The 83rd Texas Legislature restored $332 million to fund mental health and substance use disorders for the 2014-15 biennium. With additional funds, several Harris and Montgomery county mental health facilities have carried out significant service expansions and are continuing to improve treatment options to meet an ever-increasing demand for care.
"I think it was recognized by the Legislature that we had underfunded [mental health services] in years past and certainly in the 82nd Legislature when there just was literally no money available in the budget to do a lot of the things that everybody recognized as being critical," said state Rep. Cecil Bell Jr., R-Magnolia.
After years of inadequate state mental health funding methods, legislators earmarked $46 million of the $332 million appropriation last session specifically for eliminating the state's waiting list for public mental health care providers.
Since 2013, two of the largest mental health providers in the Greater Houston area—Mental Health and Mental Retardation Authority of Harris County and Tri-County Services—have been able to eliminate their waitlists entirely and serve more patients than ever.
Bell said the allocation of more mental health funds has already started to remove the burden from law enforcement and local jails by offering better treatment facilities for residents whose only crime is mental illness.
Identifying the need
Across the state, an estimated 894,000 residents have a severe mental illness, such as schizophrenia, major depression or bipolar disorder, MHMRA Executive Director Steven Schnee said. Of that amount, 163,724 adults in Harris County—one of the state's fastest growing areas—are believed to have a severe mental illness, he said.
"We have less than 10 percent treating capacity on an ongoing basis of what the need is," Schnee said. "Every day, every week and every month there are young people between ages 16 and 24 who are beginning to manifest symptoms that could be indicative of a major mental illness. It is not a static population."
There are several common misconceptions regarding mental health, including the perception that individuals cannot recover from a mental illness or that their rights are often terminated, said Evan Roberson, executive director of Tri-County Services, which operates 10 adult and child mental health clinics in Montgomery, Walker and Liberty counties. Many people are not only able to recover from mental illness but also hold jobs and lead productive lives, he said.
Along with a growing patient base in Harris County, Roberson said the increasing demand for severe mental illness care outpaces the clinic's ability to fund new patients.
"Tri-County served more persons in our last fiscal year than we have at any time in our history," Robertson said. "If 200 persons were in a state institution for 365 days a year, it would cost more than the entire Tri-County budget."
Local clinic and facilityimprovements
Through the restoration of millions of dollars in state funding, MHMRA was able to hire several new employees and plans to continue increasing staff levels in 2015, Schnee said. The facility has also increased its monthly patient base by 1,600 to reach 9,800 individuals in the past year and anticipates the capacity to treat 11,000 adults in the near future, he said.
Prior to 2013, MHMRA maintained an external waiting list of an estimated 1,800 people who were screened and determined eligible for treatment by the Department of State and Health Services. Schnee said the facility was able to expand its outpatient services to eliminate the external waiting list entirely and address the need for five new treatment teams to serve 2,500 patients with psychiatrists, nurses, caseworkers and rehabilitation staff.
"We're in the process of building out the capacity for five new treatment teams," Schnee said. "Three of those teams are fully staffed and in place, and the other two are nearing completion of their staffing pattern. We're very pleased we've been able to accomplish that in a fairly short period of time."
In 2013, Tri-County received $1.5 million in new funding to expand services at its 10 clinics and eliminate the waiting list of 200 adults and 20 children. The facility was also able to certify eight employees in mental health first aid and has started to teach first responders how to identify signs of mental illness, Roberson said.
"Certainly Montgomery County benefits enormously from the opening of the Tri-County facility," Bell said. "They are really a big advantage to our law enforcement and our mentally ill folks because they have voluntary and involuntary capacity."
Private clinic funding challenges
As a privately funded clinic, Lone Star Behavioral Health in Cy-Fair and Tomball does not receive any state funding and has encountered its own set of challenges regarding funding.
Catering to adults with mental illness or substance use disorders, Lone Star Behavioral Health opened a 24-bed inpatient hospital in Cy-Fair in 2011 and has operated a 167-acre outpatient facility for several years in Tomball. The facility accepts out-of-pocket payment or insurance coverage for services.
The outpatient facility hosts two programs for patients. Partial hospitalization involves four group sessions per day and intensive outpatient therapy consists of two sessions per day. The facility serves patients in the Greater Houston area ranging as far north as Huntsville to Porter in the south.
Erin Rollins, administrator at Lone Star Behavioral Health, said the facility has encountered issues with insurance providers, such as Blue Cross and Blue Shield, not covering the full cost of some patients' care.
With the implementation of the Affordable Care Act, Texas opted out of the Medicaid expansion that was proposed to expand coverage for millions of uninsured residents. For patients who use Medicare and Medicaid at the facility, reimbursement rates are much lower than other insurance policies, meaning the clinic receives less funding, Rollins said.
"Our facility is one of the only [private] facilities that has been able to be open for the past two years with the [President] Obama cuts," Rollins said. "[Medicare and Medicaid] reimbursement rates were cut by 33 percent each year for the past two years. It's really sad."
Legislative outlook
Looking ahead to the upcoming 84th Legislature, Schnee said he is hopeful state representatives will continue to restore funding to mental health facilities. There is a growing need for more resources and housing options to support individuals who have severe mental illness, he said.
"While we took an important step last session, we don't have sufficient resources to treat even the most severely impaired, let alone broader range of conditions," Schnee said. "Hopefully the Legislature will see the wisdom of taking step two and building up the capacity of our outpatient system."
In addition to advocating for more mental health crisis care dollars, Robertson said legislators should advocate for more equitable funding of mental health centers based on areas of high population growth.
"The funding was very helpful, but the center is approaching capacity," Roberson said."We are currently working to ensure that we have the most efficient service designs in order to maximize the dollars."
In preparation for the upcoming session, Bell said he is meeting with different agencies and county judges to determine the district's future needs for mental health care.
"I think certainly as our population continues to increase, we will continue to see challenges with whether or not we have enough resources allocated to address mental health," Bell said. "I do think in addition to looking at dollars, if we look at ways to use our resources already in the system to better serve that population—that's the other piece we've got to do."
