Nonprofit mental health providers in Fort Bend County have seen their budgets increase in recent years, yet Texas continues to rank near the bottom of the national list in mental health spending per capita. County providers have said more needs to be done to meet the needs of residents, particularly in light of proposed budget reductions at the federal level.
MORE BEDS NEEDED
Texana Center is one of only two facilities in the county that offer inpatient mental health care. Texana Center CEO George Patterson said demand for such care is outpacing the number of beds available.
“The way the county is growing combined with the difficulty getting a patient into a state hospital I would say (we need) at least double (the beds) we currently have,” Patterson wrote in an email response to questions.
In his email, Patterson wrote that people requiring hospitalization for mental illness will often be housed in jail facilities or general hospital emergency rooms “for days while waiting for a bed to become available at either the state hospital in Austin or at one of the private psychiatric hospitals with whom we contract.”
Connie Almeida, Fort Bend County director of behavioral health services, said the county needs more varied resources to address problems faced by people suffering from mental illness. Almeida agreed more beds are needed in the county to provide inpatient mental health care to those who need it, but she said the only way to add to the supply of beds dedicated to inpatient mental health care in the county is to receive more money from the state, a problem being felt by many counties in Texas.
NEW MONEY FUNDS NEW PROGRAMS
Since 2013 Fort Bend County has received about $10.93 million from the state which has allowed the county to establish new programs to help those who suffer from problems associated with mental health issues.
The money was made available after Texas received federal approval for a waiver to the Social Security Act. The nearly $11 million freed up as part of what’s known as the 1115 waiver was used to create programs aimed at providing help to people suffering from mental illness and intellectual development disabilities who might otherwise end up in the jail system.
For example, money provided by the 1115 waiver was used to fund creation of the Fort Bend County sheriff’s office crisis intervention team, which accompanies county mental health providers and social workers to situations that pose a threat to those workers’ physical safety. Without having those county staffers to send out, an individual in need of mental health treatment would likely end up being incarcerated, Almeida said.
Members of the CIT responded to 1,761 unique individuals from October 2015 to September 2016, with 254 of those people being diverted from incarceration, according to county documents. From October 2016 to March 2017, CIT responded to 829 unique individuals with 131 of those people being diverted from incarceration, those documents show.
The recovery and reintegration program helps adults who suffer from mental illness to resume civilian life after their incarceration ends. Providers follow up with the patient after release to help him or her find housing and employment among other needs. From October 2015 to September 2016 the program served 43 people, according to county documents.
A third program that was launched with the money is Successful Outcomes Utilizing Resiliency for Child Empowerment, which is focused on keeping teenagers who suffer from mental health conditions out of the juvenile justice system. Members of the SOURCE program work with families of those teens to address their individual needs. From October 2015 to September 2016 the program served 28 youths and families, according to county documents.
INSURANCE OFTEN NOT ACCEPTED
Government agencies and nonprofit entities often bear much of the burden for providing mental health services to those who cannot afford to pay for such services out of their own pocket, because many psychologists and psychiatrists choose not to accept health insurance, according to surveys published in medical journals.
A 2014 study published in the Journal of the American Medical Association Psychiatry found only 55.3 percent of office-based psychiatrists surveyed accepted health insurance. The same study found even fewer, 43.1 percent, accepted Medicaid.
Part of the reason so few mental health professionals will accept insurance could be due to the high demand for their services, said Jessica Mantel, co-director of the Health Law & Policy Institute at University of Houston’s Law Center.
“Most mental health professionals, because of the huge demand, can find enough people who can afford to pay out of pocket and fill their schedules,” Mantel said.
Another study examining the issue was published in the JAMA Psychiatry in 2015, and found that unlike most medical doctors, psychiatrists and psychologists overwhelmingly work alone. That study found more than half of office-based psychiatrists have solo practices.
Without having a fellow professional with whom to share the cost of a billing processor, those solo practices forgo the additional clients to avoid the high costs that dealing with insurance companies to get them would bring, according to the 2015 study.
“There’s the hassle factor and the extra time involved in dealing with insurance companies,” Mantel said. “It’s a lot more paperwork. They have to do it themselves or pay someone else.”
While Texas already ranks near the bottom of the national list in the amount of money it spends on mental health needs per capita, that amount could drop further if the state sees its federal funding reduced, as has been proposed.
President Donald Trump’s proposed budget for fiscal year 2017-18 calls for a 16.2 percent reduction in spending on health and human services, of which mental health counseling is a part.
Health and human service agencies in Texas received a total of $43.1 billion from the federal government in 2016-17 funding year, according to Kelli Weldon, assistant press officer for the Texas Health and Human Services Commission.
Weldon declined to answer questions about whether the commission is preparing for funding cuts.
“We’re already so underfunded,” Almeida said. “Any further reduction in services will be devastating.”
Meanwhile, the Substance Abuse and Mental Health Services Administration’s 2018 budget calls for a spending reduction of $374 million from 2017. SAMHSA, which is part of the U.S. Department of Health and Human Services, plans to reduce its Community Mental Health Services Block Grant from $532 million in 2017 to $416 million in 2018. The amount SAMHSA spends on what it deems “programs of regional and national significance” is scheduled to drop from $414 million in 2017 to $277 million in 2018. Spending on substance abuse prevention is set to drop from $223 million in 2017 to $150 million in 2018.
“It doesn’t make sense clinically and it doesn’t make sense fiscally,” Almeida said. “We know that people end up in emergency rooms and in the criminal justice system because they haven’t gotten access to needed support. You’re just shifting the cost because you can’t close the doors to emergency rooms and the jails. You’re shifting the problem to other places that can’t reject people.”