Youth behavioral health services drastically strained in Texas


Soraya Marashi


Behavioral health services in Texas, particularly for young people, have tremendously struggled to keep up with demand since long before the pandemic, according to Dr. Christopher Taylor, founder of Taylor Counseling Group. He says the origin of this mental health crisis for youth and young adults can be traced back to about 2009. 

“We … have seen a radical increase in teen suicides and pre-teen suicides, which almost did not exist before 2009, and [an increase in] self-harm as well.”

Deborah Cohen and Laura Stevens, researchers at the Dell Medical School at the University of Texas at Austin, report that less than 40% of youths in Texas receive one adult service after aging out of adolescent services, and less than 10% of those individuals remain engaged in care by the time they turn 19.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that, between 2016 and 2019, only 33.7% of Texans aged 12 to 17 that had a major depressive episode (MDE) in the past year received depression care. This number is significantly lower than the national average of 41.8%.

According to a new report by Mental Health America, 67.1% of youth with major depression in Texas do not receive any treatment. Furthermore, 11.5% of children with private insurance in the state do not have coverage for behavioral health, another one of the highest rates in the nation.

Taylor largely attributes this crisis to the lack of availability of behavioral care in rural counties.

“The state of Texas has a very large rural population … which is very difficult to manage when you talk about access. Most therapists, most psychiatrists, most psych nurses are going to be in your long-term urban centers in [Dallas Fort Worth], San Antonio, Houston, El Paso. So outside of those four major cities, in some of the smaller cities, you’re gonna find it very difficult to access [mental health services].”

He added that the onset of telehealth during the pandemic, however, has improved accessibility to care for those living in rural areas.

“I think the only positive thing … to come out of this pandemic is that it’s forced us to embrace technology. So we now have insurance companies and Medicare and Medicaid starting to embrace telehealth as a viable option for providing mental health services. But the bottom line is there are just not enough counselors and there are just not enough psychiatrists.” 

Texas is also ranked as the worst state in the nation in access to mental health care, with a mental health workforce availability rate of 880:1. Taylor said reinforcing the behavioral health workforce pipeline is crucial to remedying these major staffing shortages.

“Once you add in psychologists and psych nurses, that gives Texas a mental health population of over 70,000 people that are licensed to work in mental health settings. The problem is, that’s not enough. That’s just not enough. We need more. So we need more people to go and get master’s degrees in counseling, which is a challenge … 

It’s going to be at least two to three years, just so that you can go out and become a licensed professional counselor associate for eighteen months … or social worker … so that you can start seeing clients and taking insurance so it takes a long time to bulk up that population. I’m excited to say that we have more students in school today studying to become therapists than ever before, but we still don’t have enough to keep up the growing demand on mental health.”

Taylor said due to the complicated and difficult-to-understand process of insurance, behavioral health care is also often not affordable, which can discourage people from seeking that care.

“Insurance is extremely complex … sometimes rates change or they don’t want to pay you what you think you should get paid. Deductibles are difficult to navigate, co-pay is difficult to understand. And if you’re just a therapist that has a master’s degree in helping people and not a master’s degree in business administration or insurance, it can be very daunting to take those things on. So many therapists choose not to because they’re not trained in it and they just want to focus on helping people. So they have private practice rates … and for many people that’s not affordable.”

Taylor believes participating in a counseling compact is in the state’s future. 

“Once that compact is in existence, it’ll be very similar to the nursing compact … So as a therapist, if you live in, say, North Dakota, and you want to come to Texas and become a therapist here, you have to go through a long process of getting a license here, even though you’ve been licensed. Once we get that process sorted out, I think that’s going to improve portability of the license …”

Taylor also emphasized that in addition to providing more access, working to destigmatize mental illnesses for young people and encouraging them to seek support when they need it is a crucial component to improving Texas’s youth behavioral health landscape.

“So once we let the kids know that it’s okay to not be okay, we’ve got to make sure they get someone to talk about why they’re not okay.”