members in front of policymakers and they tell their story in an effective way. We have seen that, in many examples, resulting in policymakers taking the position that we want them to make. So the ‘My Story’ campaign is part of that approach.

And we’ll continue to do that. We had a mental health rally virtually this year. We had several elected officials who spoke at that event. We also had people with lived experience speaking at the event, and their stories are powerful, they’re indicative of the gaps in the mental health care system, and because of the emotions that their stories evoke, they’re the most powerful tool that we have in advancing a reform agenda in mental health. So we’ll just continue to do that and try to get as many people in front of elected officials as we can to get them to act for mental health.”

EK: Are there any other projects NAMI Texas plans for the future that you want to mention?

GH: “We have lots of initiatives in store. We just announced the annual state conference for Texas, November 12th and 13th. That’s a free, virtual conference. We provide various trainings and support groups and classes, generally in a virtual setting, and we’re really going to be focusing on, over the next few months, focusing on resources for youth and adolescents. 

We just received a grant from the Offutt Family Foundation that’s going to give us the opportunity to have a NAMI basic feature training for parents and caregivers. It’s going to allow us to triple our capacity to offer family support groups for parents and caregivers, and it’s going to allow us to stand up a youth mental health resources hub on our website.

I think there’s an increasing recognition that early intervention is the wave of the future, and the investments that are made in early intervention have the highest return on investment in comparison to any other public expenditure on mental health. So we’re focusing a lot of our programming in that area, and we’re also focusing a lot of our advocacy in that area.

One of our key priorities for the last few years has been best practice care for people experiencing a first episode of psychosis. We know what works for that population. Research is clear. There is a package of services called Coordinated Specialty Care that makes all the difference and totally transforms the trajectory for young people experiencing psychosis.

Unfortunately, we weren’t able to get the Legislature the bill that would have required insurance companies to provide coverage for coordinated specialty care, and we also weren’t able to get the Legislature to invest general revenue dollars in coordinated specialty care. So that will be something that we continue to work on and get the Legislature involved with.”

This interview was edited for clarity and length.