State health officials delivered a sobering assessment of mental health treatment in Texas, telling a Senate committee Wednesday that waiting lists for services have increased by 642 percent since September 2004 and that there is a severe shortage of psychiatrists and mental health workers available to treat patients.
Overall, nearly 10,000 Texans who have been diagnosed with a mental health disorder are waiting for access to treatment, though the number has decreased slightly since demand reached its peak in 2010.
“Sometimes, they have to go home and wait. Sometimes they end up not getting served and end up in the criminal justice system,” said Michael Maples, the assistant commissioner for the Department of State Health Services’ Mental Health and Substance Abuse division. He said patients are offered treatment based on the severity of their diagnosis.
The Senate Health and Human Services Committee’s nearly six-hour meeting is part of its interim work to reform the state’s mental health system. The committee is expected to come up with recommendations for improving efficiency and outcomes by the 2013 legislative session.
Last year, lawmakers slightly increased mental health carefunding for adults, children, crisis, community hospitals, state hospitals and the NorthSTAR system, from $1.91 billion to $1.97 billion over the 2012-13 biennium. But stakeholders in the field told lawmakers that Texas remains “terribly underfunded” compared with other states.
Dr. Daryl Knox, a Houston psychiatrist representing the Federation of Texas Psychiatry and the Texas Medical Association, pointed out the state spends an average of $39 per consumer compared with the national average of $122 per patient. (A 2011 study ranked Texas 50th when it comes to mental health spending.)
Knox said that patients often wait four to six months to receive outpatient treatment, and that some end up back in hospitals before they’ve received help.
DSHS reported that statewide, 158,010 adults and 46,463 children are receiving services. An additional 49,582 people are receiving crisis services.
Crisis conditions can vary widely for patients, from minor frustrations over everyday life to suicidal or homicidal tendencies.
“The funding is not adequate to meet the need out there for people in crisis,” said state Sen. Jose Rodriguez, D-El Paso.
Knox testified that lawmakers have increased funding for crisis services in recent years at the expense of long-term treatment.
“We realize the task is a complex and very hard one,” he said, but “mental health can be a complex medical condition. They require at times acute emergency services, hospitalization, as well as ongoing maintenance and outpatient services."
Maples said the state is building a foundation for treating patients, but “it’s difficult to know what would be the exact amount of money that would be necessary, because as we showed here, we built something and it grew.” He said the state’s population surge is putting more demand on the system.
State Sen. Joan Huffman, R-Southside Place, asked the agency to look into costs before the 2013 session.
The challenges “still cost the state in some way, shape or form. And we need to know who they are, where they’re going, and see if we can’t meet them early on,” she said.
Maples said his agency is attempting to expand capacity at state psychiatric hospitals by increasing bed space. Currently, the state's 11 state psychiatric hospitals have a total of 2,461 beds. The department has purchased 348 additional beds. Each of those beds costs the state $433 per day to maintain.
Within the offender mental health population, the state lost a lawsuit in January against a group that alleged the state was too slow to house criminals in state psychiatric hospitals after they’d been declared incompetent to stand trial. The court ruled DSHS must make beds available to such detainees within 21 days. Still, Maples said the state is dealing with a backlog of 121 individuals waiting for a maximum-security bed. The state is considering contracting out beds for non-criminals in order to free up space.
In the meantime, the state will continue to fund pilot projects that have since 2008 shown a tendency to improve outcomes at a lower cost. One such program emphasizes the training and use of peer specialists to enhance clinical services. The peer specialists have experienced and recovered from mental health issues themselves. According to Maples, more service providers in Texas are using peer specialists to treat clients because they can identify with those consumers and show them it is possible to break behavior patterns.
Another experiment that appears to be working is the Outpatient Competency Restoration program, which allows some compliant nonviolent felons to receive outpatient care while they are moving through the court system.
“It’s certainly a lot more cost-effective,” Maples said, adding that 67 percent of the participants completed the program “with positive outcomes.”
During the public testimony period, lawmakers heard from more than a dozen stakeholders. Chairwoman Jane Nelson, R-Flower Mound, encouraged many of them to submit their recommendations before the Legislature reconvenes in January.
Nelson told the committee she is concerned that funding levels are based more on historical data “when we should look more closely at performance and quality.”
Ron Stretcher, a board member with the North Texas Behavioral Health Authority, testified that measuring outcomes and performance indicators is “critical” but challenging, because “people with serious mental illness are so impacted by their community,” including their access to treatment and housing. He said budget limitations had forced them to "ration" services and focus more on providing medications to clients.
Other mental health experts testified that the state must do more to increase funding for graduate medical education to beef up the state’s critical shortage of mental health workers. Nelson said that she understands the importance of doing so but that the state’s budget problems persist.
“I’m not sure we’ll ever have enough money to do what we want to do,” she said.
Video of the May 9 hearing can be viewed at this link.