In this Q&A, Hani Talebi, PhD, chief clinical officer and senior vice president for Health Systems Integration at Meadows Mental Health Policy Institute (MMHPI), spoke with State of Reform about supporting the mental health of Texans.
Talebi will be speaking on the “A Focus on Children’s Health: Telehealth, School-Based Services, & More” panel at the 2024 Texas State of Reform Health Policy Conference coming up on Feb. 27th. You can register for the event here!
State of Reform: From your time as a psychologist and your work at MMHPI, what would you say are some of the key mental health issues facing Texans?
Hani Talebi: Things have changed dramatically over the last three to four years with respect to mental health. I think one unintended consequence of the COVID crisis was that the stigma around talking about mental health issues and behavioral health issues reduced dramatically.
… If there was a secondary unintended consequence of the public health crisis there, in stigma reducing, was that so many people were talking about the struggles they had, but they had nowhere to turn. It really exacerbated issues we had with respect to workforce shortage, with access issues, and social drivers of health …
Thinking about Texans in general, I think oftentimes we forget that Texas is larger than any country in Europe. It’s just a massive geographical state, and so we have so many different rural areas that have little to no support in the way of mental and behavioral health, and then when the public health crisis happened, it really exacerbated all of those shortages and issues that we’ve had there.
The most pervasive types of issues that we see most commonly are referred to as high base rate presentations. [Those] are pretty traditional and common and we see them across different states as well, and those are anxiety and depression.
I think above and beyond that we’re really struggling with substance use disorders in Texas. We’re really struggling with adolescents expressing suicidal ideation and non-suicidal self injury … And then in different pockets we see different types of presentations, whether that’s with respect to eating disorders or other types of anxiety-based difficulties.
SOR: As the senior vice president for health systems integration at MMHPI, can you explain a bit about how integration helps to improve mental/behavioral health outcomes?
HT: Historically what happens is that an individual would go into their primary care physician’s (PCP) office … for an annual well check. They would go into the office and they would tell the doctor, ‘I’m kind of struggling with sleep difficulties, I’m having some stomach pain that’s coming out of nowhere, and I’m really not enjoying my work as much as I used to, I’m not spending as much time with my friends as I used to, and I have this back pain …’
What would happen in the past is the physician would take a really medical approach to that, and they would run a bunch of medical tests, and this would take time and money, and they would figure out, ‘There was nothing wrong with your back and there was nothing really wrong with your stomach that we can find out through our testing. Your blood and your labs look normal, so why don’t we just see how things go?’
Two weeks later the patient comes back and things are getting worse. [They] don’t know what is going on, they run more tests, and they still can’t figure it out. If that physician was a good physician, they could figure out that maybe this isn’t medical, maybe it has to do with mental health. But the medical model in the past really focused on everything from the neck down.
And so what would happen there is the physician would write a referral to what we call specialty care, and essentially try and find a psychiatrist, a psychologist, somebody in the community they could refer the patient to.
With that referral, we have found over time that over 60 percent of the time, when individuals get referrals for mental and behavioral health from their PCP, they wouldn’t follow through on them for a number of reasons …
The two primary ways individuals in the US interface with mental health for the first time would be [through] law enforcement and the emergency department because they never got a referral early enough when things were in the mild to moderate range …
Integrated behavioral health ends up being how we get those services in the way of mental and behavioral health into the primary care doctor’s office to circumvent the need for a referral in the first place.
… Nowadays in the collaborative care model, a patient can fill out [anxiety and depression] screeners on their phone or an iPad before they even get in, in the waiting area before they go in to see the physician.
When they come in, they go through their usual annual well check protocols. They’ll draw labs, they’ll ask all the questions, review systems, those types of things. And then we review those screeners.
… Then the physician can essentially say, ‘It really sounds like you have some anxiety right now. How would you feel if I was to tell you I have a team member here today in my clinic that can talk to you about these things? They can run a quick evaluation, they can create a treatment plan, and they can potentially provide some strategies for symptom relief, all today.’
SOR: Was there any legislation in the 88th legislative session that MMHPI supported? Can you speak to any policy that MMHPI is supporting, developing, or working towards for the next legislative session?
HT: [I give] major thanks to the Texas legislature for their investment in the future with respect to the approximately $11 billion they put toward behavioral health funding.
We’re [also] really supportive of what we call the Caruth Plan and the Handle With Care (HWC) work that we’ve been doing. HWC ends up being this really comprehensive coordinated care program, insofar as it provides school and childcare agencies with a “heads up” when a child has, for example, been identified at the scene of a traumatic event.
Law enforcement is trained to identify these kids at the scene, find out where they go to school or daycare, and then they communicate with the school or whatever the agency is via a confidential email that simply says, ‘This child was exposed to this situation. This is a child that’s appropriate for a handle with care situation.’
… Sometimes there are school-wide interventions to help create a trauma-sensitive school system that’s a little bit more cognizant about what is going on. If any of those kids who have been identified as appropriate for the HWC system, if they continue to have issues with behavioral or emotional problems in the classroom, a referral to a counseling agency can really be appropriate at that time.
… The Meadows Institute will continue to support MST—multisystemic therapy—and CSC—coordinated specialty care—and then the HWC program and the Caruth Plan we have in the North Texas region.
… [We also support] the Texas Child Health Access Through Telemedicine, or TCHATT, program. That one is kind of a virtual, straight-to-schools mental health evaluation and support for Texas kids in the public school system. This is one initial evaluation and four follow-up sessions free of charge for any public Texas school student … After those sessions, if a child is deemed to need additional support, they are referred to the region’s local mental health authority.
MMHPI has an 88th legislature wrap-up detailing the funding and policy they supported last session in order to improve the mental and behavioral health of Texans.
SOR: The panel you are on during this month’s conference is all about childrens’ mental health. Could you provide a preview of the topics you look forward to discussing at the event?
HT: I think I will be speaking a little bit more to the legislative and policy side of things as it relates to some of the [Texas Child Mental Health Care Consortium] efforts, [and] some of what we saw in the 88th legislative session. The 88th legislature put in about 11 billion dollars into behavioral health funding.
We really want to talk about what that means for pediatric mental health access and the workforce. Those are going to be insistent issues moving forward. We know that there will never be enough psychiatrists, psychologists, counselors, community health workers, all of those types of things.
Maternal mental health is a huge issue right now, for example. How do we make sure those obstetricians and gynecologists have the support they need to support “to be” moms or “just new” moms with depressive symptomatology or other mental health issues?
Then we get into pediatrics. I like to take a lifespan approach to these things. What can we do to ensure there is better access where and when Texas kids and families need them? Then what about transitional-age youth?
I think more than anything, I’d like to speak about the bi-directional nature of the research that we’re seeing, the clinical work and programming that we’re seeing, and the policy work that we’re seeing. They all kind of cascade back and forth to both inform and support each other in very unique ways.
Texas has always been good about innovating as a function of need and urgency, and I don’t think there has ever been more of an urgent time than now to really speak to what can be done.
This Q&A has been edited for clarity and length.