The Williamson County Mental Health Task Force—made up of representatives from area school districts, mental health hospitals and agencies, the Commissioners Court, area churches, the sheriff’s department, and the county’s Mobile Outreach and Crisis Intervention teams—gathers monthly to help identify those gaps and come up with solutions, task force Chairwoman Kathy Pierce said.
“It’s a collaboration when you have everybody at the table,” she said. “It’s easier to work together when you know each other. It’s amazing how solutions can come about.”
Andrea Richardson, executive director of Bluebonnet Trails Community Services, which serves as the local mental health authority in eight area counties including Williamson County, said a shortage of mental health care providers has made it difficult to help area residents get the services they need.
“It’s what we’re living,” she said. “There are particular levels of providers that we are having difficulty finding, [such as] psychiatrists, nurse practitioners and counselors … licensed professionals that are highly sought-after.”
The shortage of providers is a local, state and national issue, Richardson said.
According to Dallas-based physician search and consulting firm Merritt Hawkins, Texas has the fourth-lowest number of psychiatrists per 100,000 residents in the United States, with 4.1 psychiatrists per 100,000 residents, according to a 2015 report. Only Nevada, Mississippi and Idaho have fewer psychiatrists per capita, the report states.
“There’s an increasing awareness among our leadership that this [shortage] is an issue that has been ignored for far too long,” said Greg Hansch, National Alliance on Mental Illness-Texas public policy director.
Richardson said Central Texas has 11.7 psychiatrists for every 100,000 people. The national standard is 25 per 100,000.
The unwillingness of providers to accept private insurance or patients with Medicaid—government-funded insurance that provides free or low-cost health care—has also worsened the issue, according to an April 2016 Hogg Foundation policy brief, “The Mental Health Workforce in Texas Continuing Challenges & Sensible Strategies.”
Half of Texas psychiatrists accept private insurance as opposed to nearly 90 percent of physicians in other fields. And only 21 percent of Texas psychiatrists accept Medicaid patients compared with 37 percent of physicians in other fields, according to the brief.
Merritt Hawkins cites a trend that indicates although primary care doctors are anticipated to be in short supply, the steepest deficits may be among psychiatrists.
This shortage can be attributed to an aging psychiatrist population—with 60 percent of Texas psychiatrists being age 55 or older, the small numbers of medical school graduates who choose psychiatry residency programs and the continued negative stigma of mental health issues, the report states.
“There is a potential in the near future to have more psychiatrists leaving the specialty per year than entering,” according to Merritt Hawkins’ 2015 paper, “Psychiatry: The Silent Shortage.”
Despite a shortage in mental health professionals, new area mental health facilities have opened in the past year.
In Travis County, on March 2, 2015, Cross Creek Hospital opened at 8402 Cross Park Drive, Austin. In spring 2017, Housing First Oak Springs will open at 3000 Oak Springs Drive, Austin, and will house homeless people living with mental illness and/or substance abuse.
On April 18, Bluebonnet Trails opened in a suite on Cedar Park Regional Medical Center’s campus. Because of the shortage in mental health professionals, Richardson said Bluebonnet Trails is utilizing nurses via a temporary nursing staffing agency to help staff the Cedar Park location.
Richardson said she hopes The University of Texas’ Dell Medical School will bring new nurses and mental health professionals to the area to eventually work for Bluebonnet Trails.
Bluebonnet Trails is also in discussions to help expand its services in Georgetown, including adding beds to its observational unit at the San Gabriel Crisis Center at 117 N. College St.
The unit currently has four beds, she said.
“We are hoping to expand access to that level of care,” Richardson said. “We know that there is an increased need for that in Williamson County as well in many other counties, and we are hoping to alleviate that pressure.”
The mental health authority is also a part of the Williamson County Mental Health Task Force and is working with the group to help outline an agenda for the upcoming 2017 Texas legislative session, which will begin in January.
“We are getting ready for that upcoming session,” Pierce said. “We always like to come with … possible solutions and a way we can work together.”
One of the items expected to be up for discussion includes asking to amend legislation sponsored by Sen. Charles Schwertner, R-Georgetown.
Schwertner sponsored Senate Bill 239, which established a student loan repayment program, during the state’s 2015 legislative session that encourages recent graduates to focus on underserved geographic areas, or Health Professional Shortage Areas, by offering school loan repayment assistance for certain mental health professions.
The bill, which Richardson said is going to help incentivize doctors to go into those fields with shortages, excludes providers who conduct their work through telemedicine, which is often used to benefit patients in rural areas where lack of transportation can make it difficult to access care, she said.
“The lack of providers and therefore having easy access by telemedicine … makes sure that services are available at the point someone needs them,” Richardson said, adding that telemedicine must also be approved by the Texas Medical Board.
Schwertner also championed the Mental Health First Aid Bill in 2013 that allowed educators at the primary and secondary levels to take voluntary training courses to help identify the signs and symptoms of a student in need of mental health aid.
What can be done?
Integrating primary health care providers to better coordinate mental health treatment is a possible solution since most adults with a mental health condition also have one or more chronic physical conditions, according to a Hogg Foundation brief. Other possible improvements include increasing treatment reimbursement rates for doctors, advocating peer-
support services, expanding physician internship and residency slots in-state, and broadening the use of technology to connect a patient with a mental health professional, the brief stated.
The state’s recent increased mental health focus may account for more people accessing mental health care, reduced wait lists for treatment and more community centers, Hansch said.
“Texas in the past few years has come a long way in bolstering resources that are dedicated to the public mental health system,” he said. “[However], there’s a need for more resources for the public mental health system.”
Additional reporting by Lyndsey Taylor