Even Bigger Budget News, a Local Jail Update, and More Bills

In this post, learn about preliminary Senate Finance Article II Workgroup decisions on mental health and substance abuse funding, news about privatization plans for the Harris County Jail, and more behavioral health legislation.

Andreas Loves the Article II Workgroup

Budget proceedings as they relate to mental health and substance abuse just keep getting better and better, at least in the Senate. Last week the Article II Workgroup met to determine preliminary funding levels for health and human services. There are three different decisions the workgroup can make:

PRIORITY 1–items that the workgroup gives its highest priority and recommendation for funding
PRIORITY 2–important items the workgroup would like to fund, if funding is available
PENDED–items on which the workgroup took no action (this does not mean action will not be taken at a later date)

The workgroup’s decisions related to the current Department of State Health Services mental health and substance abuse Exceptional Items are as follows (and thanks to a Senate staffer and Lee Johnson with the Texas Council for filling in details!):

DSHS Exceptional Item # 6–$80 million to eliminate statewide waiting lists
a. Children with Special Health Care Needs (802 additional clients served per year) $23,600,000 PRIORITY 2
b. MH Adults (6,242 additional clients served per year) $54,100,000 PRIORITY 1
c. MH Children (286 additional clients served per year) $3,100,000 PRIORITY 1

DSHS Exceptional Item #7–$33,550,084 to improve substance abuse services
a. Capacity Expansion (948 additional clients served per year) $4,941,828 PENDED
b. Substance Abuse Provider Rate (12% increase) $18,471,549 PRIORITY 1
c. Set aside slots for people referred by DFPS (6,000 over the biennium) $10,136,707 PRIORITY 1

DSHS Exceptional Item #8–$28,037,202 for supportive housing services for people with mental illness and substance use disorders
a. Oxford House (supportive housing for people in substance abuse recovery) $ 1,140,000 PRIORITY 1
b. Relinquishment Slots for DFPS (10 beds per year) $ 2,056,262 PRIORITY 1
c. Rental Assistance (people with mental illness who are homeless or at-risk for homelessness and new Medicaid 1915i state plan option)–$24,840,940 PRIORITY 1

In addition, the $115.5 million plan that DSHS unveiled last week also was made a Priority 1 item. So all in all, the Article II Workgroup prioritized almost $30 million for substance abuse related services, and about $200 million for mental health services!

The total Article II Workgroup Priority 1 ask was $2.5 billion, the lion’s share of which was related to Medicaid. Senate Committee Finance Chairman Tommy Williams asked the workgroup to pare down its ask to $1.7 billion, but specifically asked Workgroup Chairwoman Jane Nelson to do everything possible to protect the $200 million identified for mental health! I am hoping the Workgroup also will preserve the current substance abuse Priority 1 items, as well as add the $5 million substance abuse capacity expansion item to that list. 

The full Finance Committee is expected to meet this Friday to consider the Workgroup’s final health and human services recommendations, so stay tuned for more on this!

County Poised to Say “No” to Privatization

This morning, Harris County Commissioners Court will meet to approve a number of different projects recommended by the Purchasing Office. Privatization of the Harris County Jail will not be among them.

In April 2011, Commissioners Court voted to accept bids to privatize the jail. This caused concern among a number of advocates, including this blogger, particularly due to the potential disruption of health and mental health services to inmates. On any given day, the Harris County Jail houses almost as many people with mental illness as the entire state hospital system, so privatizing these services would have affected more people with mental illness than the recently scrapped proposal to privatize a state hospital.

According to the Houston Chronicle, out of the four bids that were submitted, the bid from the Corrections Corporation of America (CCA) was the only proposal that was seriously considered. While CCA estimated cost savings of between $8 and $11 million, there was uncertainty about whether the savings actually would be realized.  Additional concerns included the impact of privatization on security, re-entry programs and inmate treatment.

So, we can put the nail in the coffin on this one for now. Kudos to the County for making what appears to be the right decision, particularly for the 2,100 or so inmates with mental illness who are housed in the jail each day!

Behavioral Health Legislation

OK, so back to the Legislature.  As of yesterday, over 2,700 bills have been filed by House and Senate members. The filing deadline is next Friday, March 8th, and if previous sessions are any guide, we’ll probably see another two or three thousand bills filed between now and then! I’ll save my “sigh” for when I’m sifting through a thousand bills next weekend. Anyhoo, mental health and substance abuse bills of interest include:

HB 1541 by Turner, which requires the Texas Department of Criminal Justice, along with the Texas Juvenile Justice Department and Department of Public Safety, to conduct a comparative study on the supervision, incarceration and treatment practices of TDCJ and TJJD on recidivism and rehabilitation rates of young offenders;

HB 1698 by Farrar, which adds school social workers to the Education Code and details their responsibilities, including assessment and counseling of students and their families, providing crisis prevention and intervention services, and coordinating community resources to meet the needs of students and their families; and

HB 1745 by Naishtat, which requires hospitals and emergency rooms to report to the Department of State Health Services regarding suicide attempts

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

Hasta next week!

Big Budget News, School Behavioral Health and Bills

In this post, learn about the Department of State Health Services’ big budget recommendation for mental health, information about school behavioral health initiatives, and an updated list of behavioral health legislation.

Biggest Possible Mental Health Increase…EVER?

Yesterday, DSHS Commissioner David Lakey unveiled a comprehensive mental health services plan to the Senate Finance Article II Workgroup. According to my friend and colleague Danette Castle of the Texas Council of Community Centers, the $115.5 million plan includes the following components:

    • Public Awareness Campaign:  $4 million
      To address stigma and increase public awareness of mental health, mental illness & how to access help.
    • Prevention & Early Identification:  $2 million
      To increase availability of school-based training for teachers and other school staff (through 20 Educational Service Centers)
    • Crisis Services:  $30 million
      Includes 15 grants (would require 25% local match) for crisis stabilization and other crisis services to divert hospitalization.
    • Mental Health Treatment:  $52.5 million
      To address increased demand as a result of public awareness campaign and increased crisis services.  $20 million of this amount for mental health adults & children services, $32.5 million to expand YES Waiver services.
    • Collaborative Projects:  $10 million
      Provide grants to leverage public and private resources to address mental illness, substance use disorders and contributing factors.  5 grants at $2 million each – Haven for Hope in San Antonio used as example.
    • Funds for Underserved:  $17 million
      To address people receiving fewer services than they need in lieu of creating waiting list.

I should note that these funds are ABOVE and BEYOND what DSHS already has outlined in its $100 million plus mental health and substance abuse Exceptional Items requests (more on these below). 

Needless to say, this plan is HUGE for advocates!  I’ve been around for less than 40 years, but I think it’s safe to say that the passage of this plan would represent the single largest increase for mental health EVER. It’s going to take a full court press to pass this, but I know advocates are up to the challenge!

And don’t fret, my substance abuse friends–the Senate Article II Workgroup already has declared the substance abuse exceptional item a priority! 🙂

Looks like It’s shaping up to be a pretty good legislative session for behavioral health!

House Appropriations Article II Subcommittee

Although it’s tough to beat that first bit of news, the House Appropriations Article II Subcommittee also met last Wednesday to take testimony on funding for the Department of Health Services. I was there to deliver testimony, along with fellow Houston consumers and advocates from St. Joseph’s House. Thanks so much for making the trek, gang!

Mental health and substance use disorders were a significant focus of the hearing. Commissioner Lakey laid out Exceptional Item 6 ($57.2 million–eliminating the statewide mental health service waiting list), Exceptional Item 7 ($33.6 million–eliminating the statewide substance abuse waiting list and increasing provider reimbursement), and Exceptional Item 8 ($23.2 million–increasing housing and support options for people with mental health and substance use disorders). He noted that substance use disorders are among the largest cost drivers in the criminal justice and child welfare systems and also discussed the successful outcomes of the Oxford House model. When pressed by Subcommittee Chairman John Zerwas about whether there was a need for a significant increase in funding for mental health services due to the large number of 1115 waiver projects that address mental health, Commissioner Lakey was adamant that the 6,000+ people waiting for mental health services across the state need services now, not later. Amen to that!

A Plan for Improving School Behavioral Health

MHA’s School Behavioral Health Initiative, which convened school district personnel, behavioral health providers, child-serving and education-related agencies, and parents, recently issued its full report containing recommendations to improve the prevention, identification and treatment of behavioral health issues among students. The report includes 37 recommendations aimed at the Texas Legislature, state agencies, Commissioners Court, school districts and community agencies.  MHA already has been working at the state legislative level to promote legislation that furthers the implementation of these recommendations.  Among them are SB 460 by Deuell, which would require mental health training in educator preparation programs.  I will keep you abreast of additional legislation and budget riders that are filed!

Federal School Behavioral Health Legislation

On a related note, U.S. Senator Al Franken and U.S. Representative Grace Napolitano have filed S. 195 and H.R. 628, the Mental Health in Schools Act. The Mental Health in Schools Act would provide grants to partnerships between school districts and community organizations to implement programs that promote behavioral health, reduce the likelihood of students developing mental health and substance use disorders, and provide early identification of mental health and substance use disorders.  It also calls for the appropriate training of school personnel, as well as parents and other family members.

Please urge Senators John Cornyn and Ted Cruz, as well as your U.S. Representative, to support this legislation. You can do so easily by clicking here!

Behavioral Health Legislation

While almost 2,200 bills have been filed, MHA is now tracking over 100 mental health and substance abuse related bills! Gotta be honest–I’m really hoping we don’t reach 200! Mental health and substance abuse bills of interest include:

HB 1191 by Burkett, which requires the Texas Department of Housing and Community Affairs to make information about public and private housing options for people with mental illness available through the Texas Information and Referral Network website;

HB 1266 by Guillen, which establishes the 18-member Adult and Juvenile Administrative Segregation Task Force to review and make recommendations regarding administrative segregation and seclusion policies in Texas juvenile and adult correctional facilities;

HB 1396 by Susan King, which requires the Department of Family and Protective Services to annually report information regarding the number of children who are born addicted to alcohol or controlled substances; and (just for fun)

SB 612 by Lucio, which requires that candidates for elected office submit to a drug screen. 🙂

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

As always, stay tuned for more up-to-date mental health and substance abuse legislative news!

Another Week in the Lege

In this post, more information about upcoming budget hearings and the House Supplemental Appropriations bill, Mental Health Day at the Capitol, as well as plenty of new mental health and substance abuse legislation.

Budget Business

Yesterday the House Appropriations Committee voted out a $4.8 billion Supplemental Appropriations bill to cover the budget shortfall in the current biennium, largely due to the unpaid Medicaid tab left from last session. Somewhat surprisingly–at least to Chairman Jim Pitts–the bill was voted out of committee 25-0.

As previously mentioned, the House Appropriations Article II Subcommittee will be hearing public testimony regarding the Department of State Health Services, which oversees funding for public mental health and substance abuse services, tomorrow, February 13th. The hearing will be held at 7:30 am in Room 120 of the John H. Reagan Building, located at 105 West 15th Street in Austin, TX. Yea to leaving home at 4:30 am! Sigh. Good thing I already have my testimony drafted, which you can access here.

The Senate Article II workgroup, chaired by Sen. Jane Nelson, with Senate Members Bob Deuell, Joan Huffman, Dan Patrick and Judith Zaffirini, will be meeting the following day to begin making its funding recommendations for health and human services items.

Mental Health Day at the Capitol

Mental Health Day at the Capitol will be held on February 28th! A bus will leave Houston at 6:00 am from the NAMI of Greater Houston office. If you want to reserve your seat, you can do so by contacting Natalie Cloyd at ncloyd@namimetrohouston.org or 713-970-4419.

Whether you are driving or riding the bus, the day requires a $10 registration fee, which includes the cost of lunch. You will need to complete a registration form and return it, along with your $10 fee, to the Texas Federation of Psychiatry. Please note that MHA will be covering the registration cost for all participating MHA Members, as well as for consumers. 

If you have any questions, contact me directly at ausanga@mhahouston.org. Hope that many of you will participate in this exciting day!

Behavioral Health Legislation

We’re now passed the 2,000 filed bill mark–woo hoo!  There were a number of mental health and substance abuse bills filed in the past week, including:

HB 933 by Sylvester Turner, which allows the expunction of a juvenile record after the juvenile’s 17th birthday if the juvenile completed a deferred prosecution program and had no other referrals resulting in adjudication or deferred adjudication. This will be of benefit to youths participating in the Harris County District Attorney Office’s Juvenile Non-Petition Deferred Prosecution Program;

HB 1023 by Burkett, which creates a task force to investigate the mental health workforce shortage in the state and to make recommendations to alleviate the identified shortages;

HB 1070 by Allen, which allows the expunction of arrest records for offenses related to the possession of alcohol or controlled substances under certain circumstances; and

SB 460 by Deuell, which requires that, in educator preparation programs, teachers receive training in the detection and education of students with mental or emotional issues. This bill is the result of a recommendation from MHA’s School Behavioral Health Initiative.

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

Hero? Moi?

Finally, I surprisingly was named Children at-Risk’s February Hero of the Month.  It is an honor to receive this recognition, particularly from an organization that has done so much to advance the cause of children both locally and across the state!

That’s all I’ve got for now.  Until next time…

House Budget Hearings

Get ready–the House Appropriations Article II Subcommittee has been named, and public hearings will begin next week! Rep. John Zerwas is the Chair, and members include Rep. Dawnna Dukes, Rep. Stefani Carter, Rep. Sarah Davis, and Rep. Four Price. Yea to some good Houston-area representation!

The Article II agencies will be heard on the following dates:

Monday: Health and Human Services Commission

Tuesday: Department of Aging and Disability Services

Wednesday: Department of State Health Services

Thursday: Department of Assistive and Rehabilitative Services and Department of Family and Protective Services

Get ready for some long days, as the subcommittee likely will start meeting in the afternoons once the House adjourns (with the possible exception of Monday). But hey, that’s the price of advocacy!

Hope to see many of you there advocating for increased mental health and substance abuse funding!

Legacies, Lawsuits and Legislation

The Legislature has been pretty busy the past week.  House Committees have been assigned, budget hearings are under way and mental health received its long-awaited “shout-out”.

The Legacy of JFK

Our National organization noted that today marks the 50th anniversary of President John F. Kennedy’s special message to Congress regarding mental illness and intellectual and developmental disabilities.  In it, he called for expanded mental health research, an increase in the mental health workforce, improved care in state mental hospitals and “a new type of health facility, one which will return mental health care to the main stream of American medicine, and at the same time upgrade mental health services.”  Thus was born the community mental health center.  He stressed that “prevention as well as treatment will be a major activity” of these new centers, and that they will provide “a more cordial atmosphere for [an individual’s] recovery.” Wow.

We’ve come a long way from the 3,000-patient state mental hospitals of the past, but we are still struggling with some of the very concepts JFK so boldly declared. How much do we really invest in prevention? Are we making recovery a central focus of treatment?  What would the former president think about the newer version of institutions, namely jails and prisons? I cringe at the thought.

As we reflect on and celebrate how far we’ve come in the care and treatment of people with mental illness, we must recommit to going further still.

House Committees Assigned

The Legislature is now in full swing–Speaker Straus released his House committee appointments last Thursday.  Lots of changes in committees, as over a quarter of the House members are freshmen. The Appropriations Committee has many familiar faces, with at least one notable addition–State Representative Sara Davis.  She has an interest in health and human services and, from what I can determine from previous meetings with her, does have a knowledge base of mental health and substance abuse issues.  I’m disappointed though, that in addition to Rep. Davis, there are only 2 other Houston-area representatives on this 27-member committee–Vice-Chairman Sylvester Turner and Rep. John Zerwas. Rep. Debbie Riddle was not reappointed this session. 

Perhaps we have so few Houston-area reps on Appropriations because they are all on Public Education–4 of the 11 members are from Harris County.  At least 3 of them have been advocates for mental health and/or substance abuse issues, so I’m hoping some of our teacher training legislation will do well in this committee.  Public Health had a little shake-up, but institutional knowledge was preserved with the reappointment of Chairwoman Lois Kolkhorst, Vice-Chair Elliott Naishtat, and long-time member Rep. Garnet Coleman. Criminal Jurisprudence only has one survivor from last session’s committee–Rep. Stefani Carter–so it’s anyone’s guess how amenable the committee will be to Not Guilty by Reason of Insanity statute changes and similar legislation.  Far more committees than I have time to dissect–what are your thoughts?

Budget Hearings

Now that the House Appropriations Committee has been appointed, members are hard at work resolving Texas’ budget issues.  This week the committee is looking at the supplementary bill to take care of the hole in the current budget.  Next week they will start looking at the budget for the upcoming biennium.  This means another opportunity for advocates to deliver testimony on mental health and substance abuse funding needs.  Stay tuned for more details!

Post-State of the State Shout-Out

In response to Governor Perry’s State of the State Address, the Texas House and Senate Democratic Caucuses issued a joint statement laying out their priorities for the 83rd Legislative Session.  We finally received the long-awaited shout-out of the session, as one of their priorities is to “strengthen the mental health system to adequately serve people in need.”  Hip hip hooray!  Hopefully this priority translates into reality this session.

Unconstitutional…again

Yesterday, State District Judge John Dietz declared that the Texas school finance system is unconstitutional…again.  While some behavioral health advocates may think this is not “our” issue, we must remember that a sizable percentage of the 25,000-plus public school jobs that were lost last school year were professional support staff such as counselors.  I think most of us can agree that we need more, not less, of these important positions in our schools.  Let’s hope that the Legislature makes the right decision and moves quickly to adequately fund our public schools.

Bills, Bills, Bills

As of Monday, February 4, over 1,600 bills have been filed during the 83rd Legislative Session.  Mental health and substance abuse bills of interest include:

HB 838 by Zerwas, which requires that a person consenting to the use of a psychotropic medication for a foster child ensure the child has an office visit with the prescribing physician at least every 90 days to monitor the effects of the drug and whether or not it is meeting prescribed treatment goals;

SB 278 by Watson, which requires that alcohol awareness programs for middle, junior high and high school students be taught as part of the school science curriculum (as opposed to the current health curriculum); and

SB 337 by Rodriguez, which requires Medicaid Managed Care Organizations to coordinate care with community centers and local mental health and mental retardation authorities for their clients who are also served by those entities.

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

Ta ta for now!