window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'UA-29484371-30');
Wednesday , August 21 2019
Amy’s Astronomy
Mountains 728
Lucha 728
EP ELEC 2019 728×729
Khalid 728
Soccer/Volleyball 728
Utep Football Generic 728
STEP 728
Bordertown Undergroun Show 728
Home | Tag Archives: texas mental health

Tag Archives: texas mental health

Texas lawmakers are prioritizing mental health for school safety. But advocates worry about stigma.

Mental health is at the forefront of gun violence prevention conversations among Texas legislators this session, but advocates for people with mental illness are wary of that focus.

After the Santa Fe High School shooting in May that left 10 dead and 13 others wounded, Gov. Greg Abbott held a series of roundtable discussions around school safety that resulted in proposals like more resources for school safety personnel and closing gaps around mental health access. He named school safety as one of his top 2019 session priorities.

The newfound push among state leaders and legislators around school safety and preventing mass shootings is reinvigorating ideas around mental health care for Texas children. But mental health advocates often cringe when legislators make the argument that mental health care can prevent mass shootings, saying the rhetoric stigmatizes people with mental illness as if they’re inherently violent. Increasing access to care is just one part of the solution, advocates say.

One of the high-profile mental health bills of the session is Senate Bill 10, filed by Sen. Jane Nelson, R-Flower Mound, chair of the Senate Finance Committee. Nelson told senators as she laid out her bill that it was her “best shot” at helping students in the aftermath of the Santa Fe High School shooting. The legislation is deemed a priority by Abbott and cleared the Senate in a 31-0 vote March 5. It has been sent to the House for consideration.

The bill would create the Texas Mental Health Care Consortium, a $100 million initiative to bring universities and other health care providers together to connect children to mental health services. The bill also aims to promote use of telemedicine and mental health research and to expand the state’s mental health workforce.

“This bill is going to help young people get the care that they need, and it will ultimately save lives,” Nelson said.

She said she is troubled that “kids need to worry about there being a school shooting” and how students are dealing with issues around drug use and suicide. She said she worked with mental health experts, pediatricians and local judges to understand the scope of the problem before filing the bill and found that people often don’t know where to send kids who need help.

Nelson has faced criticism and questions about potential concerns over children’s data privacy, parental consent and pharmaceutical company involvement with universities. The bill has also been criticized because it does not provide mental health services — rather, it connects children and families to professionals they can see for help.

Josette Saxton, director of mental health policy for Texans Care for Children, said students are more likely to see youth violence on their campuses in the form of bullying, dating violence, physical fights, or self-inflicted harm like cutting or suicide rather than “the horrific but much more jarring and visible incidents like what happened in Santa Fe.”

“It’s a tricky area because the conversation and the attention about ensuring or addressing mental health concern especially in youth is something that is definitely needed,” Saxton said.

The state previously found it still needs to improve access to care for Texans, especially children, according to a final report released two years ago by the House Select Committee on Mental Health. Some of those challenges included identifying and treating mental health issues and families finding mental health professionals covered by insurance. Another challenge was that school districts were not using the Mental Health First Aid program, created to provide mental health training for public school personnel. The report found that schools were not using it because the state was not paying for travel and the course required a full day of staff time.

“While there are some excellent models of collaboration between mental health professionals and educators, there is a genuine disconnect in serving public school age children with mental health issues,” the report said.

States have become “the vanguard of policy” around violence prevention, especially when it comes to mental health access, but it can’t be the only solution, said Mark Barden, co-founder and managing director of Sandy Hook Promise. His organization was founded after the 2012 shooting at Sandy Hook Elementary School, where 20 children and six staffers were killed in Newtown, Connecticut.

Barden said that the people committing such acts may not have a diagnosable mental illness but are instead lacking anger management and impulse control. He pointed out that Sandy Hook Promise works with schools and communities to provide trainings about social isolation, suicide prevention, and how to recognize and determine the seriousness of a potential threat.

“There needs to be many tools available in the toolkit to address this effectively,” Barden said. “Providing access to better quality mental health care is part of that equation, but we also know that the vast majority suffering from mental illness are no more likely to perpetuate an act of violence than anyone else.”

Texas legislators are looking at those other solutions, such as arming teachers, “hardening” schools by reducing the number of entrances and exits so teachers and administrators better monitor who’s coming in, and increasing requirements around security cameras. They fielded testimony at a hearing in June from hundreds of people around gun storage and “red flag” orders that would allow law enforcement, family members or others to ask the courts to confiscate guns from people who are considered dangerous. Lt. Gov. Dan Patrick has previously suggested that this kind of bill would be dead on arrival in the Senate.

The Sandy Hook shooting is arguably what has made the Texas Legislature more focused on mental health since the 2013 session, says Greg Hansch, interim executive director for the Texas chapter of the National Alliance on Mental Illness. He pointed out that legislators have made significant investments in mental health in recent years, including launching a community grant program for mental health services, addressing how health insurance companies offer mental health benefitsand funding to renovate state mental health hospitals.

While shootings at Santa Fe High School and Sutherland Springs have reinvigorated the conversation around mental health this session, “there are stronger arguments than ‘they’re going to prevent school shootings’ or ‘they’re going to reduce violence,’” Hansch said.

He said some of the bills filed this session may reduce violence against others and self-harm cases like suicides and attempted suicides. He pointed out it’s more likely that the mental health legislation filed will have an impact on a smaller scale, like helping students with behavioral issues that can lead to disruptions or fights.

“It’s hard to say what is going to prevent those high-profile incidents from happening again,” Hansch said.

Author: MARISSA EVANS –  The Texas Tribune

State Spending More on Mental Health Care, but Waitlist for Beds Grows

When Stephanie Contreras picked up her son last October from a private psychiatric hospital in South Texas, “he was white as a sheet, blue in the lips,” she said.

Her son’s emergency hospitalization had been intended to stabilize his mental illness, but she found him on the verge of a diabetic coma. He had failed to receive proper medication, she said. Contreras, who lives in McAllen, believes this would not have happened if he had been able to get care at one of Texas’ 10 state hospitals for people with severe mental illness, where he had stayed before. But in at least five cases over about a decade, Contreras said, her son was turned away from state hospitals because they were full.

“He was emotionally traumatized” by the difficulties of getting into high-quality psychiatric care and facing a shifting team of medical professionals, she said. “Time after time, there would be no beds in the Valley.”

Contreras’ son, now 36, has schizoaffective disorder, which includes schizophrenia and mood disorder symptoms. Over an 11-year period of his adult life, he spent more time in psychiatric hospitals than in the outside world, Contreras said. But getting him into care often proved difficult. Contreras remembered spending long nights in the emergency room, calling private and public hospitals to see if any had space to take him in for stays that ranged from two weeks to three months.

Despite an infusion of funding from lawmakers for the state’s mental health care system, Texas struggles to provide psychiatric care for all patients who need it. Crumbling, century-old state hospitals today have around 400 people on waiting lists, and the number of beds the state pays for in private facilities has not kept up with the state’s rapid population growth.

At the same time, publicly funded options for people who need mental health care but are not yet in crisis are even harder to come by, experts say.

Advocates for people with mental illness say the result is a public health emergency. The longer people must wait to get emergency mental health care, the greater a danger they pose to themselves and others, advocates say. They hope to persuade Texas lawmakers in 2017 to finance more psychiatric hospital beds, but where those beds would go — and where the money would materialize from to pay for them — remains to be seen.

Contreras, now the executive director of the Rio Grande Valley affiliate of the National Alliance on Mental Illness, said her son has enjoyed a “blessed” life despite his medical issues. In 2014, he graduated with an associate’s degree in architectural drafting.

But in her work advocating for people with mental illness, Contreras said her son’s challenges with the current system are instructive, as she regularly encounters people who struggle to get adequate and timely mental health care close to home.

In the face of criticism, Texas lawmakers tout recent improvements to the state’s mental health safety net. They point to new funding that encourages mental health professionals to practice in underserved areas, an expansion of innovative behavioral health care programspaid for by Medicaid and new telemedicine regulations intended to make it easier for patients to connect with psychiatrists remotely.

In March, the Senate’s chief budget writer and former Health and Human Services Committee chairwoman, state Sen. Jane Nelson, R-Flower Mound, said Texas had invested “significant resources” in mental health care in recent years. Her office calculated that public expenditures on mental health care had grown by $192 million from the 2013 legislative session to the 2015 session. And when mental health spending from Medicaid, the joint state-federal insurance program for the poor and disabled, is included, total spending was up $483 million, she said.

“We have serious challenges to address, but I want to make sure we have a true understanding of our commitment to mental health — by knowing not only how much we are spending but also how we are spending the funds,” Nelson said in an emailed statement.

Still, the number of state-funded beds in psychiatric hospitals has remained flat since 2013, hovering around 2,900 at any given time, according to the Department of State Health Services. That includes capacity in the state hospital system as well as state-contracted beds at private facilities.

More troubling for advocates is a decline in the number of beds relative to the state’s population. As Texas has grown, the per-capita psychiatric hospital capacity has fallen, from 11.3 to 10.5 beds per 100,000 people between 2013 and 2015.


State public health officials say there were 388 people on waiting lists for state hospitals as of April 1.

“Almost all of our state hospitals are currently at capacity, and we are admitting patients as soon as other patients are discharged,” said Christine Mann, a spokeswoman for the Department of State Health Services.

Meanwhile, more than half of state hospital beds go to people who have been ordered there under a “forensic” commitment through the criminal justice system. Texans who were found by a court to be not guilty of a crime by reason of insanity or who were considered incompetent to stand trial currently fill about 1,200 state hospital beds.

That leaves only about 1,100 beds available at any given time for people, like Contreras’ son, who seek treatment outside of the criminal justice system.

For patients in the Houston area, non-forensic or “civil” commitments to a state hospital are particularly hard to come by, which has prompted Texas to contract with public and private facilities not operated by the state.

The Harris County Psychiatric Center is “largely filling” the gap for civil commitments, said Stephen Glazier, the hospital’s chief operating officer. In 1988, Glazier said, there were 1,525 people in the Houston area admitted to state hospitals through civil commitments. By 2013, he said, that number had fallen to two.

Glazier’s 276-bed facility — Houston’s primary safety net hospital for psychiatry — is “functionally full,” he said, which means that if there is an empty bed, it’s only because there’s an assigned patient who hasn’t arrived yet. About 14 percent of patients are “super-utilizers” who are likely to be readmitted because they have few options for supportive care after they’ve been discharged.

“We discharge many people to a [homeless] shelter,” Glazier said. “We see a lot of chronic recidivists, and we see a lot of rapid readmits within 30 days.”


Most of Texas’ state hospitals were built in the 19th and early 20th centuries, when mental health care was poorly understood and many people with mental illness were expected to spend their lives in insane asylums, said David Lakey, the associate vice chancellor for population health at the University of Texas System and a former commissioner of the state agency that oversees state hospitals. Now, he said, the buildings are decaying.

“State mental health hospitals are in really bad condition,” he said. “Every session, I would go and ask for like $100 million to repair basic things, like roofs and HVAC systems. In most years I’d get zero, and in some years I’d get $30 million.”

A recent Department of State Health Services study determined that five state hospital facilities — Rusk, Austin, San Antonio, Terrell and North Texas at Wichita Falls — were beyond repair and should be replaced. Buildings at other facilities should be repaired and renovated, the study recommended.

Photo by: Shelby Tauber The Austin State Hospital is shown on April 29, 2016. Officials said that as of April 2016, state hospitals have nearly 400 people on waiting lists, and the number of beds the state pays for in private facilities has not kept up with the state’s rapid population growth
Photo by: Shelby Tauber The Austin State Hospital is shown on April 29, 2016. Officials said that as of April 2016, state hospitals have nearly 400 people on waiting lists, and the number of beds the state pays for in private facilities has not kept up with the state’s rapid population growth

Some advocates for people with mental illness say a solution would be for the state to build new facilities, but such a proposal would be costly. Replacing the large hospitals is estimated to cost about $180 million each, according to Lakey. And the total price tag for replacing the five hospitals, repairing the remaining hospitals and adding capacity is closer to $2 billion.

As an alternative, Lakey pointed to the University of Texas Health Science Center at Tyler, which converted an empty ward in a university building into a mental health hospital. Lakey said similar public-private partnerships could be a cheaper and effective solution that the fiscally conservative Legislature might find palatable.

Advocates like Contreras say that until the state finds more capacity, thousands of Texans in mental health crises will suffer.

She recalled the story of a woman in her 60s in the Cameron County jail who sought treatment at a state hospital because she had a psychotic disorder that caused her to lose touch with reality. Working for the National Alliance on Mental Illness on the woman’s behalf, Contreras said she made several calls and secured a court-ordered transfer for the woman from the jail to the Rio Grande State Center, a state hospital.

But as an intermediate step, the woman underwent a routine medical exam at a local private hospital. When a nurse drew blood, Contreras said the woman passed out and hit her forehead on the floor, leaving a bloody gash. The state hospital, Contreras said, declined to accept the patient because of the injury.

“Even though she was under a judge’s order to be in jail and then transferred directly to Rio Grande State Center, she was put in a taxi — you’re not going to believe this — and the taxi driver drove into a canal,” Contreras said.

“So here we have this woman, over the age of 60, she’s psychotic, she’d been in jail, she had a gash in her forehead, floating in the dirty canal,” she continued. “I have so many stories.”

Mann, the Department of State Health Services spokeswoman, declined to discuss a specific patient’s case. But in an email, she said it would be “standard practice” for a state hospital to refer a person needing immediate medical attention to an outside health care provider for treatment.


Advocates who seek to improve access to mental health care in Texas say the state will need to do more than just expand the number of hospital beds for patients in crisis. Despite applauding state lawmakers’ recent investments in mental health care, they still have a long list of recommendations for improvement. That includes raising Medicaid payments to psychiatrists, psychologists and other mental health care providers and boosting funding for community-based services and affordable housing.

The solution isn’t just to build more hospitals, said Andy Keller, president and chief executive of the Meadows Mental Health Policy Institute. He said the state should provide options for people before they reach a mental health crisis.

Keller said making more services available to people after they are discharged can help them avoid being readmitted, ultimately reducing the overall demand for psychiatric beds.

“Families, a lot of times, are under this sort of illusion that people go to the hospital forever,” he said. “That’s not what happens.”

“We have to look at the flow out [of hospitals], as well as the flow in,” he said.

Keller said state law restricted the ability of social workers and health care providers to do effective outreach, under a program known as Assertive Community Treatment, to work with people at risk of being hospitalized. That program requires even the neediest Texans, such as the homeless, to undergo hourslong assessments before they are eligible for subsidized services, Keller said. People who do not have a stable place to live or are unaware they have a mental illness are unlikely to get assessed for treatment.

Alison, a Houston mother who spoke on the condition that her last name be kept private, offered the story of her adult son as an example. She said he has paranoid schizophrenia and a history of assaulting family members and strangers. Arrest records show her son, who is in his mid 20s, has a criminal history in Texas and Florida. On several occasions, Alison said, a judge has ordered a short-term commitment for her son at a private psychiatric hospital.

But because he has anosognosia, or a lack of awareness of his illness, he is skeptical of his need for treatment and mistrusts the people who try to help him, Alison said. He is currently homeless, living out of his car, she said.

In order to get him into a psychiatric hospital, she must wait for law enforcement to get involved, which only occurs whenever her son is considered a public safety risk, such as the time he assaulted a roofer on top of a neighbor’s home, Alison said. Until then, she can’t get her son into a psychiatric bed if he doesn’t want to go.

“When you have gotten to the point where you are presenting as an imminent risk of serious harm, that is a painful thing to wait for,” said Alison, who attends National Alliance on Mental Illness support group meetings. “What that has meant for us is, now he is assaulting someone, now we get to call the police. But before that I can see it coming.”

Disclosure: The University of Texas System and The Meadows Mental Health Policy Institute have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

Author: Edgar Walters – The Texas Tribune

The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them – about public policy, politics, government and statewide issues

Amy’s Astronomy
Utep Football Generic 728
STEP 728
Soccer/Volleyball 728
Mountains 728
EP ELEC 2019 728×729
Khalid 728
Lucha 728
Bordertown Undergroun Show 728