Written Comments on Draft Policy for House Bill 2466 Postpartum Depression Screening

On Monday, December 18, 2017, Annalee Gulley, Director of Government Affairs and Public Policy at Mental Health America of Greater Houston, provided the Texas Health and Human Services Commission feedback on the proposed draft policy language for Texas Health Steps (THSteps) Preventive Care Medical Checkups:
Postpartum Depression Screening and Referral Services.

December 18, 2017


Texas Health and Human Services Commission
Attn: Medicaid/CHIP Office of Policy
Brown-Heatly Building
4900 North Lamar Blvd
Austin, Texas 78751

Submitted via email to MCDMedicalBenefitsPolicyComment@hhsc.state.tx.us; Joanna.Seyller@hhsc.state.tx.us

Re: Written Comments on Draft Policy for House Bill 2466 Postpartum Depression Screening

To Whom It May Concern,

 Mental Health America of Greater Houston thanks you for the opportunity to submit comments on the draft policy for House Bill 2466 regarding the ability of an infant’s provider to conduct and bill for postpartum depression (PPD) screening for the infant’s mother in Medicaid and CHIP. We believe the following recommendations will assist in the successful implementation of this Medicaid benefit.

In early 2017, the American Academy of Pediatrics (AAP) recommended PPD screening at one, two, four and six months postpartum.[i] Line 1 of the draft policy states the Academy’s recommendation of screenings at the infant’s pediatric well-child visits but does not include the suggested intervals. We recommend adding language to line 1 about the appropriate integration of screenings at the 1-, 2-, 4- and 6-month visits.

HHSC’s draft policy (line 22) limits screening to once per provider in the year postpartum. We understand the need to implement this benefit within existing funds. That said, we recommend the agency consider the feasibility of screening according to national recommendations, as indicated by the American Academy of Pediatrics. This will result in multiple screens reimbursed per provider, and the language should be changed appropriately.

Mental Health America of Greater Houston participates in the Regional Maternal Mortality Task Force, where we examine the leading causes of maternal deaths in Houston. This task force is acutely aware of “white coat” syndrome, in which individuals are likely to lessen the severity of a condition when speaking to a doctor to disclose physical and behavioral health issues. Significantly more positive screens result in studies in which the screen was performed by a licensed clinical social worker, rather than a medical doctor.  Line 7 states that screening tools may include the Edinburgh Postnatal Depression Scale (7.2), Postpartum Depression Screening Scale (7.3) and the Patient Health Questionnaire 9 (7.4). To ensure the successful roll-out of this new benefit and accurate screenings, it is important all THStep providers including physician assistants, nurses and licensed social workers are trained on the screening tools and the risk factors for postpartum depression.

The three tools listed above are all validated and routinely used for postpartum depression and identify a range of severity or level of need, which help guide clinician-patient decision making regarding necessary supports. The Edinburgh is most routinely used and available in more than 20 languages. While these screening tools are effective, they may not capture positive screens for women facing other maternal mental health disorders, including anxiety and obsessive-compulsive disorder present during the postpartum period. We recommend adding to the list of validated tools (line 7) so THSteps providers may screen moms using validated tools identifying a range of postpartum mood and anxiety disorders, such as the Generalized Anxiety Disorder-7 (GAD-7) tool, among others. No-cost screening tools should be prioritized to increase access to THSteps providers.

We appreciate HHSC recognizing that screening alone does not improve clinical outcomes for moms and infants, but more guidance is needed to ensure successful referrals and improved outcomes. Specifically, pediatric providers need to know the appropriate and available supports for mothers. While some pediatric providers may already screen mothers, most are not familiar with the mental health providers serving parents. We recommend HHSC should provide a menu of resources with which provider can refer when a mother screens positive for postpartum depression or other perinatal mood disorder. At a minimum, HHSC should provide THStep providers a menu of referral options in each region that serve women enrolled in or eligible for Medicaid, Healthy Texas Women or the Family Planning Program, as well as city or county indigent care programs. Also, at a minimum, this should include clear guidance to THSteps providers on how to refer women, in consultation with any existing primary care physician to the Local Mental Health Authority (LMHA). The Office of Mental Health Coordination offers a list of mental health and substance use professionals, including LMHAs and other mental health clinicians across the state. Including a list of postpartum depression treatment providers on this list would be a good resource for pediatric providers screening for perinatal mood disorders. Some moms may need more intensive therapy or medication; others may need a lower level of supports or services. It’s important that a menu of referral options is available so THStep providers, in consultation with existing primary care providers, can help refer women to services that meet her needs.

Mental Health America of Greater Houston also asks you to consider the efficacy of the existing referral process for postpartum mental health treatment. New mothers who are not eligible for Medicaid are automatically enrolled in Healthy Texas Women sixty days following delivery when their CHIP perinatal benefits expire. Healthy Texas Women’s coverage of postpartum depression treatment is minimal at best. Many women with the most complicated postpartum mood disorders cannot receive adequate treatment within the confines of the Healthy Texas Women reimbursement model. Should mothers require more intensive medication or hospitalization, they are typically referred out to another facility, frequently an emergency room, where they do not have coverage for services. We need to ensure that doctors have a safe place with the appropriate supports to send mothers who screen positively for postpartum mood disorders; otherwise, doctors will not feel comfortable making referrals and women won’t get the treatment they need. We recommend HHSC shall communicate clearly to state health programs and community mental health providers, including LMHAs, that women with postpartum depression fall under priority diagnosis of major depressive disorder and assist them to prepare for increased referrals of women with postpartum depression.

Lastly, the results of the screenings used are not digital – leaving a paper form to record the results of a postpartum screen. Mothers are sent from the pediatrician’s office with the paper medical record and information can be lost in the process. With digital records, a “warm handoff” can be more secure knowing that all information is transmitted to the next provider. We recommend the agency consider the feasibility of digital records to ensure successful referrals and improved clinical outcomes.

Again, we sincerely thank you for the opportunity to provide input on the draft policy for HB 2466. We look forward to continued partnership with the Texas Health and Human Services Commission to ensure families have access to needed mental health supports. For any questions or concerns, please contact Annalee Gulley at agulley@mhahouston.org or (210) 823-5818.


Annalee Gulley
Director of Public Policy and Government Affairs
Mental Health America of Greater Houston

[i] American Academy of Pediatrics (Bright Futures). (2017). Recommendations for Preventive Pediatric Health Care. Retrieved from: https://www.aap.org/enus/Documents/periodicity_schedule.pdf

Tracking Women’s Mental Health Policy in Texas: Implementation of House Bill 2466 (85 R)

On June 15, 2017, Governor Greg Abbott signed into law Texas’ first post-partum depression screening legislation. HB 2466, authored by Representative Sarah Davis (R-Houston), allows for Texas Health Steps provider reimbursement for post-partum depression during the twelve-month period following delivery. Reimbursement will be funded through an infant’s Medicaid or perinatal CHIP.

Parents with postpartum depression experience a range of physical, emotional, and behavioral changes including sadness, anxiety and exhaustion that interfere with day-to-day life and routines. Postpartum depression is the most common complication of childbirth, with approximately one-in-nine women experiencing depression or anxiety during pregnancy and/or the first year after childbirth. Postpartum depression, and other perinatal mood disorders, can result in adverse maternal, infant and child outcomes, including lower rates of breastfeeding initiation and shorter duration, poor maternal and infant bonding and infant developmental disorders.

Symptoms of postpartum depression include:

  • Feeling sad, hopeless, empty or overwhelmed
  • Crying more often than usual or for no apparent reason
  • Worrying or feeling overly anxious
  • Feeling moody, irritable or restless
  • Oversleeping, or being unable to sleep even when her baby is asleep
  • Having trouble concentrating, remembering details and making decisions
  • Experiencing anger or rage
  • Losing interest in activities that are usually enjoyable
  • Suffering from physical aches and pains, including frequent headaches, stomach problems and muscle pain
  • Eating too little or too much
  • Withdrawing from or avoiding friends and family
  • Having trouble bonding or forming an emotional attachment to her baby
  • Persistently doubting her ability to care for her baby
  • Thinking of harming herself or her baby.

Under current state law, women who receive prenatal care through Medicaid for Pregnant Women remain eligible for Medicaid benefits for 60 days following delivery. During this time, Medicaid will cover the postpartum visits as well as medication and follow-up necessary for women who are diagnosed with postpartum depression. However, postpartum depression and other perinatal mood disorders can present anytime within the first four-to-six weeks up to 12 months following childbirth. When coverage under Medicaid for Pregnant Women ends, a woman will transition to the Healthy Texas Women Program, if she meets eligibility requirements.

For more information on postpartum depression, click here.

To review HB 2466’s draft policy language or provide public comment, click here before Tuesday, December 19.

Testimony on Hurricane Harvey presented to the House Public Education Committee

On Tuesday, November 14, 2017, Annalee Gulley, Director of Government Affairs and Public Policy at Mental Health America of Greater Houston, was invited to provide testimony before the House Committee on Public Education.

The Committee considered the following interim charges:

– Recommend any measures needed at the state level to prevent unintended punitive consequences to both students and districts in the state accountability system as a result of Hurricane Harvey and its aftermath.

– Examine the educational opportunities offered to students displaced by Hurricane Harvey throughout the state and the process by which districts enroll and serve those students. Recommend any changes that could improve the process for students or help districts serving a disproportionate number of displaced students.

Ms. Gulley was on one of five panels of invited testimony and shared the importance of trauma training for classroom teachers and the impact transition plans could have on displaced students. Other panelists included Superintendents from Aldine, Alief,  Aransas County, Flour Bluff, Katy, Orange Field, Port Arthur, and Sheldon Independent School Districts. Josette Saxton, Director of Public Policy for Texans Care For Children, also provided testimony. This was the last House Public Education Committee meeting of 2017.



AEG 11147 Testimony

Annalee Gulley testifying in front of the House Public Education Committee (Left to Right: Rep. Linda Koop, Rep. VanDeaver, Rep. Ken King, Rep. Bernal (Vice Chair), Rep. Huberty (Chair), Rep. Allen). Ms. Gulley was on a panel with Mr. Loius Malfar, President of Texas AFT, Dr. Bruce Marchand, Director of Charter School Growth and Development with Texas Charter School Association, and Ms. Josette Saxton, Director of Mental Health Policy at Texans Care for Children.



Annalee Gulley
Director of Government Affairs and Public Policy
Mental Health America of Greater Houston

Chairman Dan Huberty
Texas House Committee on Public Education
Austin, Texas

November 14, 2017

Chairman Huberty and Public Education Committee Members:

Thank you for the opportunity to testify today, Chairman Huberty.

Last week, Governor Greg Abbott said, “[T]he invisible wounds left behind after this storm are often the most difficult to recover from. It is crucial that the State of Texas provides our educators and students with all available resources to address mental health needs as quickly as possible.”

Since Harvey hit Houston, Mental Health America of Greater Houston has prioritized the mental health needs of Houston’s approximately 800,000 youths aged 6-17 with supports and interventions that are more important now than ever. Our primary focus has been to provide trauma-informed training to teachers within 27 schools across 10 independent school districts in the Greater Houston Area. We are also advocating for the implementation of transition plans within school districts with a disproportionate number of displaced students to aid in the successful reintegration into the public-school system.

Before the storm, national prevalence data estimated that 10 percent of Texas’ youth will experience an average of three adverse child experiences – or traumas – before the age of 17. With 2 in 5 youths affected by mental health or substance use issues, we know that approximately 250,000 Houston-area students went into the storm with a predisposition to trauma, as trauma affects individuals with mental health issues more severely. Even if you excluded youth predisposed to adverse childhood experiences from the conversation, we are no longer just talking about kids with mental health issues, or “bad kids” or “problem kids.” We are talking about every kid throughout the region.

The psychological reaction to disaster lasts approximately one to three years, with signs and symptoms presenting most frequently three months after the traumatic event. Unlike some affected groups, we know how to access this population and the necessary supports for trauma-affected youth. Teachers are our entry point. They work in classrooms eight hours a day, five days a week. With trauma-informed training, they can properly identify and respond to signs and symptoms of trauma such as inattentiveness, poor academic achievement and difficulty following rules of the classroom. Trauma-trained teachers also will better know how to prepare for triggering events such as heavy storms, the holidays and the first anniversary of a disaster.

State funding will be required for comprehensive, trauma-informed training within public schools. Mental Health America of Greater Houston has been fortunate to partner with private sponsors to provide trauma-informed training, but the funds allocated were not enough to meet the existing need in Harris County – and Harris County is not the only affected county by Hurricane Harvey.

Again, we appreciate the Committee’s time today and the opportunity to bring trauma-informed training and transition service plans into the conversation surrounding Hurricane Harvey recovery efforts. The Governor was right when he said that our hardest to heal wounds would be invisible. That does not mean they should be forgotten. With trauma-informed training and transition service plans, we can provide impacted youth with the necessary supports begin anew.


Annalee Gulley
Director of Public Policy and Government Affairs,
Mental Health America of Greater Houston

The Texas House and Senate release interim charges: A look ahead for Behavioral Health in the 86th Legislative Session

On Monday, October 23, Speaker of the House Joe Straus and Lt. Governor Dan Patrick released a full list of interim charges for Texas’ State House and State Senate committees to study before the 86th Legislative Session begins in January 2019. Many of the interim charges examine Hurricane Harvey and the state’s response, including the storm’s impact on public health, the juvenile justice system, agriculture and the state’s tax structure. In addition to these charges, Speaker Straus called for the creation of a Select Committee on Opioid and Substance Abuse which will study the prevalence and impact of substance abuse and substance use disorders in the state. This committee, chaired by Representative Four Price, is an extension of the work of the Select Committee on Mental Health, convened following the 84th Legislative Session.

Mental Health America of Greater Houston will be following many of the charges issued, with special attention to the following charges pertaining to mental and behavioral health:

House Committee on Appropriations:

  • Examine the Early Childhood Intervention Program (ECI) in Texas, including a review of historical funding levels, programmatic changes, challenges providers face within the program and utilization trends. Evaluate ECI’s impact on reducing the long-term costs of public education and health care. Identify solutions to strengthen the program.
  • Monitor Congressional action on federal healthcare reform and CHIP reauthorization. Identify potential impacts of any proposed federal changes. Identify short- and long-term benefits and challenges related to converting Texas Medicaid funding to a block grant or per capita cap methodology. Determine how Texas should best prepare for federal changes, including statutory and regulatory revisions, as well as any new administrative functions that may be needed. Explore opportunities to increase the state’s flexibility in administering its Medicaid program, including but not limited to the use of 1115 and 1332 waivers.


House Committee on Corrections:

  • Examine the use of social workers and peer support specialists in the Texas criminal justice system to assist individuals on probation, on parole or who have been discharged, in order to reduce recidivism and improve outcomes. Identify best practices and make recommendations for legislative action.


House Committee on County Affairs:

  • Study how counties identify defendants’ and inmates’ behavioral health needs and deferral opportunities to appropriate rehabilitative and transition services. Consider models for ensuring defendants and inmates with mental illness receive appropriate services upon release from the criminal justice system.


House Committee on Criminal Jurisprudence:

  • Assess developments in medical science and legal standards related to the imposition of the death penalty on defendants with serious mental illness or intellectual and developmental disabilities. Review statutorily prescribed jury instructions used during capital sentencing.


House Committee on Defense & Veterans’ Affairs:

  • Examine the needs of homeless veterans in Texas. Examine obstacles veterans may face finding housing across the state. Recommend measures to bolster the state’s efforts to address veteran homelessness in Texas.
  • Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. In conducting this oversight, review the implementation of S.B. 27 (85R) and the related Veterans Mental Health Program, as well as S.B. 578 (85R) and the development of the Veterans Suicide Prevention Action Plan.


House Committee on Human Services:

  • Review the history and any future roll-out of Medicaid Managed Care in Texas. Determine the impact managed care has had on the quality and cost of care. In the review, determine: initiatives that managed care organizations (MCOs) have implemented to improve quality of care; whether access to care and network adequacy contractual requirements are sufficient; and whether MCOs have improved the coordination of care. Also determine provider and Medicaid participants’ satisfaction within STAR, STAR Health, Star Kids, and STAR+Plus managed care programs. In addition, review the Health and Human Services Commission’s (HHSC) oversight of managed care organizations, and make recommendations for any needed improvement.
  • Review the availability of prevention and early intervention programs and determine their effectiveness in reducing maltreatment of children. In addition, review services available to children emancipating out of foster care, as well as services available to families post-adoption. Determine if current services are adequately providing for children’s needs and meeting the objectives of the programs. While reviewing possible system improvements for children, follow the work of the Supreme Court of Texas Children’s Commissions’ Statewide Collaborative of Trauma-Informed Care to determine how trauma-informed care impacts outcomes for children.
  • Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Public Health)


House Committee on Judiciary & Civil Jurisprudence:

  • Study the increased use of specialty courts across the state. Examine the role these courts play in the judicial system and recommend improvements to ensure they continue to be appropriately and successfully utilized.


House Committee on Juvenile Justice & Family Issues:

  • Evaluate the use of telemedicine to improve behavioral health services in the juvenile justice system.


House Committee on Public Health:

  • Review state programs that provide women’s health services and recommend solutions to increase access to effective and timely care. During the review, identify services provided in each program, the number of providers and clients participating in the programs, and the enrollment and transition process between programs. Monitor the work of the Maternal Mortality and Morbidity Task Force and recommend solutions to reduce maternal deaths and morbidity. In addition, review the correlation between pre-term and low birth weight births and the use of alcohol and tobacco. Consider options to increase treatment options and deter usage of these substances.
  • Study and make recommendations to improve services available for identifying and treating children with mental illness, including the application of trauma- and grief-informed practices. Identify strategies to assist in understanding the impact and recognizing the signs of trauma in children and providing school-based or community-based mental health services to children who need them. Analyze the role of the Texas Education Agency and of the regional Education Service Centers regarding mental health. In addition, review programs that treat early psychosis among youth and young adults.
  • Study the overlays among housing instability, homelessness, and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Urban Affairs)
  • Review opportunities to improve population health and health care delivery in rural and urban medically underserved areas. Identify potential opportunities to improve access to care, including the role of telemedicine. In the review, identify the challenges facing rural hospitals and the impact of rural hospital closures.
  • Analyze the prevalence of children involved with Child Protective Services (CPS) who have a mental illness and/or a substance use disorder. In addition, analyze the prevalence of children involved with CPS due to their guardian’s substance abuse or because of an untreated mental illness. Identify methods to strengthen CPS processes and services, including efforts for family preservation; increasing the number of appropriate placements designed for children with high needs; and ensuring Texas Medicaid is providing access to appropriate and effective behavioral health services. (Joint charge with the House Committee on Human Services)


House Committee on Urban Affairs:

  • Study the overlays among housing instability, homelessness and mental illness. Review the availability of supportive housing opportunities for individuals with mental illness. Consider options to address housing stability and homelessness among people with mental illness. (Joint charge with the House Committee on Public Health)


House Select Committee on Opioids and Substance Abuse:

  • Study the prevalence and impact of substance use and substance use disorders in Texas, including co-occurring mental illness. Study the prevalence and impact of opioids and synthetic drugs in Texas. Review the history of overdoses and deaths due to overdoses. Also review other health-related impacts due to substance abuse. Identify substances that are contributing to overdoses, related deaths and health impacts, and compare the data to other states. During the review, identify effective and efficient prevention and treatment responses by health care systems, including hospital districts and coordination across state and local governments. Recommend solutions to prevent overdoses and related health impacts and deaths in Texas.
  • Review the prevalence of substance abuse and substance use disorders in pregnant women, veterans, homeless individuals and people with co-occurring mental illness. In the review, study the impact of opioids and identify available programs specifically targeted to these populations and the number of people served. Consider whether the programs have the capacity to meet the needs of Texans. In addition, research innovative programs from other states that have reduced substance abuse and substance use disorders, and determine if these programs would meet the needs of Texans. Recommend strategies to increase the capacity to provide effective services.
  • Examine the impact of substance abuse and substance use disorders on Texans who are involved in the adult or juvenile criminal justice system and/or the Child Protective Services system. Identify barriers to treatment and the availability of treatment in various areas of the state. Recommend solutions to improve state and local policy, including alternatives to justice system involvement, and ways to increase access to effective treatment and recovery options.
  • Identify the specialty courts in Texas that specialize in substance use disorders. Determine the effectiveness of these courts and consider solutions to increase the number of courts in Texas.


For a full list of the Texas State House of Representatives’ Interim Charges, click here.


Senate Finance Committee:

  • Adult and Juvenile Corrections Funding: Examine the funding patterns used to fund the juvenile justice system and adult probation departments. Develop recommendations to ensure the Texas Juvenile Justice Department budget does not dis-incentivize the use of cost-effective best practices such as diverting youth from the juvenile justice system, providing services to youth in their community and keeping youth closer to home. In addition, review funding to adult probation departments and ensure it provides for an equitable distribution to all Texas Probation Departments.
  • Monitor the state’s progress in coordinating behavioral health services and expenditures across state government, pursuant to Article IX section 10.04, including the impact of new local grant funding provided by the 85th Legislature.


Senate Health and Human Services Committee:

  • Substance Abuse/Opioids: Review substance use prevention, intervention and recovery programs operated or funded by the state and make recommendations to enhance services, outreach and agency coordination. Examine the adequacy of substance use, services for pregnant and postpartum women enrolled in Medicaid or the Healthy Texas Women Program and recommend ways to improve substance use related health outcomes for these women and their newborns. Examine the impact of recent legislative efforts to curb overprescribing and doctor shopping via the prescription monitoring program and recommend ways to expand on current efforts.
  • Medicaid Managed Care Quality and Compliance: Review the Health and Human Services Commission’s efforts to improve quality and efficiency in the Medicaid program, including pay-for-quality initiatives in Medicaid managed care. Compare alternative payment models and value-based payment arrangements with providers in Medicaid managed care, the Employees Retirement System and the Teachers Retirement System, and identify areas for cross-collaboration and coordination among these entities.
  • Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 85th Legislature and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
    • Initiatives to increase capacity and reduce waitlists in the mental health system, including the construction of state hospitals and new community grant programs;
    • Initiatives to better understand the causes of maternal mortality and morbidity, including the impact of legislation passed during the first special session of the 85th Legislature. Recommend ways to improve health outcomes for pregnant women and methods to better collect data related to maternal mortality and morbidity;
    • Initiatives intended to improve child safety, Child Protective Services workforce retention, and development of additional capacity in the foster care system. Make additional recommendations to ensure children with elevated levels of medical or mental health needs receive timely access to services in the least restrictive setting.


Senate Veterans’ Affairs and Border Security Committee:

  • Veterans’ Health: Study the effectiveness of veterans’ health and mental health initiatives in Texas and recommend ways to improve access and delivery. Explore the state of the federal VA Choice Program, including potential expiration, continuation or expansion of the program. Consider the impact of the VA Choice Program on improving the delivery of health care, and determine ways to raise awareness and increase participation among Texas veterans. Consider the potential connection between chronic pain and mental health and identify strategies to improve the prevention of veteran suicide.
  • Monitor the implementation and impact of legislation passed by the Texas Legislature, including SB 27 by Campbell 85(R), relating to the mental health program for veterans.


For a full list of the Texas State Senate’s Interim Charges, click here.

Lessons Learned: The 85th Texas Legislature

While Texas’ 85th Legislative Session has been touted as one of the most contentious sessions in recent memory, mental and behavioral health funding and programming received important time and attention – largely due to the formation of the Interim Select Committee on Mental Health. Below is a brief summary of both the regular session and the special session and the status of MHA of Greater Houston’s legislative agenda.
MH Photo

MHA Houston 85th Legislative Briefing [Regular and Special]

As always, The Texas Tribune is an incredible resource in Austin. Please listen to recordings of their recent TribFest, which covered important topics including mental health, maternal mortality and the future of Medicaid.



At 9:00 a.m. on Thursday, House Bill 2623 (Allen, Alma | Thompson, Senfronia) and House Bill 3887 (Coleman) will be heard before the Senate Education Committee – because of you.

Your calls, your emails to friends, your commitment to advancing legislation for youth mental health. You made this happen. And you can’t stop now. We’ve come too far. Together.

Each member of the Senate Education Committee needs to know how important these bills are to Texas students and that, when I stand before them to testify tomorrow, I have all of you standing beside me.

We have eight days left to pass these bills.

Please take five minutes to call your State Senator and the Senate Education Committee to let them know you support our Senate sponsor, Senator Zaffirini, and House Bill 2623 (Transition Services) and House Bill 3887 (Trauma Training). Ask them to vote yes on both bills and send them to the Senate floor for a vote.

With gratitude,

Annalee Gulley
Director of Public Policy and Government Affairs
Mental Health America of Greater Houston

Please call your Houston Senator – and members of the Senate Education Committee – and ask that they support HB 2623 (Allen | Thompson, Senfronia) and HB 3887 (Coleman).  The more support they hear, the better our chance of getting the bills voted out of the Education Committee as soon as possible.

State Senator Larry Taylor, Chair (Houston): (512) 463-0111
State Senator Eddie Lucio, Jr., Vice Chair: (512) 463-0127
State Senator Paul Bettencourt (Houston): (512) 463-0107
State Senator Donna Campbell: (512) 463-0125
State Senator Bob Hall: (512) 463-0102
State Senator Don Huffines: (512) 463-0116
State Senator Bryan Hughes: (512) 463-0101
State Senator Kel Seliger: (512) 463-0131
State Senator Van Taylor: (512) 463-0108
State Senator Carlos Uresti: (512) 463-0119
State Senator Royce West: (512) 463-0123
Senate Education Committee: (512) 463-0355

Here is a sample script to use for your calls to Senate Education Members:

Hello, my name is ________. I am calling Senator _______ because I want to make sure they support HB 2623 (Allen | Thompson, Senfronia) and HB 3887 (Coleman). Both bills are scheduled for a hearing in the EDUCATION COMMITTEE this Thursday, May 18. I support these bills and the positive impact they will have on mental health in education in the state of Texas and encourage Senator ______ to do so as well. Thank you very much!

Sample script for Senate Education Committee:

Hello, my name is ________. I am calling Senate Education Committee to show my support of HB 2623 (Allen | Thompson, Senfronia) and HB 3887 (Coleman). Both bills are scheduled for a hearing in the EDUCATION COMMITTEE this Thursday, May 18. I support these bills and the positive impact they will have on mental health in education in the state of Texas. Thank you very much!

When the Dust Settles: Bill Filing Deadline

Great news from Austin!

Friday, March 10 marked the deadline to file legislation for Texas’ 85th legislative session. Mental Health America of Greater Houston is excited to report on the progress of our priorities.

MHA of Greater Houston successfully filed four bills, supporting both our Center for School Behavioral Health and Women’s Mental Health programs. We have also worked closely with Chairman Four Price and Representative Sarah Davis to ensure specific language reflecting our priorities was inserted into their existing bills concerning these legislative issues. We are proud both of the final bills resulting from these ongoing conversations and of the influence MHA of Greater Houston demonstrated during a critical moment when competing political priorities can too often sink impactful legislation.

After meeting with many members of the Houston delegation, we believe that our legislative agenda is strong; however, the current fiscal outlook and political climate in Austin make the passage of any bill a very difficult task. We have our work cut out for us during the next 67 days.


Bill Number  Author  Caption Status Focus Area
HB 2623 Allen  Relating to requiring school districts to assist students in making the transition back to school after certain prolonged placements outside of school.  03/21/2017 H Referred to Public Education Center for School Behavioral Health
HB 3853 Coleman  Relating to the availability of certain behavioral health professionals at certain public schools. 03/10/2017 H Filed Center for School Behavioral Health
HB 3887 Coleman  Relating to trauma training for public school personnel.  03/10/2017 H Filed Center for School Behavioral Health
HB 2135 Coleman | Farrar Relating to coverage for certain services and the provision of certain information relating to postpartum depression under the medical assistance and CHIP perinatal programs. 03/13/2017 H Referred to Public Health Women’s Mental Health


Bill Number  Author  Caption Status Focus Area
HB 11 Price Relating to consideration of the mental health of public school students in school planning, educator training requirements, curriculum requirements, educational programs, state and regional programs and services, and health care services for students. 03/09/2017 H Referred to Public Health Center for School Behavioral Health
HB 2466 Davis Relating to coverage for certain services related to maternal depression under the Medicaid and child health plan programs. 03/21/2017 H Referred to Public Health Women’s Mental Health

First Comes Filing Then Comes Referrals …

Now that our bills have been filed, the next step is getting them through their respective committees. HB 2135, our Post-Partum Depression bill, and HB 11, Chairman Four Price’s children’s mental health bill, were referred to the House Public Health Committee in the beginning of March. Earlier this week, HB 2135, Representative Davis’s Post-Partum Depression bill, was referred to the House Committee on Public Health and HB 2623, our transition services bill, was referred to the House Committee on Public Education.

In a session in which 6,657 bills were filed and money is tight, now is the time to connect with your legislators and bring our bills to the front of their priority list.

We Need Your Help!

Center for School Behavioral Health
We are thrilled House Bill 2623 (Allen), relating to requiring school districts to assist students in making the transition back to school after certain prolonged placements outside of school, has been referred to the House Public Education Committee! For a refresher on the importance of this bill, check out our recent Center for School Behavioral Health post in which local expert Latashia Crenshaw, Director of Educational Support and Advocacy Services at the Harris County Juvenile Probation Department, talks to MHA of Greater Houston about transition services.

Here is a brief summary of House Bill 2623:

Bill Snapshot:
House Bill 2623 (Allen): Back to School: Transition Support for Students Returning to School

What does House Bill 2623 (Allen) do?
This bill requires that school districts provide assistance to students transitioning back to school after 30 or more days in a disciplinary alternative education program, a juvenile justice alternative education program, a residential program or facility operated by or under contract with the Texas Juvenile Justice Department, a juvenile board, or any other governmental entity, a residential treatment center, or a public or private hospital.

Under this legislation, schools will be required to create individualized transition service plans for returning students. The plan, to the extent possible, must be developed in conjunction with the student’s parent/guardian. As appropriate, the plan must include: consideration of the best educational placement for the student; provision of counseling, behavioral management assistance, or academic assistance; and access to community mental health or substance abuse services.

What problem does the bill solve?
Education is the key to a successful life, reducing juvenile recidivism, and ending the school-to-prison-pipeline. For a child returning to school following a prolonged absence, particularly for a disciplinary placement in the judicial system, succeeding once there is not easy. There are a variety of individual, school, and systemic factors that must be addressed if young people are to successfully return to schools. Individual factors include poor academic and social–emotional skills, credit deficits, special education needs, and the failure to develop an identity as a learner. Systemic factors include the failure of agencies and institutions to share records quickly, the absence of alignment and articulation between sending and receiving schools at both ends of the transition process, the dearth of accountability for mobile student outcomes, and inadequate systemic capacity to collaborate with families.

Through collaboration and planning, administrators that serve transitioning youth can prepare youth, from entry through discharge, for their return to their home-based school, enabling them to resume educational services successfully.

While HB 2623 was referred to the House Public Education Committee, there is no guarantee it will be heard before the committee. The House Public Education Committee is chaired by Houston State Representative Dan Huberty and includes Houston-area Representatives Alma Allen, Harold Dutton, Jr., and Representative Dwyane Bohac.

Please call your Houston Representatives on the Public Education Committee – and the Public Education Committee itself – and ask that they set a hearing date for this bill. The more support they hear, the better our chance of getting a hearing scheduled as soon as possible.

State Representative Dan Huberty: (512) 463-0520
State Representative Alma Allen: (512) 463-0744
State Representative Harold Dutton, Jr.: (512) 463-0510
State Representative Dwayne Bohac: (512) 463-0727
House Public Education Committee: (512) 463-0804

Here is a sample script to use for your calls:

Hello, my name is ________. I am calling Representative _______ because I want to make sure that House Bill 2623 (Allen) gets a hearing scheduled in the PUBLIC EDUCATION COMMITTEE. I support this bill and the positive impact it will have on mental health in education in the state of Texas and encourage Representative ______ to do so as well. Thank you very much!

While we still need support for HB 3853 and HB 3887, we will focus our attention on scheduling a hearing for HB 2623 until they are referred to a committee.

Women’s Mental Health

We urge you to connect with members of the House Public Health Committee to let them know that you support MHA of Greater Houston and hope the Representatives will fight to make sure our bills are heard before their committee as quickly as possible!

Luckily, the House Public Health Committee includes Houston-area Representative Garnet Coleman and Representative Tom Oliverson.

State Representative Garnet Coleman: (512) 463-0524
State Representative Tom Oliverson: (512) 463-0661

Please call these State Representatives and ask for these bills to be heard in front of the Public Health committee. The more support they hear, the better our chance of getting a hearing on this important women’s health issue.

Sample script for your calls:

Hello, my name is ________. I am calling Representative _______ because I want to make sure that House Bill [ ] gets a hearing scheduled in the PUBLIC HEALTH COMMITTEE. I support this bill and the positive impact it will have on women’s mental health in Texas and encourage Representative ______ to do so as well. Thank you very much!

Call Your Local Representative
While you’re making calls, call your local State Representative to express support for House Bill 2623 (Allen), as well! While your local Representative may not be a member of House Public Education, his or her support for House Bill 2623 is important! As a constituent, your opinion matters! Ask them to use their influence with their colleagues on the Public Education Committee to make sure House Bill 2623 (Allen) gets a hearing! Better yet, ask them to “Joint Author” the bill!

To find your Representative, click here: http://www.house.state.tx.us/members/find-your-representative/

A sample script is below:

Hello, my name is ________, I’m a constituent from Houston, zip code ___. I am calling Representative _______ to urge [him/her] to consider becoming a joint author of House Bill [2623| 3853| 3887]. This bill is incredibly important for the future of the kids in our local schools and a great step toward ending the school-to-prison-pipeline. If you won’t consider joint authoring the bill, please reach out to your colleagues on the PUBLIC EDUCATION COMMITTEE and tell them your constituents want this bill to be heard in front of this committee. Thank you very much!

Mental Health America of Greater Houston Bill Tracker
In addition to our priority partner bills, we are also following these bills for their impact on mental and behavioral health in Texas.

Bill Number  Author  Caption Status Focus Area Position
HB 2897 Price Relating to the mental health first aid program training and reporting. 03/06/2017 H Filed EDUCATION Support
 HB 322 Canales  Relating to the automatic expunction of arrest records and files for certain veterans and the waiver of fees and costs charged for the expunction.  03/21/2017 H Committee report sent to Calendars VETERANS  Support
 SB 74 Nelson  Relating to the provision of certain behavioral health services to children, adolescents, and their families under a contract with a managed care organization. 03/22/2017 S Committee report printed and distributed MENTAL HEALTH–CHILDREN  Support
 HB 1486 Price Relating to peer specialists, peer services, and the provision of those services under the medical assistance program.  03/21/2017 H Scheduled for public hearing MENTAL HEALTH–GENERAL  Support
SB 1 Nelson General   Appropriations 03/22/2017 S Ordered not printed MENTAL HEALTH–GENERAL  Support
HB 2094 Price Relating to coverage for serious mental illness, other disorders, and chemical dependency under certain health benefit plans. 03/16/2017 H Referred to Public Health MENTAL HEALTH–GENERAL  Support
SB 861 Zaffirini Relating to coverage for serious mental illness, other disorders, and chemical dependency under certain health benefit plans. 02/27/2017 S Referred to Business & Commerce MENTAL HEALTH–GENERAL  Support
 HB 10 Price | Bonnen, Greg | Rose | Muñoz, Jr. | Coleman  Relating to access to and benefits for mental health conditions and substance use disorders. 03/22/2017 H Committee report sent to Calendars MENTAL HEALTH–GENERAL  Support
SB 1107 Schwertner|Perry Relating to telemedicine and telehealth services. 03/22/2017 S Committee report printed and distributed MENTAL HEALTH–GENERAL  Support
HB 2697 Price Relating to telemedicine and telehealth services. 03/02/2017 H Filed MENTAL HEALTH–GENERAL  Support
HB 2096 Price Relating to access to and benefits for mental health conditions and substance use disorders. 03/16/2017 H Referred to Public Health SUBSTANCE ABUSE–GENERAL  Support
SB 674 Schwertner Relating to an expedited licensing process for certain physicians specializing in psychiatry; authorizing a fee.  03/21/2017 H Received from the Senate WORKFORCE  Support
HB 1488 Price Relating to eligibility requirements for repayment assistance for certain mental health professional education loans. 03/09/2017 H Referred to Public Health WORKFORCE  Support

Countdown to Sine Die

In the meantime, take heart in knowing we still have time to get some great work done.

What’s Our Agenda? Center for School Behavioral Health

In April 2012, Mental Health America of Greater Houston (MHA) launched the Harris County School Behavioral Health Initiative, a community-wide collaboration aimed at ensuring students with behavioral health needs are identified early and able to receive needed services. The initiative convened school district personnel, behavioral health providers, child-serving and education-related agencies, and parents to develop recommendations to improve the prevention, identification, and treatment of behavioral health issues among students. The initiative was born out of a 2003 report on school-based mental health care sites in Abilene, Austin, El Paso, Houston, Lubbock, Tarrant/Denton Counties, and Tyler. According to the report, counselors across the state faced challenges in providing appropriate levels of mental health services to students; teachers lacked both experience in recognizing early signs of mental health issues and an awareness of available community treatment resources; and schools burdened by financial constraints were unable to adequately meet the needs of students with mental health problems who were ineligible for services under federal law.

What began as a stakeholder meeting comprised of 40 organizations has grown into The Center for School Behavioral Health,  thanks in large part to the ongoing commitment and engagement of collaborative members and generous philanthropic support. A major gift from the Houston Endowment enabled the creation of the Center, which serves as a “living laboratory” for incubating innovative, cost-effective and replicable best practices to improve the behavioral health of students by facilitating collective action; providing highly specialized professional development opportunities, technical assistance and community education; and conducting research, advocacy, and policy analysis. The long-term vision of the Center is to transform school behavioral health to support the healthy psychological and cognitive development of children in the Greater Houston region through services and programs promoting behavioral health, as well as the prevention, early identification, and treatment of behavioral health disorders.

School Behavioral Health Initiative: 37 Recommendations

Harris County School Behavioral Health Initiative (SBHI) meetings included personnel from ten school districts, county level educational organizations, behavioral health providers, child-serving agencies and advocacy organizations, and during the course of a year, workgroups prioritized the following activities:

  • Review of state and federal laws that govern the identification and treatment of students with behavioral health issues, including the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act, as well as relevant state regulations;
  • Creation of a system “maps” of four school districts to determine their policies related to prevention, identification and treatment of mental health and/or substance use issues;
  • Examination of national evidence-based and promising school behavioral health programs. These included best practices related to prevention, identification, and intervention;
  • Completion of 32 individual interviews with key community members to obtain their views of how school behavioral health processes currently are working and ways in which they can be improved;
  • Execution of site visits to locations that have been recognized statewide or nationally for innovative and best practice-based school mental health initiatives.
  • Collection of data from the 20 Harris County school districts related to special education categorization, racial patterns, and disciplinary placements.

By February 2013, the SBHI developed and shared 37 recommendations based on their activities, including 7 recommendations for the Texas legislature:

  • Restore the $5.4 billion in education funding cuts made during the 82nd Legislature
  • Restore the almost $13 million in funding cuts made to Communities in Schools during the 82nd Legislature.
  • Increase funding for substance use prevention, intervention and treatment for children and adolescents.
  • Increase funding for children’s mental health treatment services.
  • Designate at least 5% of current funding for children’s mental health treatment services to prevention programs, such as mental health literacy, personal safety, and suicide prevention.
  • Appropriate General Revenue funds to increase grants for school-based health clinics.
  • Require, in educator preparation programs, that teachers receive training in the detection of students with behavioral health issues.

Between 2013 and 2016, the School Behavioral Health Initiative worked toward system or district-wide implementation of the 37 recommendations. All seven of the legislative recommendations were fully or partially implemented, and 20 of the 21 school district recommendations were being implemented district-wide by at least one area school or charter school district.  In total, 34 of the 37 recommendations have been realized.

85th Legislative Session Platform: Education

Guided by the 37 recommendations at the core of the Center’s advocacy efforts, MHA prioritized the development and implementation of school behavioral health services in our 85th Legislative Session Platform. Some may ask why it is necessary or, even, appropriate to address mental and behavioral health issues in a classroom environment instead of a home or doctor’s office. The answer to that question is simple, but not easy: One out of every five children has a mental illness or addictive disorder that causes some type of functional impairment. Youth with behavioral health issues may experience challenges such as academic underachievement, criminal justice involvement, and even suicide, and more than one-quarter of the total costs for mental health treatment services among adolescents were incurred in the education and juvenile justice systems. Lastly, children and adolescents spend much of their waking hours at school, making classrooms the ideal setting to recognize and initiate services to address the social, emotional and behavioral needs of our kids. Based on these facts, we support legislation focusing on school-based initiatives to improve prevention, identification and treatment of behavioral health issues among students. Specifically, we are looking at legislation related to behavioral health campus professionals, general reporting and trauma training, and transition services planning.

We spoke with Center for School Behavioral Health Director, Janet Pozmantier, and Professional Development Manager, Betsy Blanks, to get a comprehensive understanding of the legislative needs of the Center.

Janet: The Center came about because our schools were being overwhelmed with the number of children who were experiencing severe emotional difficulties and because of the severity of the difficulties our students were experiencing. We had long-time educators who were at a loss of what to do and how to handle so many children. We had a big win during the legislative session with Senate Bill 460, which mandates that all educators receive training in identifying the signs and symptoms of mental health problems among students and how to assist the child to get the appropriate help.  We are grateful for that legislation being passed. It was very unusual because normally legislation does not pass right out the gate. Usually, it takes at least three sessions to pass.

What we have found four years later is that most of our educators are not aware of the fact that this mental health training is required, and the districts that are implementing the training do not have the time or resources to reach all of their teachers in an effective manner.

There are some wonderful evidence-based trainings out there. A free online training is Kognito At-Risk, a phenomenal interactive avatar based training. Unfortunately, free access to that may end and then I don’t know what’s going to happen. A lot of us offer the Youth Mental Health First Aid training.  These trainings are free to districts through the Harris Center for Mental Health and IDD, our local mental health authority. However, there is a limit to how many the Harris Center can serve in any given year so organizations like Mental Health America of Greater Houston and NAMI are certified trainers. The challenge we have encountered is that our training is eight hours and costs money, limiting the number of school personnel who can take the training. The legislature did provide some money during the 83rd legislative session for these trainings but it is not enough to take care of the majority of teachers in the Greater Houston region because the money is to fund trainings statewide. That is a big problem.

The Center’s priority is getting these trainings out to people. Making sure people know about it. Currently, there are no “teeth” in the training legislation and that is why we have the proposed amendments to SB 460 that we are looking at today. There is no reporting requirement and so the schools are not going to do it. So, we want to make sure we have that reporting component inserted into the language of the updated bill. We also want to have trauma training included because of the things we have learned– especially from our conference this past fall — is there is an overwhelming desire from schools and districts to learn more about trauma and how it shows up in the classroom, and how to handle it. So many of the behavioral health problems we are seeing are not necessarily due to someone having a serious mental illness, but because it is a response to unresolved trauma and grief.

Betsy: Students who experience trauma are two and a half times more likely to be retained and are suspended and expelled more often. A student’s academic achievement can also be harmed because of trauma with reports of lower scores on standardized achievement tests and substantial impacts on IQ, reading achievement and language. Over the last ten years, teachers have really started to realize that this is an issue.  Many of their students are not necessarily suffering from a mental illness but they are impacted by trauma. Teachers are recognizing it but they do not know what to do about it.

Annalee: Betsy, as a former teacher coming into this, what can you say about seeing both sides of this issue?

Betsy:  The first time I attended the Mental Health First Aid course, it was after I started here at the Center, throughout the training, all day long, it just hit me over and over and over again how many kids I failed because I did not have this mental health training; the context. I worked at an inner-city school where kids were coming in with a lot of trauma and my school never talked about mental health, never talked about trauma. Teachers did not receive any information about that side of a child. It was all academic focus, and they did great things academically at my school, but you lose a lot of kids if you are not addressing that side.  It was really hard as someone who cared deeply about being a good teacher and about my students. It was really difficult to later receive this training and get this information and look back and think about the specific children I let down because I was not prepared to handle their traumas. That’s not acceptable. We do such a disservice to our children in schools when our teachers are not prepared to address the whole child. They want to. No one goes into teaching with bad intentions. They want to do the best for their students and it’s not fair to the child to not equip our teachers with those tools. We send them to a lot of professional development and it’s not acceptable that at least a certain portion of that training is not dedicated to mental health training.

Janet: Our public schools are de facto providers of mental health services, and who is on the front lines at schools? The teachers. They don’t have the necessary training so we want to give them the tools to be trauma informed and understand mental health issues in order to understand how to refer out. We don’t want teachers to be therapists. That’s not their role. But who are they going to refer to?  In many of our schools, there is no one there. Even if there is someone there, for example, school counselors are busying working on graduation plans and writing letters of recommendation or doing lunch line duties or testing. So, that is why we are advocating for one licensed behavioral health professional on every school. To help our teachers have more time to teach. If they identify a student who is in need of some type of service, then they can make sure that student gets those services. In other school districts around the country, schools have three, four, five counselors per grade because they realize a child cannot learn if they are experiencing homelessness, poverty, hunger, or trauma of any kind.

Trauma is everywhere, in all strata of society, and that is why we want a licensed behavioral health professional on every campus. I don’t buy the argument that we don’t have the money. We have the rainy-day fund, and you can get very creative with Medicaid reimbursement. We have great models here in Houston. Legacy Community Health has partnered with schools and figured out how to host integrated health care clinics on every campus so we can do this. You cannot live in a city like Houston and use the arguments that we cannot afford it. It’s not okay. Or in a state like Texas.

Behavioral Health Campus Professional

No conversation about improved prevention, identification and treatment of behavioral health issues among students would be complete without addressing the shortage of school counselors in Texas schools. National prevalence estimates indicate that one in five children have a mental illness or addictive disorder, meaning that approximately one million Texas public school students are dealing with these issues on a daily basis.  These illnesses can cause mild to significant impairment in home and school activities and can lead to school failure, disciplinary placements,  juvenile justice involvement, and, in extreme cases, suicide.

Despite the high prevalence of mental health and substance use disorders among children and adolescents, most schools do not have a designated staff person available to provide counseling or other needed services. In addition, school counselors, who historically were responsible for providing some of these services, are increasingly loaded down with administrative duties unrelated to mental or behavioral health counseling. They also are expected to handle increasingly large student caseloads.

Although the counselor shortage can be attributed to a mix of overburdened caseloads, funding cuts, and hiring shortages, the result is a student-to-counselor ratio well above the American School Counselor Association recommendation of 250-to-1. Following the 2011 cuts to public education, the Ray Marshall Center for the Study of Human Resources at the LBJ School of Public Affairs released Texas School Counselor Study: Exploring the Supply, Demand, and Evolving Roles of School Counselors. The study found “[b]eginning in 2012 and through 2014 the student-to-counselor ratio also remained relatively constant … between 460:1 and 470:1.”  These numbers do not take into consideration the counselors’ ability to identify and address the behavioral health needs of students.



To address the shortage of counselors and other student support staff, MHA of Greater Houston supports legislation requiring at least one licensed behavioral health professional on each campus, as funding allows. While the long-term goal would be requiring one behavioral health professional per campus, the cost of associated with this type of legislation would be prohibitive in the current legislative climate. We have seen great success in meeting the behavioral health needs of students in public-private partnerships between school districts and community-based organizations like Communities in Schools and believe this is an incredibly positive starting point that would greatly benefit students.

Reporting and Trauma Training

MHA is incredibly proud of our work on Senate Bill (SB) 460, passed by the 83rd Texas Legislature in 2013. SB 460 requires school districts to provide teachers, administrators and staff with training in mental health intervention and suicide prevention to help them identify red flags in a child’s behavior and respond effectively.  House Bill (HB) 2186, passed by the 84th Texas Legislature in 2015, requires suicide prevention training for all new school district and open-enrollment charter school educators annually and for existing school district and open-enrollment charter school educators on a schedule adopted by the Texas Education Agency (TEA) by rule.

Source: Understanding Child Trauma, National Child Traumatic Stress Initiative

Currently, Section 161.325 (Early Mental Health Intervention and Suicide Prevention), Health and Safety Code requires teachers, counselors, principals, and all other appropriate personnel to be trained in how to recognize and appropriately respond to signs of mental health and substance use disorders, as well as suicide. However, the trainings are not required to cover students who have experienced physical and emotional trauma. Additionally, there are not any reporting requirements to ensure that school districts are conducting the trainings.

The goal of MHA’s proposed general reporting and trauma training legislation is two-fold: 1) to provide accountability measures to reinforce the training mandate through reporting to the  Texas Education Agency; 2) to require all school personnel to receive training in how to recognize and appropriately respond to signs of trauma.

As proposed, this legislation would amend SB 460 to require school districts to train educators in how to recognize and appropriately respond to physical and emotional trauma, as well as to report all training information to the Texas Education Agency. This accountability measure does not serve as a new mandate. SB 460 already requires school district employees to receive training. The school district is also required to keep records of all training participation. This amendment would strengthen the already existing requirements in the bill by ensuring the records kept by the district on the required training would then be reported to the TEA and be accessible to parents and community members.

To better understand the need for trauma training and the impact of trauma on students, Annalee Gulley sat down with Julie B. Kaplow, Ph.D., A.B.P.P., Director of the Trauma and Grief Center for Youth at The University of Texas Health Science Center at Houston. The Trauma and Grief Center for Youth opened in December 2014  and treats youth ages seven to 17 who have experienced trauma and loss.

Annalee:  If you were a teacher and were in your classroom, what are some of the signs you might recognize in a child who has experienced some type of trauma?

Julie:  What makes this difficult is that posttraumatic stress symptoms can look a lot like ADHD symptoms. We will often hear from teachers, “This child won’t sit still. They are distracted. They seem like they are in another world. You say one thing that sets them off and you cannot seem to calm them down.” These may be signs of ADHD, but they can also be signs of posttraumatic stress. It is important to help teachers understand how kids may react in the aftermath of trauma and put these behaviors into context. Many traumatized kids may be triggered without knowing why inside the classroom. It is often helpful to inform teachers about potential trauma reminders – people, places, situations, or things that remind kids of the frightening thing that happened to them. Trauma reminders can be as subtle as kids screaming on the playground (if the traumatic event involved the sound of screams) or the teacher giving that child a certain look or scolding them. These kids often get mislabeled or are misunderstood as “behavior problems” when in fact they are simply reacting to their environment and are being reminded of whatever traumatic experience they had.

A trauma training would help to educate teachers about the many ways in which various forms of trauma and adverse life events, such as the death of a loved one, as well as accompanying posttraumatic stress or maladaptive grief can impact learning and how this may manifest in the classroom. When teachers really do understand how trauma impacts children, they are able to have more empathy in the classroom, they are better able to see why certain children may be behaving the way they are and are then able to help them to modify those behaviors in a much more effective way. What we also know is that teachers can use all of the behavioral strategies and positive reinforcement they want with a traumatized child, but if they are not able to identify what it is that is triggering them, that’s not going to help them in the classroom. A trauma training for teachers would help to explicate the ways in which posttraumatic stress and/or grief reactions can manifest in the classroom and what teachers can do to help these youth to de-escalate and stay on track.

Annalee: How would you respond to the argument that this is not a teacher’s job? That we are turning teachers into counselors or behavioral health professionals when we ask them to identify a child who has been traumatized or ask them to de-escalate a situation or determine whether a child has been abused or is suffering PTSD?

Julie: I would say that, first, we are obviously not asking teachers to treat a child’s posttraumatic stress because that would require a higher level of training and intervention. What we are suggesting though is that teachers can play a critical role in identifying those youth who may need to be referred for an evaluation. It is important to remember that, for many traumatized youth, their teachers may be the only adults in their lives who are actually seeing their posttraumatic reactions and/or behaviors. So the school can actually serve as a critical point of entry. In addition, we know that trauma and PTSD can directly impede the child’s ability to learn, and a primary goal of most teachers is to create an environment in which all kids in the classroom are able to learn in the most effective way possible. When youth are struggling with PTSD, this may directly interfere with the primary goal for teachers. By empowering teachers with the knowledge and information needed to identify trauma and PTSD in youth, they will begin to feel like they have more control over their classroom. We see many teachers, particularly in underserved communities, who are faced with a lack of resources and high levels of trauma in the neighborhoods in which they work. Many teachers feel overwhelmed and think “I’ve just got to get through this day” as opposed to ” I am starting to notice a pattern with this child and this might be a sign that they have a history or trauma.” This new knowledge allows teachers to feel more in control of their classroom, less overwhelmed, and better equipped to refer those kids who may need a thorough trauma-informed evaluation and/or intervention.

 Transition Services Plan

To ensure students with prolonged placements in out-of-school facilities, including disciplinary programs and residential treatment facilities to address disciplinary or behavioral health needs, have a continuum of services, MHA of Greater Houston seeks to require the creation of a transition plan for the returning student. Annalee Gulley spoke to Latashia Crenshaw, Director of Educational Support and Advocacy Services at the Harris County Juvenile Probation Department. The Education Support and Advocacy Services is tasked with “advocate[ing] for improved educational services for probation-involved youth in community settings.”

Annalee: When you are able to get them back to the home campus, do you encounter many schools that have the ability or systems in place to integrate that child successfully back into school?

Latashia: Some districts, as with everything, are better than others when it comes to transitioning our youth back into their home school. It also depends on how long the youth has been out of their system and involved in our system. For youth who have not been out of their home school for very long, I can say that they have much easier chances transitioning back into the school from an out-of-school facility. Those who have been out of their school for quite a while, or not attending their home school prior to coming to us, those are the youth who concern us the most. We are trying to focus on making sure we have the correct records, the correct grade level for that student or making sure that the special education services are in place. Transitioning the services we have in place while the youth are in a placement because they may look completely different than what needs to happen when the youth returns to the home school. We have found there are gaps when making sure there is a continuum of support and services between placements.

Annalee: If you were to help facilitate the process of creating a standardized transition plan, what do you think some of the core elements of the plan would need to include?

Latashia: In an ideal world, we would have transition specialists or people designated in the district who would track youth who have been withdrawn from their district and in our facility because once the youth is enrolled in our system for a designated number of days, they are withdrawn from their home district and placed in our school system.

For transition plans, if the youth is in our facility — for say 60 days or longer– if we could have a transition specialist work with us when we know that youth is going to be released, to have the home school become involved with the youth transition plan so that we can ensure that everything is in place when they go back to the home school. This would include setting up Admission, Review, and Dismissal (ARD) meetings, as well as 504 meetings because most of our students have some sort of disability. A  transition plan would definitely include looking at the courses the youth is enrolled in with us versus what they need to be enrolled in when they return to their home school. Again, what types of transition services this youth would need just to really get reintegrated back into their home school system versus the education system we were involved in. To me, a transition plan would include reintegration meetings prior to the youth being released, including staff from probation, the home school and any other services they are going to be involved with in the community. Some sort of meeting that includes all the people who are going to be working with the student and family.

Latashia:  I cannot stress how significant it would be, especially for those youths who have significant mental health concerns and disability, to collaborate on transition meetings while the youth is in placement. This would include having home school personnel come to ARD meetings or hold these meetings in conjunction with our staff so that we can ensure that when this youth leaves placement they are actually successful with transitioning back to their home school and don’t return to us simply because records are not there or they are sitting at home waiting to be in enrolled in a school, which may or may not happen.

What’s Next?

As we build support for this legislation in Austin, we will report on important milestones like bill filings, committee assignments, and committee hearings. Your voices need to be heard by legislators to ensure they understand the importance of these issues for students in Houston and beyond. Stay tuned!

One Month In: A Look at the 85th Legislature

On Tuesday, January 10, the 85th Texas Legislature was officially gaveled into session. As we mark the close of the first month of this biennial 140-day period, our team at Mental Health America of Greater Houston took a quick look back at what has happened thus far inside Austin’s Pink Dome.

Biennial Revenue Estimate
Comptroller Glenn Hegar released the 2018-2019 Biennial Revenue Estimate (BRE) on Monday, January 9, kicking off the 85th Legislative Session with a bleak fiscal report that left lawmakers with roughly $104.9 billion in general revenue funding for the state’s two-year budget. The 2018-2019 BRE is approximately $7 billion less than the 2015 allocation, largely because of low oil prices coupled with the required reallocation of billions of tax revenue dedicated to the State Highway Fund following the passage of Proposition 7* in 2015.

Estimates suggest that it would require $109 billion in general revenue monies to fund state programs at currently established levels. In July, anticipating the budget shortfall to come, Governor Greg Abbott, Lt. Governor Dan Patrick and House Speaker Joe Straus requested all state agencies to scale back their budget requests by 4 percent in an effort to curb government spending. Mental and behavioral health services were deemed priority funding areas, along with funds for public schools, border security, and Child Protective Services, and were excluded from the required 4 percent scale back scenarios. However, the 2.7 percent decrease in overall funding for state provided services established by the Comptroller’s BRE in January leaves less money available for schools, child welfare, and health care, among many others, than originally expected – leading some advocates to call for legislators to dip into the Economic Stabilization Fund, commonly known as the “Rainy Day Fund,” which is currently valued at nearly $12 billion. Legislators have been reticent to draw funds from this emergency fund in the past, which points to difficult – and contentious – decisions to come.

*Proposition 7, passed by taxpayers in November 2015, requires the state to dedicate up to $5 billion in sales tax revenue to the State Highway Fund.

Base Budget Breakdown: SB 1/HB 1
On Tuesday, January 17, State Senator Jane Nelson, Finance Chairman, filed SB 1 – the  Texas General Appropriations Act, which serves as the Senate’s base budget and establishes state funding priorities for the next two years. SB 1 includes $103.6 billion of general state funding with overall spending — including federal and other funds — of $213.4 billion.

Like many of her colleagues, Senator Nelson shared concerns regarding “difficult decisions to make this session,” which makes the inclusion of key funding items for mental and behavioral health significant as they signal the Senate’s commitment to prioritizing these issues this session. Included in the budget is funding for workforce development, with an additional $44.1 million for Graduate Medical Education to ensure residency slots are available for Texas medical school graduates; and $260 million for Child Protective Services. To address current needs, SB 1 committed $1 billion for the state hospital system and facilities and $63 million for community mental health services to eliminate waitlists. Women’s health and veterans’ services programs maintained existing funding levels, including funding for Texas Veterans + Family Alliance, a $20 million grant program to assist veterans with post-traumatic stress and other mental health issues.

Shortly after SB 1 was filed, Texas House Speaker Joe Straus filed HB 1, the House’s initial 2018-2019 budget. HB 1 includes $108.9 billion in general fund allocations, approximately $4 billion more than the Comptroller’s estimated available revenue, and a total budget of $221.3 billion.

The House’s base budget touts a significant investment in public education, child protection, and mental health services, while only increasing the state budget by less than one percent. “We keep overall spending low while making investments in children and our future … This is the first step toward producing a balanced budget that reflects the priorities of the Texas House and does not raise taxes,” said Speaker Joe Straus.

Under the House budget, mental and behavioral health services receive $162 million of additional funding. These funds would eliminate wait lists for mental health services and allow for the implementation of many of the House Select Committee on Mental Health’s recommendations, including efforts to increase the implementation of early identification and jail diversion programs across the state. As in SB 1, HB 1 also earmarks monies for the treatment of post-traumatic stress disorder among veterans.

Nearly $8 billion separates the Senate and House base budgets [difference between the Senate and House base budgets ] and we have until May 29th to see how negotiations between the two chambers unfold.

House Select Committee on Mental Health – Interim Report to the 85th Texas Legislature
In early January, the House released an interim report from the Select Committee on Mental Health. Speaker Joe Straus formed the Select Committee in November 2015 to better understand the existing behavioral health system for adults and children in Texas. Chaired by Representative Four Price, the Select Committee on Mental Health held eight hearings throughout 2015-2016. Representatives Garnet Coleman, Sarah Davis, and Senfronia Thompson served as Houston’s representatives on the committee.

When he announced the formation of the committee, Speaker Straus identified the need for “[a] smarter approach to mental health” and expressed his hope that this approach would result in “improve[d] treatment and care while saving taxpayers money.” The interim report is intended to “give the House valuable guidance,” on how to make positive advancements in behavioral health during this legislative session.

The interim report highlights opportunities to solve existing service gaps and key takeaways include:

  • Prioritizing early intervention and prevention measures – especially among school age children;
  • Expanding innovative public school-based programs;
  • Sustainability of the 1115 Transformation Waiver / DSRIP funded programs;
  • Expanding bed capacity by expanding step-down beds to provide a continuum of care, including expanding jail diversion programs for nonviolent offenders;
  • Continuing to address mental health workforce shortages through educational incentives and by expanding the availability and utilization of technology, such as telemedicine;
  • Integrating healthcare to treat the whole person, physically and mentally, although questions remain among the committee surrounding the implementation.

Committee Assignments: Senate and House Committees Announced
On January 18, Lt. Governor Dan Patrick announced Senate committee assignments for the 85th Legislative Session. The Houston delegation includes Chair and Vice Chair assignments to the Criminal Justice, Education, and State Affairs, Intergovernmental Relations, and Business & Commerce Committees, and is represented on committees relevant to behavioral health work.


Traditionally, behavioral health bills pass through the Senate Health and Human Services Committee, but to monitor the Center for School Behavioral Health’s bills and issues relevant to Veterans Behavioral Health Initiative, MHA of Greater Houston will also watch the Senate Education Committee and Senate Veteran Affairs & Border Security. Houston Senator Borris Miles is a member of the Health and Human Services Committee. The Education Committee had two members of the Greater Houston delegation: Senator Larry Taylor, Chair, and Senator Paul Bettencourt.

Health and Human Services Committee

Role Senator City
Chair Charles Schwertner Georgetown
Vice Chair Carlos Uresti San Antonio
Member Dawn Buckingham Lakeway
Member Konni Burton Colleyville
Member Lois W. Kolkhorst Brenham
Member Borris L. Miles Houston
Member Charles Perry Lubbock
Member Van Taylor Plano
Member Kirk Watson Austin

Education Committee

Role Senator City
Chair Larry Taylor Friendswood
Vice Chair Eddie Lucio, Jr. Brownsville
Member Paul Bettencourt Houston
Member Donna Campbell New Braunfels
Member Bob Hall Edgewood
Member Don Huffines Dallas
Member Bryan Hughes Mineola
Member Kel Seliger Amarillo
Member Van Taylor Plano
Member Carlos Uresti San Antonio
Member Royce West Dallas

Senate Veteran Affairs & Border Security

Role Senator City
Chair Donna Campbell New Braunfels
Vice Chair Don Huffines Dallas
Member Dawn Buckingham Lakeway
Member Bob Hall Edgewood
Member Eddie Lucio, Jr. Brownsville
Member José Rodríguez El Paso
Member Carlos Uresti San Antonio

On February 9, Speaker Straus shared House assignments to the 38 standing committees, as well as the creation of two new select committees: the Select Committee on State and Federal Power and Responsibility and the Select Committee on Texas Ports, Innovation & Infrastructure.


The Houston delegation includes Chair assignments to Appropriations, County Affairs, General Investigating & Ethics, Government Transparency & Operation Juvenile Justice & Family Issues Local Consent & Calendars, Public Education, Special Purpose Districts, and Urban Affairs. Vice Chairs committee assignments from the Greater Houston area include Corrections, Environmental Regulations, Economic & Small Business Development, International Trade & Intergovernmental Affairs, Judiciary & Civil Jurisprudence, Special Purpose Districts, and Texas Port, Innovation, & Infrastructure.

House Committees of particular interest to MHA of Greater Houston are Public Education, Human Services, Public Health, and Defense & Veterans’ Affairs. Representative Dan Huberty chairs Public Education and members include Representative Alma Allen, Harold Dutton, Jr. and Dwayne Bohac. Public Health membership includes Representatives Garnet Coleman and Tom Oliverson. Houston-area legislators make up half of the membership of the Human Services Committee with Representatives Mark Keough, Rick Miller, Valoree Swanson, and Gene Wu.

Public Education

Role Representative City
Chair Dan Huberty Houston
Vice Chair Diego Bernal San Antonio
Member Alma Allen Houston
Member Joe Deshotel Beaumont
Member Harold Dutton, Jr. Houston
Member Lance Gooden Terrell
Member Dwayne Bohac Houston
Member Ken King Canadian
Member Linda Koop Dallas
Member Morgan Meyer Dallas
Member Gary VanDeaver New Boston

Human Services

Role Representative City
Chair Richard Peña Raymond Laredo
Vice Chair James Frank Wichita Fall
Member Mark Keough The Woodlands
Member Stephanie Klick   Fort Worth
Member  Toni Rose  Dallas
Member Rick Miller Sugar Land
Member Ina Minjarez San Antonio
Member Valoree Swanson Houston
Member Gene Wu Houston

Public Health

Role Representative City
Chair Four Price Amarillo
Vice Chair J.D. Sheffield Gatesville
Member Garnet Coleman Houston
Member R.D. “Bobby” Guerra Mission
Member William “Bill” Zedler Arlington
Member Diana Arévalo San Antonio
Member Nicole Collier Fort Worth
Member Phillip Cortez San Antonio
Member Stephanie Klick Fort Worth
Member Tom Oliverson Cypress

Defense & Veterans’ Affairs

Role Representative City
Chair Roland Gutierrez San An
Vice Chair César José Blanco El Paso
Member Diana Arévalo San Antonio
Member Stan Lambert Abilene
Member Briscoe Cain Deer Park
Member Dan Flynn Canton
Member Terry Wilson Marble Falls

Stay Engaged: Know Your Reps, Advocacy Taskforce, and Social Media 

The procedural nature of the Texas Legislature requires a somewhat paradoxical mix of steadied patience and swift action. In this space, we’ll discuss effective advocacy strategies in the weeks ahead. One simple step to begin to make your voice heard in Austin is to become familiar with the offices of your State Senator and State Representative. Find their district and capitol offices, save their phone numbers, and research the issues they care about the most.

Here within Mental Health America of Greater Houston, the Center for School Behavioral Health and the Women’s Mental Health Initiative joined forces and launched an Advocacy Task Force for the 85th Texas Legislature. The Task Force will be instrumental in advancing legislation around children and women’s mental health in the coming months. We welcome anyone interested in helping our cause to join the Task Force and our Rapid Response Team. For more information, visit our Advocacy Task Force page or email Lauren at lpursley@mhahouston.org.

To keep up with our advocacy work, check back in with Minding Houston every other Thursday starting February 23, like us on Facebook and follow us on Twitter.

Minding Houston XVII: Parity Disparity

With all the issues surrounding mental health, perhaps none has a bigger impact than parity. But parity also happens to be one of the hardest to understand and hardest to implement. In this episode, we will look at the legislative history of parity, current problems with enforcement, and a new ruling that impacts parity across the country. Insurance parity for behavioral health coverage makes providing behavioral health services possible and it is impossible to improve access without it.

This is Minding Houston, I’m Bill Kelly.

When we talk about parity, we need to talk a little political history. The Houston Chronicle’s Jenny Deam wrote about the situation regarding parity and its roots in federal legislation, and she sums it up nicely:


“President George W. Bush signed a law requiring any insurance policy that included mental health treatment to be equal in coverage to medical treatment, in an effort to stop the long-standing practice of charging higher co-pays for mental health care, limiting treatment or denying it outright. It was cheered as a triumph for the nation’s millions with mental illness.

The measure was further strengthened in 2010 with the passage of the Affordable Care Act, which extended federal parity requirements to individual and small-group plans and mandated mental health and substance abuse be covered in any plan sold on the federal marketplace or state exchanges.

But the lofty goal of equality has fallen far short of its promise, providers, patients and policy experts say.”

So with federal legislation passed, what’s the problem? Parity is the law of the land, why isn’t it the standard practice of providers? Well, as Ben Franklin once said, “”Justice will not be served until those who are unaffected are as outraged as those who are,” which I think was his way of stirring up those of us who care about behavioral health coverage. Deam’s article continues:

“In fact, certain managed care groups are well known within the Houston behavioral care community of having a “predictably higher rate of denials” and a “higher hassle factor,” says Dr. George Santos, chief medical officer and executive medical director at Houston Behavioral Hospital. “They hide behind statements like, ‘We are not telling you what to do.’ But I have had many instances where these physicians will make specific treatment recommendations regarding medications and doses. They will certainly say a patient no longer needs inpatient care and will deny approval.”

Take Dr. Richard Noel, medical director at IntraCare North, a Houston psychiatric facility. He spends hours each week on the phone arguing with doctors paid by insurance companies who have never seen his patients. He says he now has to prove that medications for inpatient children and teens are being adjusted every few days – often before the drugs have had a chance to work – or insurers will no longer cover a hospital stay. He says he has had issues with nearly all of the major insurance companies.”

What are the consequences when parity for behavioral health isn’t enforced with providers? Well, I would refer to statements made by Dr. William Streusand, an adolescent child psychiatrist at the Texas A&M Health Science center. He testified in front of the House Select Committee on Mental Health on March 22nd and answered the following question from Rep. Greg Bonnen, also a physician:

Bonnen: “You don’t take private insurance in your practice, why is that?”

Streusand: “I don’t have to.”

Bonnen: “Well, okay, could you elaborate on why you wouldn’t have to?”

Streusand: “Yeah, like I said it is a seller’s market.”

While that is true, what else is true, as followers of Minding Houston well know, is Texas has a scarcity of providers. How bad is the situation and how does it affect parity? From the Chronicle article:

“Texas ranks 47th out of 50 states and the District of Columbia in access to mental health care, and 50th in the number of mental health providers with only one for every 1,757 in the state, according to a study by Mental Health America. By contrast, Massachusetts, which ranks first, has one provider for every 248 people.

“They flat out tell me, ‘We don’t take insurance anymore because we have too much trouble getting paid,’ ” says Carrie Stowell, a single mother whose 16-year-old daughter has been diagnosed with bipolar disorder, attention deficit hyperactivity disorder and anxiety. She lives in Conroe and found 10 doctors in a 40-mile radius who treat adolescents, but only one is taking new patients or is in her plan. The wait for an appointment is six months.

Santos also feels the shortage. “It is extremely difficult to recruit a physician willing to work at an inpatient setting because of insurance,” he says.”

Because of poor parity enforcement, Texas finds itself in a situation where access to care is being limited not only to the number of providers but the number of providers that take insurance. Having a “cash only” payment model for behavioral health is a dangerous trend for Texas and can be one of the most limiting factors in the provision of care. Texas has too many people needing services to be a “seller’s market.” It is time to make some changes.

So how can this parity enforcement problem be addressed? Based on his experience as a prosecutor and his observations of the mental health needs of so many in the criminal justice system, Congressman Joe Kennedy III has a plan that he believes can help enforce the parity laws on the books. We talked with the Congressman about his Behavioral Health Coverage & Treatment Act last week:

BK & Kennedy

Bill Kelly and Congressman Joe Kennedy III

Kelly: I’m here today with Congressman Kennedy. Congressman, thank you so much for joining us. In December you filed your Behavioral Health Coverage and Transparency Act and, unlike in Texas where we face large problems due to our large uninsured population, this act primarily goes after folks with insurance looking to access services. What particular aspect really raised this on your radar screen?

Kennedy: So, I’ve been diving into issues around mental health now for a while, since I came into office and, actually, really beforehand. Before I ended up running for office, my first campaign, I was a prosecutor. I cannot tell you how many cases came across my desk from the district courts, lower courts, criminal courts in Massachusetts for folks struggling with either mental illness, substance abuse, drug abuse, or alcoholism and my boss at that point, a Republican DA,  said, “Your job is to make sure that person never commits another crime.”

And some folks are bad people and you lock them up for a long time. For others suffering from mental illness or substance abuse, the way you can do that is to treat the underlying condition. It doesn’t matter if you lock them up for three months if they are not able to get treatment for their mental illness or get clean off of a heroin addiction.

So use the tools that you have in your tool kit to help address the underlying concern. As a prosecutor, there are some tools we got; there’s a lot that we don’t and from my perspective trying a bunch of drug cases and working with a lot of drug cases, I became convinced that the way to ensure that those files that were people’s lives on my desk, the way to actually address them much further upstream is to focus on prevention and treatment rather than on prosecution.

The question then becomes how do we make sure there is access to mental health care throughout our society? And as we start peeling back the layers on this, from my perspective on it, there are two main segments. There is the public side of things where folks get their healthcare from the federal government, Medicaid primarily. Medicaid is, of course, the largest payer of mental health care services in the country. Then there is, of course, the private side doing private insurance. We’ve started by looking at the private side marketplace.

What this bill’s focus is to say, look, the combination of mental health parity, which is a simple law that has helped expand coverage, but it’s the combination of mental health parity and the Affordable Care Act that actually said as an essential health benefit in order to participate in these exchanges, you have to actually cover mental health care. So we have the combination of the Mental Health Parity Act, which says we have to treat mental health care like we do physical health care, and then the Affordable Care Act, which says you have to now cover mental health care. That leads to a huge expansion in coverage for states, particularly those who took the Medicaid expansion, which not all states did.

The challenge though is that the marketplaces still are not functioning so we still hear cases all over the country that say “I don’t need to take insurance,” because there are so many people that are in need of care and so few doctors that the doctors are essentially empowered to say “I can cherry pick my clients, I can make sure to get rates that are higher that other insurance companies will reimburse me for and I’ll just be an all-cash doctor.”

The problem with this is that you can’t just create more doctors overnight. So there are systemic issues that are affecting our ability in this country to have patients that are suffering from mental illness to actually access mental health they need. One other step for you: according to one study I saw recently 55% of the counties across our country do not have a single practicing psychiatrist, psychologist or social worker, 55% of the counties across our country!

So when we start talking about trying to get access to care, insurance is an important part to this, but we have to make sure you can actually get a doctor and stay treated. So the bill that we filed is a first step in trying to basically force insurance companies to divulge information around how they are actually covering mental health care. As you know, there are many people that are suffering from mental illness who get their insurance claims denied at a much higher rate than those suffering from typical, physical maladies such as a broken leg or a broken arm. So this bill will hopefully shine a light on some of those practices and force insurance companies to actually make this transition to focus on prevention and treatment, rather than triage at the back end of mental health.

Kelly: And you mention that this bill, it doesn’t put forth any new regulations as much as it focuses on transparency the for given laws that you mentioned with parity and the ACA.

Kennedy: Absolutely. Part of the way we crafted this is to say, look we are not trying to add any additional burden to these insurance companies, but disclose the methodology at which you end up making your decisions and make sure that information is available and digestible to regulators so we can actually start to shine a light on this and ask are things actually going as they should – which case there might be something else that needs to be done – or are they not?

And the idea behind this bill is that if insurance companies can essentially get away with not covering people at the back end when they are in need of mental health care, then there is essentially no reason for them to make the investment they need to actually force the focus of treatment to move up that scale to prevention and treatment rather than just focusing on the back end for folks that end up in a crisis point.

So what we want to do is try to take a step back and say how are we going to address access to mental health care in the system? It needs a full-on continuum of care adjustment. We need the private sector to play a role in that and I think a critical piece to it is by getting insurance companies to not just focus on the back end, the really expensive cases of triage after you’re becoming the victim of mental illness, but to focus on treatment and prevention on the front end. How do we flesh that out? We make sure that you are actually abiding by the terms of the regulation that are already in place.

Kelly: When you talk about the regulations that are already in place, one of the things that make mental health and behavioral health a very bipartisan issue is that people in a very partisan health care landscape, have been really willing to come together. You’ve seen bills move both in the House and the Senate. Do you see your bill possibly being able to hitch onto one of these bills that seem to be making some headway down the track?

Kennedy: Absolutely hope so. This is something that I think Democrats and Republicans agree on, that our mental health system is in crisis. Whether it was folks in Congress that have had similar experiences to me as prosecutors saying this is a real problem, whether you see it in emergency rooms because you have some doctors in Congress, or you are a member in Congress involved in trying to help our access to health care period.

And if you go around even hospitals in Massachusetts it’s one of the things you will hear about in emergency departments is there are a lot of people in their EDs suffering from mental illness. So we hear about this all the time; the question is how do we go about addressing it, again in that full-on continuum of care model? I hope that this legislation will address this, either as a standalone or perhaps as an amendment to one of those other pieces of legislation that we have been working hard on. We have been working with some of our colleagues on it and they have been doing a really good job. There is also a really tricky issue on how to make these reforms across the entire system and some of my colleagues and I are trying to dive into this so hopefully we will get there.

Kelly: Well, thank you, Congressman so much for your time today and for your work on this really important issue that I hope gets the traction that it needs. Like you said, this is a critical first step to ensuring that those with private coverage get the help that they need.

Kennedy. Thank you for your time too, Bill.

As the Congressman mentioned, the largest payer of behavioral health services in the country is Medicaid. And a recent announcement by the Department of Health and Human Services is good news for increasing access.

On March 29th, the Center for Medicare & Medicaid Services (often referred to as CMS) announced the new rule in coordination with President Obama’s visit to the National Rx Drug Abuse and Heroin Summit. From the press release:


” . . . the Centers for Medicare & Medicaid Services (CMS) today finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children’s Health Insurance Program (CHIP) coverage, aligning with protections already required of private health plans. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits on equal footing as medical and surgical benefits.

“The Affordable Care Act provided one of the largest expansions of mental health and substance use disorder coverage in a generation,” HHS Secretary Sylvia M. Burwell said. “Today’s rule eliminates a barrier to coverage for the millions of Americans who for too long faced a system that treated behavioral health as an unequal priority. It represents a critical step in our effort to ensure that everyone has access to the care they need.

“This rule will also increase access to evidence-based treatment to help more people get the help they need for their recovery and is critical in our comprehensive approach to addressing the serious opioid epidemic facing our nation.”

“The need to strengthen access to mental health and substance use disorder services is clear,” said Vikki Wachino, Deputy Administrator of CMS and Director of the Center for Medicaid and CHIP Services. “This final rule will help states strengthen care delivery and support low-income individuals in accessing the services and treatment they need to be healthy.”

The protections set forth in this final rule will benefit the over 23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP.

A link to the press release and the finalized rule can be found here

Overall, our goal at MHA of Greater Houston has been to make the provision of behavioral healthcare a successful business model. After all, if people want to access services, there needs to be providers available to treat them. Parity can help provide the basic regulatory functions under which providers can be paid in a timely manner for their services. And it is already the law . . .

Parity will continue to be a big issue at the state and national level. We look forward to continuing to work with our elected leaders in Austin and Washington to make sure parity coverage is enforced. Without this level playing field, progress in mental health care access continues to be an uphill battle.

This has been Minding Houston, I’m Bill Kelly.


Music for this Episode: “Hotel Rodeo”, “Quisling”, and Bricolage” by Anitek and “Vacate the Premises” by Deadly Combo