State of the State, Elections and More

It was another slow week for the Legislature, but as always, there were a few interesting developments to note.

State of the State

This morning, Governor Perry delivered his 7th biennial State of the State address to a joint session of the Texas Legislature.

Declaring that “the state of our State is stronger than ever,” the Governor discussed Texas’ strong business climate and being “the nation’s prime destination for employers and job-seekers alike.” He gave a few bipartisan shout-outs to members who have worked to improve the overall climate in Texas without bureaucracy, including local legislators Rep. Allen for her work in education, and Sen. Huffman for her work in reducing frivolous lawsuits against employers. He also discussed states that are following Texas’ lead, including Michigan’s recent decision to become a right-to-work state and Louisiana seeking to eliminate their state income tax. Specific initiative he endorsed (or opposed) included:

  • Providing at least $1.8 billion in tax relief over the biennium;
  • Not expanding Medicaid or establishing an exchange under the Affordable Care Act;
  • Providing $1.3 billion over the biennium for water and transportation infrastructure;
  • Expanding school choice through an increase in charter schools and scholarships; and
  • Tying at least 10% of state funding for a college or university to the graduation rate

Unfortunately, nothing about mental health or substance abuse, but maybe in two years!

Money, Money, Money

Budget hearings are underway in the Senate, and the Finance Committee has been hearing from the Legislative Budget Board, state agencies, and the public regarding the appropriations bill. The hearings for Article 2, which encompasses the Health and Human Services Commission, Department of State Health Services, Department of Family and Protective Services, Department of Aging and Disability Services and Department of Assistive and Rehabilitative Services, will be held tomorrow and Thursday. I of course will be there advocating for more funding for ongoing mental health services, substance abuse prevention, intervention and treatment services, Prevention and Early Intervention Services, and school-based health centers.  Just a tip for anyone who plans on making the trek to Austin–public testimony on Article 2 will only be held for a couple of hours on Wednesday evening and then all day Thursday.  If you can only go on one day, I would make it Thursday.

Senate Terms

The terms of Texas state senators usually are staggered so all senators are not up for re-election at the same time. However, in the election cycle following redistricting, all 31 state senators are on the ballot. In the legislative session following that election cycle–like the current one–the senators have a lottery to determine who will be up for election in 2 years and who gets to wait another 4 years. That lottery took place last Wednesday, with 11 Republicans and 4 Democrats drawing 2-year terms, and 8 Republicans and 7 Democrats drawing 4-year terms. The Harris County-area senators drew the following terms:
Ellis–4
Huffman–2
Patrick–2
Taylor–4
Whitmire–2
Williams–4

For Senate District 6, vacated by the late Sen. Mario Gallegos, the Secretary of the Senate drew a 4-year term. Speaking of…

Battle of the Titans

This past Saturday was the special election for Senate District 6. The special election pretty much confirmed what most people already knew–this race was between two titans in Latino politics, and nobody else. Former Harris County Commissioner Sylvia Garcia led the race with 45.4% of the vote, and State Representative Carol Alvarado was close behind with 41.6%. The good news is, both candidates have a track record in support of behavioral health issues, so advocates will have another friend in the Senate no matter who wins. Governor Perry has less than two weeks to set the run-off election date, but it will likely be held in late February or early March. Between now and then, it’s fair to say that we will see a very “spirited” race. In the end, though, it’s all about turn-out, so grassroots mobilization will be key. May the best woman win!

Bill Updates

So far, almost 1,500 bills and resolutions have been filed in the House and Senate.  Because Senate committees already have been assigned, a number of bills have been referred and may soon be set for hearings.  Mental health and substance abuse bills of interest include:

HB 631 by Sara Davis, which requires the Department of State Health Services to establish an advance directive registry accessible by authorized healthcare professionals;

HB 645 by Dianne Patrick, which requires that at least one member of the Texas State Board of Examiners of Psychologists be a school psychologist; and

HB 720 by Price, which enhances the penalty to the next highest degree for intoxication manslaughter and intoxication assault offenses if the person did not stop at the scene, contact law enforcement or emergency personnel, and remain on the scene until law enforcement or emergency personnel arrived

For a more in-depth look at filed behavioral health legislation, and to see MHA’s position on these bills, click here.

Hasta next time!

New Rules, Different Committees, and More Bills

After the budget bills were filed, the rest of the second week of the 83rd Legislative Session was somewhat uneventful. But there were still a couple interesting developments to share. In this post we’ll focus on House Rule changes, Senate Committee appointments and more mental health and substance abuse bills.

House Rules

Last Monday the House of Representatives passed HR 4, the resolution adopting the rules under which that chamber will operate this session.  A few notable “good government” changes include:

  • Making it more difficult to sustain points of order on committee reports and related documentation “if the purpose of that section of the rules has been substantially fulfilled and the violation does not deceive or mislead.” This will likely reduce the number of bills killed for purely technical reasons in the waning days of session;
  • Allowing committees to post on the Internet committee substitutes and amendments that are laid out in committee (whether or not they have been adopted) and “non-confidential” written testimony by state agencies; and
  • Directing the committee coordinator to determine the feasibility of and, as soon as appropriate, develop procedures to allow the submission of video testimony by the public on bills being heard in committee.  For those of us who first have to travel to Austin, then wait like six hours to testify on the appropriations bill, wouldn’t this be FABULOUS???

Senate Committees

Last Friday, Lt. Governor Dewhurst released the new Senate Committee appointments for the 83rd Legislature. The major committees of interest, at least from my perspective, are Finance, Health and Human Services, Education, and Criminal Justice. There weren’t a whole lot of changes in any of those committees from the previous session, but of course a couple notable Chair switches. Sen. Tommy Williams replaced retired Sen. Steve Ogden as Chair of Finance, and Sen. Dan Patrick replaced retired Sen. Florence Shapiro as Chair of Education. Both of these Harris County-area senators have previously stated their support for various mental health issues, so hopefully we will see that reflected in the bills that pass through their respective committees this session.

Harris County has another voice on Finance with the addition of Sen. Joan Huffman. This is a great move for mental health advocates, as Sen. Huffman co-authored an op-ed during the interim about the need for more funding for community-based mental health services. Health and Human Services looks like it will be a good committee for mental health advocates as well, with the addition of Sens. Larry Taylor and Charles Schwertner. I had a great meeting with Sen. Taylor during the interim, and he “gets” mental health. Sen. Larry Schwertner also has some knowledge of the issues, and it doesn’t hurt that his mother is the Board president of one of our MHA affiliates! Having Sen. Taylor on Education is another plus, and Sen. Lucio will make a great Vice-Chair. Sen. Rodney Ellis will no longer be serving on Criminal Justice, which is definitely a loss for those of us who advocate for criminal justice reforms, but I have no doubt that he will continue his dedicated work in this area.

Behavioral Health Legislation

We had another 150 or so bills filed last week and now are up to 949 bills filed, as of Monday, January 21st. Newly filed mental health and substance abuse bills include:

HB 576 by Guillen, which requires the Texas Higher Education Coordinating Board to create a system to track the careers of medical school graduates, including how long they work in primary care and which specialties they choose, and how long they work in a professional shortage area;

HB 592 by Naishtat, which adds Post-Traumatic Stress Disorder to the list of serious mental illnesses for which health insurance plans are required to provide coverage; and

HB 596 by Naishtat, which allows the prescription and use of marijuana for medical purposes. Yup, you read correctly!

For a more in-depth look at filed behavioral health legislation and to see MHA Houston’s position on these bills, click here:

Stay tuned for more news!

President Obama’s Plan in Response to Sandy Hook

I really don’t want to flood people’s inboxes with information, but after reading Now Is the Time–the President’s Plan to Protect Our Children and Our Communities by Reducing Gun Violence, I just HAD to share it and make a couple comments.

First, I appreciate the President including mental health in his plan, but also presenting it in a non-stigmatizing way.  Unfortunately, a lot of the coverage of the Sandy Hook tragedy negatively portrayed people with mental illness, and when that happens, people are less willing to seek help.  I think the messaging for the mental health component of this report is right on target.

Second, I think the mental health recommendations themselves are excellent.  They are practical and address many of the issues for which we have been advocating–training teachers in recognizing the signs of mental illness, promoting early identification and referral to treatment, increasing the mental health workforce, and finalizing the Mental Health and Addiction Equity Rules.

Of course, whether Congress actually approves the funding tied to these proposals is still up in the air, but I think this is a great first step and one that all behavioral health advocates should support.

For ease of view, I have pasted the mental health recommendations below.

MAKE SURE STUDENTS AND YOUNG ADULTS GET TREATMENT FOR MENTAL HEALTH ISSUES

Three-quarters of mental illnesses appear by the age of 24, yet less than half of children with diagnosable mental health problems receive treatment. And several recent mass shootings, including those at Newtown, Tucson, Aurora, and Virginia Tech, were perpetrated by students or other young people.

• Reach 750,000 young people through programs to identify mental illness early and refer them to treatment: We need to train teachers and other adults who regularly interact with students to recognize young people who need help and ensure they are referred to mental health services. The Administration is calling for a new initiative, Project AWARE (Advancing Wellness and Resilience in Education), to provide this training and set up systems to provide these referrals. This initiative, which would reach 750,000 young people, has two parts:

Provide “Mental Health First Aid” training for teachers: Project AWARE includes $15 million for training for teachers and other adults who interact with youth to detect and respond to mental illness in children and young adults, including how to encourage adolescents and families experiencing these problems to seek treatment.

Make sure students with signs of mental illness get referred to treatment: Project AWARE also includes $40 million to help school districts work with law enforcement, mental health agencies, and other local organizations to assure students with mental health issues or other behavioral issues are referred to the services they need. This initiative builds on strategies that, for over a decade, have proven to decrease violence in schools and increase the number of students receiving mental health services.

 • Support individuals ages 16 to 25 at high risk for mental illness: Efforts to prevent school shootings and other gun violence can’t end when a student leaves high school. Individuals ages 16 to 25 are at high risk for mental illness, substance abuse, and suicide, but they are among the least likely to seek help. Even those who received services as a child may fall through the cracks when they turn 18. The Administration is proposing $25 million for innovative state-based strategies supporting young people ages 16 to 25 with mental health or substance abuse issues.

• Help schools address pervasive violence: Twenty-two percent of 14 to 17 year olds have witnessed a shooting in their lifetime. Research shows that exposure to community violence can impact children’s mental health and development and can substantially increase the likelihood that these children will later commit violent acts themselves. To help schools break the cycle of violence, Congress should provide $25 million to offer students mental health services for trauma or anxiety, conflict resolution programs, and other school-based violence prevention strategies.

• Train more than 5,000 additional mental health professionals to serve students and young adults: Experts often cite the shortage of mental health service providers as one reason it can be hard to access treatment. To help fill this gap, the Administration is proposing $50 million to train social workers, counselors, psychologists, and other mental health professionals.  This would provide stipends and tuition reimbursement to train more than 5,000 mental health professionals serving young people in our schools and communities.

 • Launch a national conversation to increase understanding about mental health: The sense of shame and secrecy associated with mental illness prevents too many people from seeking help. The President is directing Secretaries Sebelius and Duncan to launch a national dialogue about mental illness with young people who have experienced mental illness, members of the faith community, foundations, and school and business leaders.

ENSURE COVERAGE OF MENTAL HEALTH TREATMENT

While most mental illnesses are treatable, those with mental illness often can’t get needed treatment if they don’t have health insurance that covers mental health services. The Affordable Care Act will provide one of the largest expansions of mental health coverage in a generation by extending health coverage to 30 million Americans, including an estimated 6 to 10 million people with mental illness. The Affordable Care Act will also make sure that Americans can get the mental health treatment they need by ensuring that insurance plans cover mental health benefits at parity with other benefits.

• Finalize requirements for private health insurance plans to cover mental health services: The Administration will issue final regulations governing how existing group health plans that offer mental health services must cover them at parity under the Mental Health Parity and Addiction Equity Act of 2008. In addition, the Affordable Care Act requires all new small group and individual plans to cover ten essential health benefit categories, including mental health and substance abuse services. The Administration intends to issue next month the final rule defining these essential health benefits and implementing requirements for these plans to cover mental health benefits at parity with medical and surgical benefits.

• Make sure millions of Americans covered by Medicaid get quality mental health coverage: Medicaid is already the biggest funder of mental health services, and the Affordable Care Act will extend Medicaid coverage to as many as 17 million hardworking Americans.There is some evidence that Medicaid plans are not always meeting mental health parity requirements today, an issue that will only become more important as Medicaid is expanded. The Administration is issuing a letter to state health officials making clear that these plans must comply with mental health parity requirements.

Week 1 of the Lege and Some Local News: Part 2

In Part 2 of this post, check out the House and Senate budget plans related to mental health and substance abuse, updated legislation, and more on MHA Houston’s meeting with District Attorney Mike Anderson

All About the Budget

Well, they’re finally here! The budget bills–House Bill 1 and Senate Bill 1–were filed late yesterday. Both spend roughly $89 billion in biennial General Revenue, and both slightly increase actual funding over the last biennium.  But don’t start applauding yet. According to the Center for Public Policy Priorities, the actual amount needed to maintain current service levels and account for growth is about $97 billion for the biennium. The budget bills present a mixed bag for mental health and substance abuse services, with mostly flat funding, though a few notable increases and decreases.  Highlights include: 

  • Funding for ongoing public community mental health services was cut by about $5 million over the biennium, reducing the average monthly number of adults served by about 300 in Fiscal Year ’14. These cuts are in addition to the roughly $25 million that was cut from adult mental health services last session;
  • Funding for ongoing public community mental health services for children also was cut by over half a million dollars, reducing the average monthly number of children served by about 200 in Fiscal Year ’15;
  • Funding for both state hospitals and community hospitals was slightly increased.  This seems to continue the Legislature’s trend of investing more money in acute care than in the community-based services that help keep people stable;
  • Funding for substance abuse prevention, intervention and treatment services was slightly increased by about $2 million, with no change in the number of children and adults expected to receive services; and
  • Funding for Communities in Schools was increased in the House Bill but remained static in the Senate bill, with an increase of over 30,000 more children served if the House version prevails.

To find out how other mental health and substance abuse services fared related to prevention, treatment, education and juvenile/criminal justice, click here.

While the initial budget bills certainly leave much left to be desired for behavioral health advocates, the good news is that the process is just beginning. We have the next four and a half months to impress upon the Legislature the need to increase funding for mental health and substance abuse programs, so we need all hands on deck!

Behavioral Health Legislation

In other legislative news, we’re now up to 800 filed bills as of Monday, January 14th. Mental health and substance abuse bills of interest include:

HB 424 by Burkett, which requires a group home owner to check the sex offender status of new residents and, within three days, notify other residents if a new resident is a sex offender;

HB 446 by Dukes, which requires DSHS to develop and make available on its website a pamphlet about the risks of alcohol consumption while pregnant, including fetal alcohol syndrome, and requires health care providers to counsel pregnant women about this issue and provide them with information; and

HB 473 by Turner, which requires Medicaid Managed Care organizations to require prior authorization before a child under the age of 5 is prescribed psychotropic medications and that HHSC to authorize a psychotropic medication through the vendor drug program before it is provided to a child under the age of 5

For a more complete list of filed behavioral health legislation and to see MHA Houston’s position on these bills, click here.

Meeting with Harris County District Attorney Mike Anderson

Last Friday, MHA Houston CEO Susan Fordice, Public Policy Committee Chair George Parnham, and I met with Harris County District Attorney Mike Anderson and Denise Oncken, Chief of the Mental Health Division, to discuss recommendations to improve the handling of people with mental illness and/or substance use disorders involved in the criminal justice system. The recommendations we shared included:

  • Continue the Juvenile Non-Petition Deferred Prosecution Program for first-time Misdemeanor A and B offenses;
  • Whenever possible, opt for pre-charge diversion into treatment for people with mental illness and/or substance use disorders who commit minor, non-violent offenses;
  • Increase use of deferred adjudication—in lieu of a conviction resulting in incarceration—for people with mental illness and/or substance use disorders who commit minor offenses;
  • If trace policy is discontinued, increase use of deferred adjudication—in lieu of incarceration—for individuals caught with trace amounts (less than 1/100th of a gram) of illegal substances; and
  • Leverage use of asset forfeiture funds to increase the availability of community resources that keep repeat offenders with mental illness and substance use disorders out of jail

Anybody who may have been concerned about how DA Anderson would approach these issues need not worry. He was very open and receptive to the ideas presented. His office plans to continue the Juvenile Non-Petition Deferred Prosecution Program, though we will have to work at the legislative level to ensure the offenses are expunged from juveniles’ records; he is willing to look at pre-charge diversions and increased use of deferred adjudication for certain offenses; and he is open to using the asset forfeiture funds for effective mental health and substance abuse programming. As mentioned in Part 1 of this post, his office already has authorized $500,000 of the asset forfeiture funds for the mental health dockets.

MHA Houston has agreed to conduct mental health trainings for prosecutors in the DA’s Office and be a resource whenever and however we can. We look forward to a strong continuing relationship with the DA to ensure that Harris County diverts people with mental illness and substance use disorders from the criminal justice system whenever possible.

Growing Up in America Radio Show

Yours truly was interviewed about children’s mental health on the Children at-Risk Radio Show, Growing Up in America. We had a really great conversation about some of the issues that will be addressed this session. To hear the podcast, click here. Growing Up in America airs every Monday from 3:00 – 4:00 p.m. on 90.1 KPFT.

Well, that’s all I’ve got for now!

Week 1 of the Lege and Some Local News: Part I

Members of the Texas House of Representatives take the oath of office.

Members of the Texas House of Representatives take the oath of office on Opening Day of the 83rd Legislature.

Week 1 of the 83rd Legislative Session brought the swearing-in of 180 members of the Legislature, the re-election of House Speaker Joe Straus, and Governor Perry’s plans for the budget “surplus”. We also had a couple of interesting local developments, including a transition for the felony mental health court.

In the House

The first day of session was full of pomp and circumstance. MHA Houston viewed Opening Day ceremonies from the House Gallery. As expected, Joe Straus was re-elected Speaker of the House after Rep. David Simpson withdrew his candidacy. Straus pledged to be a fair Speaker and laid out his top priorities for the session: 1) Education, including possible revisions to the accountability system; 2) Transportation/Infrastructure; 3) Water; and 4) Budget Transparency, stating that he’d like to see collected fees go to their stated purpose or not be collected at all. Amen to that! However, it was a little disappointing not to hear any mention of health and human services–let alone mental health and substance abuse–but that just makes our advocacy all the more important.

Senate Happenings

On the east wing of the Capitol, Lt. Governor David Dewhurst pledged to make the 83rd Legislative Session “the most conservative session in Texas history.” His priorities included drug testing for unemployment benefits, school choice, a balanced budget, and securing the border. Sen. Leticia Van de Putte was elected President Pro Tempore, making her third in line for the Governorship. Her top focus areas will be education, veterans, and human trafficking. Former Presidential Candidate Rick Santorum also stopped by to support newly elected Sen. Ken Paxton.

One more development worth mentioning is last Wednesday’s vote to maintain the 2/3 Rule in the Senate. This longstanding policy requires that at least 21 members of the 31-Member Senate agree to bring up a bill before it is debated. This means that some of the more controversial bills–including some of the Leadership’s priorities–may never see the light of day.

A Word from the Governor

Governor Perry addressed both the House and Senate on Opening Day and had a message to legislators about advocates like myself: “They all want more for their causes, they all figure we have money pouring out of our ears now, and they all have your address and phone number.” No disagreement there!

The Governor’s priorities echoed some of the priorities set forth by Speaker Straus and Lt. Governor Dewhurst: Infrastructure for water, energy and transportation, an educated workforce, and budget transparency. He also brought up the prospect of tax relief and opposed using Rainy Day funds for ongoing expenses. Specific legislative initiatives for which he indicated his support were drug screening for public assistance and unemployment benefit programs and banning abortion after 20 weeks of development. Again, besides the drug screening push, no mention of mental health or substance abuse.

So after week one, behavioral health advocates need to prepare for a looooooong session. We’ll have to be in full force in order to shed the spotlight on these issues that, if funded appropriately, could lead to substantial savings in other areas of the Texas budget, potentially resulting in even more taxpayer relief. After all, isn’t that the ultimate goal of our state’s Leadership?

Shift for Therapeutic Courts

Locally, we’re going to see some changes in the felony mental health court over which Judge Jan Krocker previously presided. After a decision by the criminal court judges last week, the felony mental health court will now be split between Judge David Mendoza of the 178th Criminal Court and Judge Brock Thomas of the 338th Criminal Court. I encourage everyone to thank Judge Krocker for her tireless efforts over the past several years to bring this court to fruition.  Please also support Judges Mendoza and Thomas as they carry this important work forward.  We must all continue to be vocal about the need to promote alternatives to incarceration for people with mental health and substance use disorders. 

In related news, in a recent meeting with MHA Houston, District Attorney Mike Anderson informed us that he has approved $500,000 from his office’s asset forfeiture funds for the mental health dockets to use for staffing, transitional housing, medications and outpatient treatment. We appreciate his support of these important programs.

Tune in tomorrow for Part 2 of this post and for more on our meeting with the DA, updated mental health and substance abuse legislation, and other legislative news!

83rd Legislature, Here We Come!

Tuesday, January 8th marks the start of the 83rd Texas Legislative Session, so get ready for 140 fast-paced days of legislative wheeling and dealing. MHA Houston staff and volunteers will be under the Pink Dome tomorrow to observe Opening Day ceremonies and talk with legislators about community mental health needs. Be sure to tune in to the Texas Legislative Update for pertinent mental health and substance abuse news.

Let the Good News Roll!

With many still reeling from the deep budget cuts made to health and human services during the last legislative session, it was great to hear the newest budget estimate from Comptroller Susan Combs. According to Combs, Texas will have $101.4 billion available for the state’s general fund—an estimated $96.2 billion that will be generated during fiscal years 2014 and 2015 plus an additional $5.2 billion in unexpected revenue left in the fund from the current fiscal year 2012-2013 budget cycle. While the Texas economy actually generated $8.8 billion more in revenue in the current budget cycle than originally anticipated, $3.6 billion of that will be transferred to the Rainy Day Fund, which will increase to $11.8 billion.

Additional Mental Health Funding?

This of course is great news for mental health and substance abuse advocates. Having a budget “surplus” significantly increases the probability that additional funds will be appropriated to meet the needs of mental health consumers and people in substance abuse recovery. In fact, State Representative Sylvester Turner has announced his intent to seek “an unprecedented level of funding for mental health services in this state,” recommending that the Legislature appropriate an additional $250 million for mental health services over the biennium. This initiative has bipartisan support from members of the Harris County State Legislative Delegation, including, but not limited to, Senators Joan Huffman and John Whitmire and Representatives Alma Allen, Carol Alvarado, John Davis and Jessica Farrar. Rep. Turner also has discussed his proposal with Texas House Speaker Joe Straus.

MHA Houston will continue working with these and other legislators to advocate for increased funding for both mental health and substance use disorders so people can live their lives to their fullest potential.

Behavioral Health Legislation

At the time of writing, over 550 bills have been pre-filed in advance of the 83rd Legislative Session. A number of these bills address mental health and substance abuse issues, including:

HB 260 by Callegari, which would require an ignition interlock device to be placed on the motor vehicle of any individual placed on community supervision for certain offenses related to driving while intoxicated;

HB 282 by Lucio III, which would require school districts with 300 or more enrolled students to employ at least one certified school counselor for each 300 students. This bill reduces the counselor-to-student ratio from 1:500 to 1:300 and expands the requirement to intermediate, middle and high school students;

SB 44 by Zaffirini, which would require the Department of Family and Protective Services to track cases in which parents relinquish custody of their children to the State for the sole purpose of obtaining mental health services. While this is not an uncommon practice, DFPS currently does not track these cases; and

SB 152 by Nelson, which aims to address some of the cases of abuse and neglect against state hospital patients that have made headlines in the past few months. The bill would improve training for state hospital employees, establish a tracking system for reports of cases of abuse or neglect, and prohibit retaliation against any state hospital employee who cooperates with an investigation of these cases

For a more in-depth view of filed behavioral health legislation and to see MHA Houston’s position on these bills, go to http://www.mhahouston.org/files/255/.