With more than 500,000 Texans suffering from serious and persistent mental illness and 1 in 5 Texans experiencing a mental health condition each year, behavioral health continues to be a problem with no long-term solution in sight.

Although lawmakers locally and statewide are working to allocate more money toward mental health services, health care providers and Greater Houston area officials have said funding is still not enough to keep up with the growing population and provide services needed to keep individuals with behavioral health problems off the streets and out of jail.

Funding can’t keep up with Houston area’s mental health needsTheresa Fawvor, associate vice president for Memorial Hermann Behavioral Health Services, said while funding and new programs have increased, so has the community of those in need.

“There are just not enough specialists, not enough psychiatrists in the field,” she said. “All those concerns and issues really have an impact on creating a well-accessed, simple system, community and access to those specialists, so it’s a multilayered [issue].”

More beds, services needed

Senate Bill 1—the Senate’s state budget for the 2018-19 biennium—allocated $7.6 billion for all behavioral health services, which is up from roughly $6.9 billion allocated in the 2016-17 biennium. Gov. Greg Abbott signed the bill.

“The Texas Legislature has made a clear commitment to meeting the mental health needs of Texas,” Sen. Paul Bettencourt, R-Houston, said in a statement. “Yet, the Texas Legislature was able to meet these additional funding needs and pass a budget that only increased by 0.2 percent from the previous biennium. I applaud the work of Senate Finance Chair [Jane] Nelson, and all my Senate colleagues, for working to enact conservative solutions to Texas' challenges."    

As the state’s population grows exponentially each year, there is not enough funding in the state budget to adequately serve its residents’ mental health needs, Fawvor said. This often leaves counties and health care organizations having to bridge the gap locally. In the Katy area, 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.

Funding can’t keep up with Houston area’s mental health needsTexana Center offers inpatient mental health care services in Waller and Fort Bend counties, serving more than 16,000 people annually. 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,” he said.

Patterson said 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 Texana contracts.

Connie Almeida, Fort Bend County director of behavioral health services, said the county needs more varied resources to treat people suffering from mental illness. “It’s a problem across the state,” Almeida said.

Harris County officials said they are hopeful as state lawmakers continue to allocate more money for behavioral health services, but until they do, resources will remain limited.

“The good news is, in a world that’s become very partisan and very uncivil in terms of politics, nearly everybody agrees that mental health is an issue we can all work on,” Harris County Judge Ed Emmett said.

Funding can’t keep up with Houston area’s mental health needsNew diversion tactics, legislation in effect

Since 2013 Fort Bend County has received about $10.93 million from the state with a waiver to the federal Social Security Act, known as the 1115 waiver. The money went to programs aimed at providing help to people suffering from mental illness and intellectual development disabilities who might otherwise end up in jail.

For example, 1115 waiver funds supported 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. From October 2016 to March 2017, CIT responded to 829 unique individuals with 131 of those people being diverted from incarceration, county documents show.

Another program that was launched with the money is Successful Outcomes Utilizing Resiliency for Child Empowerment, which is focused on keeping teenagers with mental health conditions out of the juvenile justice system. From October 2015 to September 2016, the program served 28 youths and families, according to county documents.

In the Harris County Jail, Emmett said on any given night there are as many as 3,000 inmates who need—or are currently on—prescription medication for behavioral health issues. To help reduce this number, Emmett said the county is working on a jail diversion program funded through the state. As part of the program, the county works with law enforcement to refer individuals with multiple arrests who have potential behavioral health issues to health care professionals rather than booking them again in the jail.

“Because they really aren’t criminals, they really have mental issues,” Emmett said.

In addition to new programs in the area, the Texas Legislature this session passed SB 1849, also known as the Sandra Bland Act, in late May as an effort to divert from county jails certain individuals with mental illness who are arrested and may try to harm themselves. The bill is named after Bland, who committed suicide in the Waller County Jail in 2015 after being arrested several days prior by a Department of Public Safety officer in Prairie View during a routine traffic stop.

Funding can’t keep up with Houston area’s mental health needsUncertain future

Although Texas already ranks in the bottom half 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. According to Mental Health America, Texas ranks 32 out of 50 states when comparing prevalence of mental illness and rates of access to care.

President Donald Trump’s proposed budget for fiscal year 2017-18 calls for a 16.2 percent drop in spending on health and human services, including mental health counseling.

Health and human service agencies in Texas received a total of $43.1 billion from the federal government in FY 2016-17, according to Kelli Weldon, assistant press officer for the Texas Health and Human Services Commission.

“We’re already so underfunded,” Almeida said. “Any further reduction in services will be devastating.”

Meanwhile, the Substance Abuse and Mental Health Services Administration, which is part of the U.S. Department of Health and Human Services, expects to cut what it spends on “programs of regional and national significance” from $414 million in 2017 to $277 million in 2018.

Almeida said the move would not make sense clinically or fiscally because people will end up in emergency rooms or the criminal justice system if they have not received  needed mental health support.

“You’re just shifting the cost because you can’t close the doors to emergency rooms and the jails,” she said. “You’re shifting the problem to other places that can’t reject people.”