Youth mental health professionals discussed efforts to provide care to children in need at the 2024 Texas State of Reform Health Policy Conference last month.
Diana Rios-Rodriguez, a registered nurse and director of health and wellness at Manor Independent School District, discussed some of the struggles schools face when trying to provide mental health support to their students.
Rios-Rodriguez said the only real contact many kids have with healthcare professionals is with their in-school nurse, because so many of them are uninsured. Uninsured kids often do not get the help they need until they are in crisis, she said.
Almost 11 percent of children in Texas do not have health insurance. That ranks the state last in the nation in children’s health coverage.
School districts can connect children without insurance to a school-based health center or an outside partner to receive care, but this poses an issue when integrating the child back into their school after they receive counseling, Rios-Rodriguez said. Ideally, this would happen in a seamless, stigma-free way, she added.
“Sometimes we don’t have the communication from the outside provider transitioning them back to school,” Rios-Rodriguez said. “They get discharged and they come to school and we have no knowledge of how to support our students to be academically successful while still meeting their mental healthcare needs.”
Over 68 percent of the students in Rios-Rodriguez’s district are economically disadvantaged, she said, but it has a school-based health center offering year-round physical and mental healthcare to the district’s Medicaid and CHIP recipient children, as well as uninsured children.
Rios-Rodriguez said her district is lucky to have the resources it does for its students.
Dr. Hani Talebi, chief clinical officer and senior vice president of health systems integration at the Meadows Mental Health Policy Institute, said the public health crisis has exacerbated mental health issues. However, because of the crisis, more people are talking about mental health and recognizing it as a real issue, he said.
“Last biennium, in session, over $11 billion [was] directed toward mental health-focused initiatives in Texas,” Talebi said. “That’s unheard of. That’s outrageous. It’s exactly what we need right now.”
Talebi emphasized the importance of changing the healthcare system’s structure in order to improve how providers deliver mental healthcare. With its current design, many people enter the system for the first time through law enforcement or emergency departments.
Talebi is a proponent of integrated behavioral healthcare, which intertwines behavioral healthcare services into primary care so those in need do not need to follow up on a referral to an outside source. They are able to access mental healthcare at their primary care doctor’s office.
Primary care physicians and pediatricians have become de facto mental healthcare providers, Talebi said. Due to the extra stress, many physicians choose to leave the field, exacerbating the country’s healthcare workforce shortage, he said.
“[Primary care physicians and pediatricians] are burning out in mass and leaving. At the same time, they’re doing their darndest to try and get things done on behalf of their patients.”
—Talebi
Integrated behavioral healthcare can also be helpful for schools, as many children spend most of their days in a school setting, Talebi said. Having care available on campus allows students to receive care where they spend the most time.
The Texas Child Health Access Through Telemedicine (TCHATT)—an initiative from the Texas Child Mental Health Care Consortium (TCMHCC)—is helping integrate mental healthcare into schools.TCMHCC was created In 2019 when the legislature passed Senate Bill 11, which focused on school safety.
Luanne Southern, executive director of TCMHCC, said most adult mental health problems begin in childhood, but there are limited options to get help. She said Texas has out-of-home placement options and some prevention service options, but not enough options in between.
“[Access] is [available] according to geography, according to places that actually have staff available to provide the service, so what we really need is to look at that array of care that the entire system needs, that all children and families need to access in order to thrive.”
— Southern
TCHATT adds to the continuum of care by providing remote mental healthcare services, which include an initial evaluation and four follow-up sessions that can be conducted in schools, Southern said.
Approximately 3.9 million Texas children are eligible to participate in TCHATT. But parental consent must be received by TCMHCC and the school in order for a child to participate in the program.
Southern said the consortium has teams of experts that conduct training and educational initiatives in order to educate parents on mental health issues so they can better understand the emotions and behaviors their children might exhibit.
However, programs like TCHATT can be difficult to operate in schools due to space constraints. Rios-Rodriguez said stakeholders should consider alternative options to help their students access the program’s services.
“They’re all so connected to their cell phones, so why can’t we utilize their cell phones and then just have [the school counselor] find a private location for them? Let’s encourage [students] to be more vocal about the services they need because they might not be able to go home to do this because they don’t have wifi access. But they have great wifi access when they’re at school.”
— Rios-Rodriguez
Southern said some schools opt-out of TCHATT because they do not have sufficient space or staff to operate the program. When TCMHCC creates a memorandum of understanding with a school district, a staffer within the district is assigned as a point of contact so the program can be implemented properly. Some districts do not have the resources to do that, Southern said.
Talebi also noted that certain mental health issues will simply not be solved through the evaluation and sessions that TCHATT provides. However, the consortium has done well in participating in pilot programs when funding is available to help provide longer-term care for some children, he said.
“We need infrastructure and systems in place to make the entire spectrum and array of resources available because virtual services are not going to be the answer,” Talebi said. “That one domain can’t solve everything … there is no [single answer]. There are lots of different resources that folks need to know about to increase their mental health literacy, have some help in negotiating and navigating, and be able to dip in and out when and where they need [to].”
Talebi noted that children cannot learn if they are not receiving the mental healthcare they need.
Rios-Rodriguez said she hopes to see mental healthcare become more of a priority in the future, not only for children, but for everyone.
“I would just love to be able to see that mental health is a basic standard of care, that it’s there in the forefront, and that everyone has access to it,” she said.
Southern said she feels hopeful about the future of mental healthcare, especially because the legislature has identified it as an important issue.
“All of us are recognizing the need to address issues early and [that talking] about it is OK. And people [should] know you can recover from it—it’s very common—and you shouldn’t be ashamed to talk about it.”
— Southern