With over three million Texan adults experiencing a mental health condition, the state is continuing to identify ways to strengthen access to care. Experts in the field discussed how their organizations are contributing to the continuum at the 2024 Texas State of Reform Health Policy Conference last month.
Greg Hansch, executive director of National Alliance on Mental Illness (NAMI) Texas, said there are not enough mental healthcare services in Texas to meet the demand.
“Sadly, 88 percent of Texans live in a county that lacks an adequate supply of mental health professionals,” Hansch said. “When you compare access to care in Texas to other states, we generally rank pretty low.”
Hansch said that when services are accessible, it is important to ensure their quality, that they are serving the populations that need them most. It is also important to examine whether or not people are using the services. .
Only around 40 percent of residents who need mental healthcare services receive them, Hansch said. According to NAMI, only 40 percent of the care people receive is considered science-based or minimally-acceptable care, he said.
About a third of the people who receive science-based care recover, while a third of them say they benefited from care. A third of them say their condition did not improve, Hansch added.
Hansch also highlighted the importance of an equitable system. Some demographics—including people of color, non-English speakers, and the LGBTQ+ population—are more likely to experience adverse outcomes. Outcomes are even worse if the individual also experiences severe mental illness.
“Knowing what we know about the challenges with engagement, quality, and equity, it’s clear we need to look beyond the standard medical interventions … We need to embrace a combination of the medical model and the recovery model. Which, among other features, addresses the whole person and looks beyond just the specific symptoms that a person may be experiencing at a moment in time.”
— Hansch
Referencing the book “Healing” by Dr. Thomas Insel, Hansch said the behavioral health system needs to ensure that people experiencing mental illness have peer support, secure housing, and a purpose in order to properly address their recovery needs.
Sonja Gaines, deputy executive commissioner of behavioral health services at the Texas Health and Human Services Commission (HHSC), discussed the state’s behavioral health strategic plan. The plan identifies strengths and gaps in the state’s system. HHSC has grant programs that aim to fill some of those gaps.
HHSC’s matching grant program has served over 35,000 people, Gaines said. It allows the agency to provide funding to counties to deal with unique challenges that may not exist in all parts of the state.
“It has been phenomenal in terms of some of the outcomes,” Gaines said. “Ninety-one percent of the people served in some of our rural areas […] are reporting stabilization in their housing … We’re also seeing a tremendous decrease in the use of emergency rooms.”
Another HHSC grant, the mental health grant program for justice-involved individuals, aims to coordinate care across state departments for people with mental illnesses who come into contact with the justice system.
Gaines said the agency has worked to help local health authorities become certified community mental health centers. They also continue to support services for children with mental health conditions—like Youth Empowerment Services—and upkeep their highly-used 988 suicide crisis line.
HHSC also has a major web-based resource called Mental Health Texas, where Texans can find services in their area for mental health and substance use issues. The website features educational resources as well.
Other behavioral health organizations, including Carelon Behavioral Health, are also looking to expand access to care.
Julie McMasters, a senior clinical manager at Carelon, said the company focuses on whole-person health, and health equity is a priority there. She noted it is important to look at all aspects of a person when they receive behavioral healthcare.
“What are this person’s individual symptoms? What is their living situation? Who is their support system?”
— McMasters
McMasters discussed telehealth as one of the many ways the state can increase access to behavioral healthcare. She said the COVID-19 pandemic changed the way patients seek care, and more people are relying on telehealth.
Before the pandemic, she said one percent of Carelon’s members used telehealth services. At the height of the pandemic, that number jumped to 60 percent. Presently, around 36 percent of members seek telehealth services.
“We also find that members are actually preferring telehealth visits, as virtual care really affords the member more flexibility and comfort overall,” McMasters said. “This is also an added bonus in that it improves member attendance and engagement with their practitioners.”
McMasters discussed some of Carelon’s pilot programs, including a condition management program for youth and young adults who are diagnosed with and treated for attention deficit hyperactivity disorder.
“We’re really trying to get these members linked with additional outpatient resources in order to further reduce their symptoms they may be experiencing,” McMasters said. “We do this via education [and] coordination of outpatient services for that member. And if they participate in the program, they have access—anytime they need—to our outreach care specialists.”
The program also has case management teams for members with more complex needs.
Sydney Harris, director of mental healthcare redesign at Dell Medical School’s Department of Psychiatry and Behavioral Sciences, highlighted a partnership between the medical school and HHSC that aims to strengthen inpatient care access for those experiencing more complex mental health issues.
ASH Redesign aims to rebuild the old Austin State Hospital into a facility that better fits the state’s needs. The new hospital is scheduled to open in June 2024. Harris said the school approached the redesign with a “people first” attitude.
“Anytime we came to a question that we just couldn’t settle on, we brought it back down to ‘people first,’” Harris said. “We really made sure that we focused on the people receiving the care and the people that are providing the care.”
Harris said collaborators on the project want the hospital campus to be a platform for mental healthcare. She said she hopes the campus will offer additional services in the future, like housing, services for people dealing with the justice system, peer-run services, and more.
The current redesign plans will allow for a state hospital that has more beds so each patient can have their own room and bathroom. Harris said the hospital will also have patio access, common areas, and treatment locations.
The school’s goal is for patients to have a private and public space to visit during their recovery that will feel like a small community. That way, patients can interact with others. They will also be better suited to integrate back into society once their stay at the hospital has finished.
Since ASH Redesign began, Texas has invested in building more state hospitals, which Harris said will relieve the burden on all health facilities, as they will not have such a large population under their umbrella of care.