WE’RE NUMBER 50! WE’RE NUMBER 50!

No man’s life, liberty or property is safe while the legislature is in session.”

            Mark Twain

Mental Health Care in Texas

The non-profit group, Mental Health Group of America annually ranks all 50 states and the District of Columbia with regard to the prevalence of mental illness and access to care. It uses 15 different measures to compile a composite score. It then also breaks down categories according to adult rankings, youth rankings, prevalence of mental illness and access to care. Except for the prevalence category, the higher your score (on a scale of 1 – 51) the rate of access to care worsens.

So, let’s take a look at how the Great State of Texas faired:

  1. Overall Ranking – 43
  2. Adult Ranking – 25
  3. Youth Ranking – 46
  4. Prevalence of Mental Illness – 4
  5. Access to Care Ranking – 50

With the exception of the prevalence of mental illness in the State of Texas, the other rankings are appalling. But even that does not tell the complete story.

The Kaiser Family Foundation is a non-profit foundation focusing on health policy research, polling and analysis. In 2018, with regard to spending per capita on mental health care to its residents, Texas ranks second to last among ranked U.S. states and territories.

Surpassed only by California, Texas also has the most Mental Health Care Professional Shortage Areas. This issue is exacerbated when you consider that two-thirds of licensed clinical psychologists practice in the five most populous counties in the state, leaving the remaining 249 counties with inadequate care. Many counties are without a single licensed clinical psychologist.

With the lack of mental health care continuing to be in the spotlight, one could naturally assume that our politicians would be able to put their differences aside and work together to implement a system that provides greater access to mental health care for its citizens. [At this point, I will refrain from using the tired, contrived saying about “ass/u/me.”]

And so let us examine the Texas Legislature and mental health care bills and issues.

The Texas Legislature

The Texas Legislature meets every other year during odd numbered years. The session begins on the second Tuesday in January and in accordance with the Texas Constitution, is limited to 140 days.

Texas has 31 state senators and 150 representatives in the House.

Getting a bill introduced and passed and then placed on the governor’s desk for signature was intentionally made difficult. Bills passed by both the Senate and House require similar language, must pass through committees in each body and are subject to parliamentary procedures which could effectively kill a bill at the last moment. Texans historically have been in favor of limited government and self-reliance. The state’s political system reflects that reality.

In the most recent legislative session, which concluded on May 27, 2019, 10,877 bills and joint resolutions were introduced. Approximately 1400 bills were passed and await signature or veto by the governor. The numbers alone indicate that if you are proposing a bill in the State of Texas, expect about a 90% rejection rate.

With the dreadful mental health care statistics being a reality, let us review how the legislature did on mental health care issues. 

Mental Health Care Bills

Senate Bill 10

The primary mental health bill considered by the Legislature was Senate Bill 10 establishing the Mental Health Care Consortium. This bill would create an executive board to ensure that state agencies coordinate and cooperate to improve mental heath care services in Texas especially to children.

SB 10 was designed to create comprehensive child psychiatry centers (“hubs”) at state medical schools and other health-related institutes of higher education. These hubs would provide mental health consultation services from on-call mental health professionals, via telemedicine, to pediatricians and family physicians.

The hubs would also use remote services to conduct behavioral health assessments for at-risk students. It would authorize these students to have two consultations via telehealth services with social workers or other mental health care professionals, and then determine if a referral for additional treatment is called for.

$99 million for funding of the program was allocated from the general budget of the State. With all 31 Senators co-sponsoring this bill, it sailed through the Senate and approval in the House looked to be assured.

Granted, there were a few, fringe groups which opposed SB 10. The reasons usually included: it increased the size of state government; it established bureaucracy without accountability to taxpayers; the bill allowed meetings and activities without parental involvement; there was a mandate to use “evidence based tools” [when all such tools were not defined] and as such, that made them dangerously vague.

But alas, every village needs its idiot. And so steppeth to the plate, Representative Jonathan Stickland. On the last night that the House could advance a bill first proposed in the Senate (like SB 10), Rep. Stickland raised a “point of order” objection to the bill claiming that an analysis of the bill provide to lawmakers contained an inaccuracy.

Never mind the fact that SB 10 was received by the House on March 6, 2019. Never mind the fact that it was read on the floor of the House for the first time on March 28, 2019. Rep. Stickland had to attempt to indulge in gamesmanship which would have cost millions of Texans access to much needed mental health care. Further, it appeared as if his ploy was going to be successful. Unfortunately and after due consideration, the parliamentarian of the House was forced to agree that an inaccuracy did exist and the bill was returned to the House committee where it would die at the stroke of midnight that night. In a telephone interview that day, Rep. Stickland attempted to justify his conduct by stating: “I think it was a well-intentioned bill that had some very bad unintended consequences. I think it could have been stronger on parental rights to make sure our constitutional rights are protected in the bill.”

The Village Idiot had from March 6, 2019 to raise these concerns. But, he chose not to do so until the 11th hour.

But, the game was afoot. A few hours later, the major provisions of SB 10 were attached as a rider amending SB 11. SB 11 was a sweeping school safety bill that had been passed by the House earlier in the evening.

Over Rep. Stickland’s new objections and request not to reconsider SB 11 with SB 10 attached, the House passed the new SB 11 and the major provisions of the Texas Mental Health Care Consortium were born.

The implementation of the Texas Mental Health Care Consortium could be slow and cumbersome. But, it has started. Undoubtedly, Rep. Stickland will be a future beneficiary of some of the provisions of this Bill.

SB 1145

SB 1145 was an eating disorder bill written and supported by the Elisa Project, an eating disorder foundation in Dallas, Texas. Its executive director is Kimberly Martinez, whom I count as a friend.

SB 1145 required the Department of State Health Services to collaborate with the Health and Human Services Commission and prepare a report on the prevalence of eating disorders and eating disorder-related deaths in Texas.  The report was to include:

             (1)  statewide and regional statistics regarding the prevalence of eating disorders and eating disorder-related deaths in Texas;

             (2)  an overview of national trends in eating disorders; and

             (3)  an overview of state-funded behavioral health treatment options available to persons with eating disorders.

The requisite financial analysis indicated that additional state funds would not have to be allocated for this bill.

It was filed in the Senate on February 26, 2019. It jumped through the required hoops in the Senate, was passed and referred for consideration to the House on May 10, 2019. In the House, it was reported favorably without amendment and assigned to another committee to be scheduled for House debate. And there, it died.

The only issues with SB 1145 were that it was not filed expeditiously enough to warrant consideration in both chambers and it could have been supported by additional background material to both senators and representatives.

With some work in the next two years, I am confident that this bill will pass and this much needed study will be undertaken.

SB 1511

This bill also pertains to eating disorders. And yet, please let this legislation die. This bill is biennially proposed by the venerable Representative Garnet Coleman of Houston. It is a poorly written bill, does not reflect the latest research and thinking in the eating disorder industry and is vigorously opposed by the powerful insurance lobby in Texas.

I wrote an analysis of this bill two years ago when it was proposed and attach it here:

Prior Bill Analysis

It may surprise some that I am not in favor of this bill. However, I tend to support only those bills which have a realistic chance of passing, reflect the current scientific research on this disease and can be supported by the academicians and treatment professionals alike.

Conclusions

Amongst the over 10,000 bills submitted, there were a few other bills which were tangentially involved with mental health. Like most bills in Texas, they never made it to the governor’s desk for final approval or veto.

The access to care for mental health in the State of Texas unquestionably is lacking. Some of that is due to mental health care not having previously been a priority. Some of that is due to the lack of wisdom or insight of certain politicians. Some is due to the fact that Texas is a very large state and both medical and mental health care in the vast rural areas of the state are lacking.

But, with the passage of bills like Senate Bill 10 and with the passage in two years of the bill proposed by the Elisa Project, there is a glimmer of hope for the future. The road continues to be long and arduous. But, because of the work and passion of many advocates and professionals, the voices of those who suffer from mental health issues now have a chance to be heard.

 

 

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s