Minding Houston XV: Workforce Shortage? We have an app for that!

Welcome to the first Episode of Minding Houston for 2016. While it has been a while since we last spoke, we’ve been holding off as this episode isn’t just about policy discussions, it’s about results. And we need your help to get the word out about a program critical to the future workforce of Texas.

This is Minding Houston, I’m Bill Kelly

Astute listeners to this blog know that we have talked a lot about the mental health workforce being a big obstacle to access. In fact, we devoted a whole episode to it last February (See: Minding Houston IV), and almost a year to the day later, we are happy to announce the state of Texas is taking applications.

Senate Bill 239 by Senator Charles Schwertner creates the Mental Health Loan Repayment Assistance Program and is funded with almost $3 million. Details of the plan are shared below. The most encouraging aspect of the legislation (now law) is the recognition that it isn’t not just a lack of medical physicians, but the full spectrum of mental health providers are sorely needed to treat Texans.

LR slide
While in Austin talking about the lead up to the February 8th application launch, I was able to sit down with one of the leading voices for health care in Texas, Stacy Wilson of the Texas Hospital Association, to talk about the importance of this program:

 

StacyWilson and THA

Bill Kelly: Here with Stacy Wilson of the Texas Hospital Association. Thank you so much for joining me today.
Stacy Wilson: It’s a pleasure.
Kelly: We are talking about SB 239 and the specific loan repayment mental health professions bill. Who should really be looking at taking advantage of these monies.

Wilson: There are five groups of mental health professionals that are targeted under the bill: psychiatrists, psychologists, APRNs who have specialized training in mental health, licensed professional counselors, licensed clinical social workers.

Kelly: And I know we are big fans of the inclusion of social workers, especially in Houston, on it. When we talk about the monies that are available – and I know there is some restriction on exactly how many of each group can be included on that – what do people need to watch out for if they are interested in pursuing a degree in one of these fields?

Wilson: Well the great thing is that now we have included this beyond just physicians as you mentioned, but there are requirements around serving the CHIP and/or Medicaid populations and/or working in a state prison. So there are some certification requirements that you have to do, there is an application you have to fill out and at the end of each year in order to be eligible, you have to certify that you actually served that population and that you’ve met the other requirements.

Kelly: And we are going to be posting a link to information from the college coordinating board on our website, but what are some of the deadlines for people who would be applying for this for some of their graduate education?

Wilson: So what we’ve heard from the higher education coordinating board is that the applications will be available around February [8] and that they will probably be due around April 30. So there is a specific website that links to this as you have mentioned and those dates are a little flexible but obviously beginning February [8] you should start looking for them.

Kelly: And as we talk to different advocacy groups around our area, how important is this to get the message out about our workforce for behavioral health?

Wilson: It’s imperative. We can ask for all the services we want to ask and more impatient beds and outpatient services but unless you have that dedicated workforce, it doesn’t mean anything. So it is the backbone of everything else that we do

Kelly: Staci, thank you so much for joining us.

Wilson: Thank you so much

So, now here’s our deliverable. You will find a link to the Texas Higher Education Coordinating Board’s application for this program here. Now, we need you, the loyal listeners and mental health care advocates, to help get the message out by forwarding this information on to a number of audiences that need to hear it.

People we are targeting including undergraduate students looking to pursue a degree in one of the above-mentioned fields, current students already pursuing a graduate degree, college faculty or administrators, or anyone else who cares about access to mental health services.

Forward this message or cut and paste the URL for this blog to help us share this information. Our goal is to have as many people as possible help us spread the word about this new program. Texas deserves a workforce to help treat people suffering from a mental illness, and by getting the word out, you are doing your part to help make that happen.

Just as one of the newest mental health programs is rolling out, the Legislative focus is starting to heat up. On January 26th, the Senate Finance Committee, the budget crafting body for the upper chamber in the Texas Legislature, met to discuss two primary budget issues.

First, and what took up all of the media attention, was “Discussion on the Impact of Oil Prices and Production on State Revenue and the Budget” with Texas Comptroller Glenn Hegar testifying. Clearly, this was an important conversation to have, but for this session, it really boiled down to two numbers:

From the Texas Tribune:

Texas-Tribune

Texas Comptroller Glenn Hegar on Tuesday faced some skepticism as he sought to soothe lawmakers’ fears about what plummeting oil prices mean for the state’s bottom line.
“Is the sky falling?” asked Sen. Royce West, D-Dallas, at a hearing of the Senate Committee on Finance, which helps write the state budget.

“No, sir,” Hegar replied, adding that while there are “clouds on the horizon,” he’d rather be in Texas than in any other state.

“I just don’t want to live in a state of denial,” West responded.

{…}

Though Hegar has noted that oil’s plunge means Texas will send hundreds of millions fewer dollars toward road construction and maintenance than originally expected, the drilling slowdown should not leave lawmakers with a revenue shortfall, he said.

In fact, much of the certified revenue estimate Hegar released in October has stayed accurate — even though it was based on significantly higher oil prices — because producers are pumping more oil than anyone expected, Hegar said.

“The budget you passed – it works, and it will continue to work,” Hegar said, noting that lawmakers also left a significant cushion of unallocated funds.

That wiggle room totals about $4 billion, said Ursula Parks, director of the Legislative Budget Board.

There’s the number: a current $4 billion surplus of unspent funds available for the 2016-2017 session. Hegar’s assessment that despite the fall in oil prices that “the sky is not falling” is a very insightful remark. Especially in view of the second number.
According to testimony given by Comptroller Hegar on January 26th, the state has $9.6 billion in the Economic Stabilization Fund, commonly referred to as the state’s “Rainy Day Fund.” Given that the two-year total, or biennium budget, for the state was set at $209.4 billion, having almost $10 billion in the bank is a good position to be in, but should Texas not be spending some of that on needed programs?
The Pew Charitable Trusts released a report on January 19th describing how state’s save money in rainy day accounts and takes a special notice of Texas. Here’s what Pew writes about how Texas has decided to move on this issue:
Pew Trust log

Given the state’s other pressing budgetary priorities— particularly the need for improved water and transportation infrastructure and a desire to reduce the state’s total amount of outstanding debt—Texas lawmakers have been divided over whether the current level of reserves is sufficient or excessive.
At the heart of this debate lies a basic disagreement over the intended purpose of the Economic Stabilization Fund. “It’s become a surprisingly emotional issue in the political debate,” said Dale Craymer, president of the nonprofit Texas Taxpayers and Research Association and a former legislative aide who helped House leaders draft the 1987 constitutional amendment that created the fund. “The last two sessions, the rainy day fund has taken on this sacred nature that was never really intended. It was intended as a management tool.”
As revenue and spending pressures shift along with the booms and busts of the economy, states stand to benefit from the additional flexibility provided by robust rainy day funds to smooth over unexpected bumps in the road. Despite having billions of dollars in its rainy day fund, Texas struggles to answer the question of how much is enough because the state lacks a clear consensus on why the fund exists in the first place. Absent a clear purpose for saving, other states also find it extremely difficult to set a meaningful savings target, which can confound their efforts to manage the budgetary ups and downs of economic activity.

View Report: Pew Charitable Trusts – Why States Save

 

jane nelson

Senator Jane Nelson

While the Legislature deals with those numbers, one thing is clear: there is no need to cut services, especially for newly expanded behavioral health access. The Comptroller was clear in his assessment, and we hope lawmakers continue their investments in better access and quality of services, no matter what the cost of a barrel of oil.

The second part of the meeting, after all the media attention on oil prices left, was on behavioral health funding. Chair Jane Nelson was distressed about inaccurate news reports about how much Texas was spending on behavioral health.
As followers of Minding Houston, you should know all of our numbers come from the Legislative Budget Board, the same body that testified before Senate Finance. A link to their presentation is below, and as someone who has worked for a member of the House Appropriations Committee, these are the numbers I use when looking at state expenditures.

To give a recap of the presentation, the most informative slide is pictured below in what was the main point of the budget conversation: Texas spends about $3.6 billion in a biennium on behavioral health services across 18 agencies in 5 separate articles of the state budget. And as Chair Nelson repeatedly (and very rightly) points out, that total does not include Medicaid expenditures. See the slide below for a good breakdown:

BH Slide

With everyone on the same page with regards to the numbers (again, minus Medicaid), the Finance Committee expressed concern regarding the ability to coordinate spending and break down silos among various state agencies.
This is where Sonja Gaines steps in. As the Associate Commissioner for the Office of Mental Health Coordination for the Health & Human Services Commission, not only does she have a long job title, but a long list of programs to oversee and make work together.

SonjaGaines
A good example of how programs are being integrated came from Sean Hanna, Director of the Military Veteran Peer Network. He testified that after meeting with Gaines, this agency had begun to better coordinate with existing state resources of the Texas State Guard. This has greatly expanded the network of mental health peers working with our state’s armed services by maximizing existing resources.

The presentation notes that the statewide coordinating council should be developing a coordinated expenditure proposal for fiscal year 2017, and that as state budget writers, Chair Nelson will make sure any exceptional items match up within those plans.
The Health and Human Services Commission will submit that proposal to the Legislative Budget Board on June 1st of 2016.

Lastly, I wanted to mention that the new House Select Committee on Mental Health will be holding their first hearing on February 18th. We are looking forward to seeing what direction Chairman Four Price of Amarillo takes in the initial hearing.

 

photo series

Chairman Price, Rep. Thompson, Rep. Davis, Rep. Coleman

As a quick reminder, our Harris County members on this committee include Representatives Senfronia Thompson, Garnet Coleman, and Sarah Davis.

As the Legislature starts to dig into policy and resources, be sure to stay tuned to Minding Houston for the latest information on how mental health policy discussions translate to better access and services in Houston.

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

 


 

Music in this episode: “Viper” by Ray Rude, “True Hearts” by Nick Jaina, and “Fly Drexler” by Lazlo Supreme

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Minding Houston XIV: Select Committee & Mayor Parker Interview

This November, one of the biggest moves for mental health policies happened in Austin. It wasn’t an election and there weren’t a lot of politicians present. But the leader of the Texas House, Speaker Joe Straus, has made sure that mental health will get more than its fair share of attention during the next legislative session.

And with the final month of her administration coming to an end, Mayor Parker talks about the shift in city policy when it comes to substance use and why funding the Mental Health Division in HPD is a must for city leaders.

It is all about leadership and focus. For December 2015, this is Minding Houston. I’m Bill Kelly.

The State of Texas has challenges regarding how much and frankly how little is invested in public mental health systems. The November 10th edition of the Houston Chronicle explains:

MASTHEAD-Houston-Chronicle

Texas spends less per capita on mental health care than all but a couple states in the nation. Seventy percent of the counties here do not have a single practicing psychiatrist. Forty percent of children experiencing emotional, developmental or behavioral problems do not get any help. And the state’s biggest provider of treatment is the Harris County Jail.

Fair to say, there is work to be done. And while many leaders have found it convenient to not to focus on this issue, Speaker of the Texas House Joe Straus has decided to take a look at the public mental health system head on. The Chronicle continues:

Now, lawmakers are making their most deliberate effort in two decades to address the problems. House Speaker Joe Straus on Monday formed a special committee to “take a wide-ranging look at the state’s behavioral health system for children and adults.”
The House Select Committee on Mental Health, the first such panel since 1995, will study mental health care, as well as substance abuse treatment, recommend ways to improve early identification and treatment, and increase collaboration and measurement of outcomes. It will pay particular attention to services in rural parts of the state and for veterans and the homeless.

“We owe it to taxpayers to make sure the system is as effective and efficient as possible,” Straus, R-San Antonio, said in a statement announcing the committee. Republican Four Price of Amarillo will chair the committee, with Democrat Joe Moody of El Paso as the vice chair.
Republican Sarah Davis and Democrats Garnet Coleman and Senfronia Thompson of Houston will be among the 13 members. The announcement came as welcome news to mental health advocates and providers, many of whom expressed optimism while also noting the long way the state has to go.

{…}

The membership of the new panel also sparked optimism for advocates, such as Bill Kelly of the Houston chapter of Mental Health America, who noted that key budget-writers such as Price and Davis were included alongside policy experts such as Coleman and Thompson.
“That’s the A team,” Kelly said.
Coleman said that he expected the committee to make a difference, including by finding innovative ways to improve care without huge costs. “Mental health crosses into so many areas of public policy, whether it’s criminal justice, juvenile justice, education or health care in general and this is the best way to look at it, by bringing together people who are familiar with the different areas,” he said. “This is a great thing.”

{..}

According to the advocacy group Mental Health America, just 36 percent of Texas adults with mental illness receive help – 44th in the nation. For kids, the estimate of 40 percent is from Kaiser.
As a result of all that, the state’s criminal justice system has become the biggest provider of psychiatric treatment. Around 76,000 people with mental illness were arrested in Texas for minor crimes last year, according to the Texas Department of State Health Services.

One of the most encouraging statements from Speaker Straus in forming this committee was his wide-ranging view of how mental health affects different areas of government. With members from Corrections, County Affairs, Public Health, Criminal Justice, and perhaps most appropriately from Appropriations, Speaker Straus has ensured a comprehensive look at policy. In a supportive editorial, the Chronicle said of the committee, “it will take an IMAX-style approach, at least, to encompass the range of deficiencies in mental health treatment.”

While I would always question that Bill Kelly guy, the local members from Harris County delegation appointed the Select Committee are serious players that can be a strong voice for local concerns.

 

davis

Representatives Davis, Coleman, and Thompson

For example, Rep. Garnet Coleman is the chair of the County Affairs Committee and has been a leader in helping change the process and procedures for law enforcement on jail intake forms. He is widely regarded as the state’s expert on mental health policy in Texas.

Rep. Sarah Davis was one of the 5 House members on the Budget Conference Committee last session while also serving on the House Appropriations Subcommittee on Health & Human Services. She is one of the most knowledgeable members in either the House or Senate when it comes to mental health funding in Texas.

Rep. Senfronia Thompson is one of the most effective Texas House members . . . well in history. According to Capitol Inside’s Mike Hailey, “Thompson has shepherded more legislation successfully than any other state representative here in the past half-century if she isn’t the all-time leader in the respect.” For those that know, Mrs. T will fight for the “little dogs” and get things done.

For these committee members, MHA of Greater Houston will be looking to provide information and policy positions that can best represent the strengths of our region and also identify the shortcomings. Making sure our lawmakers have the best information available is exactly what the legislative advocacy of MHA of Greater Houston is all about.
As some of my fellow Houstonians listening to this can testify to, we’ve recently had an election in Houston. With a new Mayor, we wanted to sit down with Mayor Annise Parker to look back at the accomplishments of her administration and how she sees behavioral health policy at the municipal level.

The-Influentials-Mayor-Annise-Parker-January-2014_071823

Mayor Annise Parker

Bill Kelly: We are here at City Hall with Mayor Parker. Mayor, thank you so much for sitting with us today for Minding Houston. We greatly appreciate it.
Mayor Annise Parker: Glad to do it. You know I don’t have many days left so it’s nice to look back over the accomplishments.

Kelly: Well, first question, when you supported the creation of The Sobering Center, were you actively looking at changing the city’s response to substance use and addiction from a criminal justice setting to more of a health care treatment one?

Parker: I would love to say that was the foremost reason I was doing it. It was really a much more practical need and the way it turned out we were able to address several important issues at one time. The city of Houston is the last big city in Texas that has its own jail. That’s a county function. Cities have gotten out of the jail business and we have been under a consent decree for at least two decades, trying to shut it down or rebuild it. The real solution is to merge with Harris County and one of the reasons that we had been unable to do it is just the capacity of Harris County. We did some analysis and on a given year we would arrest 17,000 to 19,000 people for public intoxication of some kind. And if we could take those out of the inmate stream it would significantly reduce the census and make that arrangement with Harris County easier. At the same time as we began to analyze, a wealth of benefits came out. It was an opportunity for intervention, clearly. It was an opportunity to get a police officer who picks somebody up out of the street faster. Fifteen minute turn around at the Center for Sobriety rather than a couple of hours booking somebody into jail. It means that someone doesn’t have a criminal record and there is a whole host of problems that come when you criminalize the behavior and hang that arrest record on somebody. And then finally, it costs significantly less to put someone in the Center for Sobriety than it is to put somebody in jail. So it was a win-win-win-win and it has absolutely proved that. Going forward now that we have a few years of history with the Center for Sobriety, the challenge has been that it has to be routine for law enforcement. You have to train them to really look at who they are picking up and make an informed decision and it has to become habit. We have broadened it; it started with police officers and broadened it to the larger law enforcement community here in Houston and they just have to get it to be a routine. But the next thing we have to do is – we don’t do a forced intervention. The premise is you come, you stay four hours minimum or until you sober up and are able to leave on your own, and you don’t have to talk to a counselor although the counselor is there. You don’t have to do anything but just get yourself under control and you can walk out the door. Well, then we discovered the frequent flyers that cycle through over and over and over again. And so this is a neutral space where all of the various agencies deal with addiction and substance abuse so all those turf wars don’t have to break out. We have a number of partners there, so now we are gradually adding in the appropriate level of intervention where someone is clearly a danger to themselves. If you are coming through more than once a month – even that is a lot, but at more than once a month we have to do something. So that’s the next phase and I am very, very excited about that.

Kelly: Picking up on some of your comments, the mental health division of the HPD is one of the national models and it is the only mental health division in the state of Texas for any major police department. What made you, in some lean budgetary times, make the investment in this public safety team?
Parker: Well again, it’s a very practical decision because we recognize that a lot of the interventions from the mental health team are in our homeless community and it dovetailed with the initiative that began four years ago to move the needle on homelessness. People aren’t chronically homeless because they like living outside. People are chronically homeless because they have substance abuse or mental health issues or both. So in the mental health unit they interact with an individual who may be in their own home and in crisis, but on a daily basis they also interact with the folks on the street who are chronically homeless and, in fact, they were among those who came to me and said ‘You know, we really need to do something to these folks other than put them in jail.’ Or send them over to the emergency rooms, which is the most expensive care you can provide. Sometimes doing the right thing, the most humane thing is also the most cost effective. It’s just a matter of analyzing why you are really doing something and how you are doing something and seeing if there is a better way.

Kelly: At a recent celebration at The Sobering Center you were able to say some remarks and really see this project to completion or to the status that it has become today. It was a particular person that you mentioned and pointed out who had dealt with addiction and substance abuse and was really an inspiration to you. What would you really look back and say, in view of the accomplishments of creating The Sobering Center and the expanded mental health division in HPD as it relates to him?

Parker: Well first I would say that many of us in America have people in our families that have dealt with addiction and substance abuse, as have I, but what is important is being able to acknowledge those who have dealt with their demons successfully and can be a resource to others and an inspiration to others. My very, very close friend of 30 years is a local judge. He has publically acknowledged that more than 25 years ago he had a substance abuse problem. He himself was arrested and he did what he needed to do. He faced his problems, he still goes to AA, he counsels others who have addictions. We have to get past the stigma of talking about substance abuse problems and addiction and the fact that he is a former elected official – I know he hopes to return to the bench in the future – but that he had made it a part of what he offers that it made him a better judge because it gave him compassion and understanding. He created our homeless court because he had that heart for what some of these folks who were in homelessness were going through. You can’t address addiction with punitive measures. It solves one piece of the problem, but it doesn’t solve the problem and it doesn’t heal the person. You have to have a combination of carrots and sticks and support and compassion and the worst thing you can do is to make it something to be ashamed of.

Kelly: Last question for you, Mayor Parker, in view of this week’s election what advice would you give incoming Mayor Sylvester Turner about the city’s role in mental health and substance abuse addiction issues?

Parker: The city has to be a full partner in this because it affects the greater society. It affects us directly through law enforcement, emergency services, through our health care system but it also affects us as a society and rather than treating it as ‘well, all we as a city only have to focus on – we arrest them, we take them here or there.’ We have to be a partner and I trust that the new mayor understands that and will continue to do that because he will have the opportunity to see how well our homeless team in the city of Houston and the mental health unit of HPD and the folks at The Sobering Center and our many, many nonprofit community partner based organizations that are engaged in this space all work seamlessly together to make sure that we give a safe dignified place to sober up if that’s what’s needed or assistance to those who need help and we keep everybody healthy together.

Kelly: Mayor Parker thank you not only for your time but for your service and particularly what you have done for behavioral health here in Houston.

We offer our sincere congratulations to Mayor-Elect Sylvester Turner. Turner’s concerns about mental health are clear not only from his voting record in Austin but also the fact that his campaign website had a “mental health” platform on his Issues page. A link for that page is below, as well as this picture of his campaign’s door hangers that specifically mentions mental health investments.

Our hope is that the incoming City Council members have the same focus that Mayor-Elect Turner has in continued support for our city’s behavioral health programs.
From all of us at Mental Health America of Greater Houston, we wish you very happy holidays and hopes for an exciting and prosperous new year!

This is Minding Houston, I’m Bill Kelly.

Minding Houston XIII: Minding Houston XIII: Post Session Drama! Medicaid Rate Cuts & Jail Suicide Hearings

So after a Legislative Session that boosted mental health funding and saw the passage of important new laws and programs, how do two issues continue to make the front pages? Turns out that advocacy for mental health services isn’t confined to any legislative calendar. In this episode, we will look at the issues around recent Medicaid rate reduction for children’s therapy and new hearings focusing on jail suicide prevention that continue to generate headlines.

This is Minding Houston. I’m Bill Kelly.

MedicaidNow you may be asking: What is this all about? And why wasn’t this handled during the Legislative Session?

Well, turns out that the budget really isn’t as set as you would think it would be. Several riders direct various state agencies to do certain things, and Rider Number 50 for the Health and Human Services budget is one of them. Emily DePrang of the Quorum Report gives the specifics about how this rider looks at cuts to the Texas Medicaid Acute Care Therapy Program. She writes:

As written, they’ll slash by 25 to 90 percent what Texas pays for medically necessary physical, occupational and speech therapy through the Texas Medicaid Acute Care Therapy Program, which serves about 440,000 poor people with severe disabilities each year, most of them children. Advocates say at least 7,500 therapists will lose their jobs and 60,000 children will lose access to medical care because of the cuts. HHSC can’t refute these claims because it conducted no research in potential impact before announcing the new rates on July 8th.

Why would our Health & Human Services Commission decide to cut the reimbursement to acute care therapies for children with disabilities without doing the proper research on insuring access to services were maintained?

Texas-Tribune

That’s what our elected officials in both parties wanted to know. In an excellent piece by Texas Monthly’s Erica Grieder, the leadership of the Texas Legislature is pushing back hard against the HHSC decision. She reports:

As of August 20th, half a dozen Republicans had sent letters of concern to HHSC Commissioner Chris Traylor, asking him to hold off on implementing those changes until the probable effects could be assessed. Joe Straus, the Speaker of the House, said the same in a Facebook post on September 10: “I expect the Commission to keep us in compliance with federal law as it works through a new proposal. I also believe it is the agency’s responsibility to inform the Legislature if the proposed reductions would harm access to care and network adequacy.” And last week, Robert Garrett, of the Dallas Morning News, reported that Representative John Otto and Senator Jane Nelson–the chairs of House Appropriations and Senate Finance committees respectively—have sent their own letters to Traylor, insisting that the cuts be implemented only if access to care is preserved, and if the state remains on the right side of federal law.

Now, let’s take a step back and remember where we are coming from with this budget. Grieder writes:

On April 1, the House passed its biennial budget bill, which came in at $209.8 billion, and included $62.9 billion for Medicaid. On April 14, the Senate passed its version of the budget, which was bigger, at $211.4 billion overall, but included $800 million less for Medicaid. On May 29th, after House and Senate budget conferees hashed out their differences, both chambers passed the final budget, which authorized $209.4 billion in spending for the 2016-17 fiscal biennium. Of that, $61.2 billion was appropriated for Medicaid–less than either chamber had sought in their respective budgets.

Budget Graphic

So that’s the situation, a budget with lower funding for Medicaid than either the House or Senate passed. As you can imagine, Representatives on both sides of the aisle warned this would be bad. Grieder continues:

On April 22, for example representatives Sylvester Turner, a Democrat, and Bryan Hughes, a Republican, spoke at a rally at the Capitol, where they warned that the Senate’s proposed budget would necessitate severe cuts to Medicaid therapy services. When the conference committee budget came back to the House floor for final passage, John Zerwas and Dan Huberty, both Republicans, flagged concerns about the cuts now in question.

Texas Monthly points out that both the House & Senate chief budget writers are on record as opposing this drastic cut, it concludes with this:

This is a pretty sloppy way to run a major state, clearly. Still, we shouldn’t make poor disabled children pay the price for political exigency. HHSC should hold off on implementing the cuts as planned.

So we’ve heard from the Legislative leaders, but we haven’t heard much from the Governor’s Office. And with that silence came increased attention. After all, HHSC is an executive agency, so it would be natural for the Governor’s office to communicate with HHSC on implementation of the rider.

I’ll leave it to Harvey Kronberg, perhaps the most respected journalist covering the Texas Capitol, to talk about his search for information and the challenges he experienced:

Kronberg

Capitol Tonight: Harvey Kronberg with the Quorum Report goes on the agenda with us tonight and you know this Medicaid cut story of course is still with us. The governor publically made a comment on Friday during that emotional hearing that took place here in Austin. What did he have to say?
Harvey Kronberg: He simply said that they were working out legislative intent which was due to the Medicaid funding cuts. Of course the second half of legislative intent was to do no harm and the cuts that they are proposing do extraordinary harm.
CT: And in the mean time I know you posted your thoughts about a request for information from the governor’s office regarding all of this. What were you after and what was the response?
Kronberg: Well, the governor’s office has been amazingly nonresponsive on this really fairly significant issue, one that has gotten the legislature reengaged by being essentially appalled by the fact that they are going to do 90% cuts to providers for severely disabled children. So we have not been able to get a comment out of the governor’s office so we simply did an open records request to seek the communication between the governor’s office and the Department of Health and Human Services to see if they were trying to solve the problem or were they part of the problem. They did an extraordinary thing, something that I have never seen in almost three decades of doing this: they invoked the entire Public Information Act and said they were not going to respond and turned it over to the Attorney General’s Office. Now, anybody that reads the Public Information Act will see that includes things about exemptions for sexual offenders, for automobile accidents. Typically when someone uses the Public Information Act not to respond they cite what the clauses are that they used.
CT: And you point out about what was said during the campaign.
Kronberg: It’s still on his website unless he’s taken it down that he’s going to be the ‘Transparency Governor’ and this is anything but transparent. And it’s not unreasonable to conclude that if they are trying to hide their emails that they are actually not trying to solve the problem. The legislative budget board has a lot of discretion in being able to move funds around and enact legislative intent. It’s perfectly capable of resolving this problem if it has got gubernatorial support and legislative support. At least the House seems to be resolved and certainly the Senate finance chair seems to have come around so I’m not sure why the governor is being so mysterious and guarded in terms of his office’s communication with Health and Human Services.

So, with disagreement between the Legislature and the Governor’s Office, it took the third branch of government to break the tie. And in this case, the Court’s stepped in to provide relief for Texas families. Edgar Walters with the Texas Tribune reports:

Deep cuts to a therapy program for poor and disabled children will not take effect Oct. 1, a state district judge ruled Tuesday afternoon — the second such delay in recent weeks.

“Procedurally I’m not making a determination that these acts are valid or invalid,” said State District Judge Tim Sulak in his announcement that he would grant a temporary injunction to prevent the state from slashing payments to therapists. But he said he made his ruling in part because he’d been convinced the cuts could jeopardize the health of children receiving the therapy services.

The health commission says it’s just following the Legislature’s orders by implementing the cuts, and that opponents’ claims providers will stop treating disabled children are exaggerated. In closing arguments, Eugene Clayborn, a lawyer representing the state, said there was “no evidence” of critics’ arguments that “the sky’s going to fall in” because of the cuts.
“There will still be access to care,” he said.

The lawyers suing the state focused much of their argument on trying to disprove that point. Owners of home health agencies in North and Central Texas testified that their businesses would be forced to close, including in markets where they are the main provider of therapy care.

And they presented evidence from inside the health commission that shed light on the agency’s discussions around access to care.

One director at the health commission testified that state employees had been told never to say that they were certain the cuts would not jeopardize access to care.

And an internal memo from the health commission presented by Dan Richards, a lawyer suing the state, warned that payment cuts to therapists “could have serious negative implications for the maintenance of an adequate therapy provider base.”

So for now, it seems that the Texas Medicaid Acute Care Therapy Program will not see the dramatic rate cut, at least until the state appeals this decisions. Stay tuned to Minding Houston as this public policy drama continues to play out.

Next, we move to another issue making headlines: jail suicides. After the legislative session ended, two committees have taken up this issue in interim hearings: The House County Affairs Committee, chaired by our friend and Houston, and the Senate Committee on Criminal Justice chaired by Houston’s own Senator John Whitmire.

COLEMAN

Representative Garnet Coleman

During Rep. Coleman’s hearing, a number of officials testified about the huge challenge that County Jails face in Texas. Brandon Wood with the Texas Commission on Jail Standards testified first, and the hearing was reported on by our friends with the Houston Chronicle. They report:

The announced ramp-up of anti-suicide measures came as Brandon Wood, executive director of the Texas Commission on Jail Standards, which monitors jail conditions, told the House committee that half of the record 29 people who have committed suicide in Texas county jails this year told jailers they were suicidal when they arrived at the lockups.

The increased number of jail suicides this year – compared to 22 in 2014, 25 in 2013, and 23 in 2012 – has become the focus of several ongoing investigations and legislative inquiries, spurred, in part, by the July 13 death of community activist Sandra Bland in the Waller County Jail.

Despite general support from sheriffs to stop suicides, some counties already have expressed concerns about the additional costs the changes could bring in areas of Texas where jail budgets are small and taxpayers cannot pay for expensive new programs. In years past, several plans by state officials to impose tougher rules on county and local jails have been scuttled by opposition from local officials who oppose unfunded state mandates on their jail operations and who wield considerable clout with local legislators.

Wood said the new intake screening form is designed to help jailers better identify potentially suicidal inmates.

“We need to make this as user friendly as possible,” he said. “I’m willing to try just about anything to prevent these suicides, if we can.”

Previous screening forms asked jailers whether they suspected an inmate was suffering from mental illness. The new form removes that subjective element, officials said; if inmates give certain answers, jailers are required to notify their supervisors and contact local mental health authorities.

The form also uses a grading system to serve as an additional guide to jailers on when to contact mental health professionals even if an inmate’s answers would not immediately initiate a referral.

A draft of the new form can be found below. Mr. Wood promised to continue to work with the committee on how they could immediately change both the form and procedures during the interim.

LINK: Screening Form for Suicide and Medical and Mental Impairments

But changing the form isn’t going to be enough for the Senate Criminal Justice Committee. Before his hearing on September 22nd, I was able to sit down with the Dean to find out his ideas on preventing jail suicides:

Bill Kelly: I’m with the Dean of the Texas Senate, Senator John Whitmire, chair of the Senate Criminal Justice Committee. Senator, thank you so much for taking time to meet with us today. So Senator, we were at Representative Coleman’s hearing and you heard a lot about jail intake forms. And a lot of this has been made about moving away from subjective questions on there to more of a standard operating procedure. What do you think about the changes to intake forms and are there any other immediate fixes we can do to address jail suicides?

Sen. John Whitmire: Well, I think reviewing the forms is proper and in fact today in our hearing we will hear about the new forms and they are going to be much more comprehensive at intake.

But I’m quickly pointing out that you can redo all the forms you want, but if the person doing the screening is not trained, if the person doing the screening does not have the right compassion and attitude, doesn’t work for the right person, you can have all the new forms you want and we will still have a difficult situation. Because I think it gets down to attitude, you want to treat people in intake like you would like to be treated or one of your family members and that’s just not the case today particularly as they review any concerns for mental health or emotionally disturbed individuals. You can see it, you can question it, fill out the forms, but if you do not respond properly we will still have a person in danger.

Kelly: And Senator you have been a longtime critic of the budget cuts, particularly in 2003, to mental health services and other state services and now we have seen some of the biggest advocates for mental health services be our law enforcement community. Has their advocacy changed some of the minds of your peers when it comes to funding mental health services?

Whitmire: It’s impacting the legislature and, to some degree, local governments who often times have to pay for the jail. The problem is that it’s too slow. Obviously you know me well, I’m an impatient person. We have identified a problem and we haven’t attacked it to the degree that it needs to be. Law enforcement is recognizing and talking about it more because its impacting their criminal justice system. It’s using up valuable resources for largely non-violent low-level offenders who are mental health patients so it’s beginning to interfere with law enforcement’s main mission of going after dangerous criminals. It’s kind of a culmination of “let’s be tough on crime but we can’t do that if we’ve got these nonviolent folks.” I’m encouraged that we are having a grown up discussion, but we’ve got a hell of a long way to go.

Kelly: Senator, last question. I know the push to address a lot of this jail suicide issue has been very bipartisan. When it comes down to really making a difference a lot of times it’s going to take funding. Do you feel confident whether its increased money for training for jailers, whether its increased inspection money for the Texas Commission on Jail Standards do you have faith that your Republican colleagues will stand with you for allocating funding?

Whitmire: There’s been indication in recent sessions. Joan Huffman and a Senator from Houston helped fund a pilot diversion program for mental health for individuals in Harris county jail. That was a good start but still we’ve got to do a lot more. My colleagues are very fiscal conservative and what I’ve got to convince them is that you either pay now or you pay later. You either pay upfront with treatment and counseling and medication and diversion programs and alternatives to incarceration or you are going to pay later not only in dollars but you could be a victim and certainly we will have compromised the life of the individual who needed the treatment. We got a lot of work to do.

I hate to put a cost factor on doing the right thing, but I do work in an environment – the Capitol – where it’s not uncommon to leave money unspent so they can say that they are fiscal conservatives. I made a commitment to the mental health community ten years ago when I recognized that they didn’t really have a lobby. They didn’t have someone in your position as we do today. We have got to get people, as I have committed. I won’t give a speech about anything dealing with criminal justice without mentioning mental health because they don’t have a paid lobby; they have an organization such as yourself, but they don’t have the lineup that big business and big labor has. The only lobby that they are going to have are the legislators that care and the people of Texas and so our work is cut out for us.

Kelly: Absolutely. Senator, thank you so much and best of luck in the hearing today.

The Senator got a lot of confirmation during the hearing on his analysis of the impact mental healthcare has on the criminal justice system. One of the best presentations was provided by Lauren Lacefield Lewis, Assistant Commissioner for Mental Health & Substance Abuse Services for the Department of State Health Services. Some quick numbers to consider:

  • As of August 1st, 2015, approximately 66,625 individuals were in Texas county jails
  • An estimated 30% of inmates have one of more serious mental illnesses
  • This equates to nearly 20,000 people in Texas county jails with serious mental illnesses

Now, with those numbers in mind, check out this slide for the cost the criminal justice system bears in housing and treating individuals suffering from a mental illness.

From these numbers, it is clear that the provision of mental healthcare on the front end is ¼ the cost of prisons and jails per day, with a yearly savings of $15,000 per individual. For the 20,000 people in Texas County jails with a serious mental illness, if we were able to divert just half into treatment, it would save the state $150 million a year.

We hope the Senator will let his colleagues know, even in Texas, that’s a LOT of money.

Texas-TribuneThe Texas Tribune’s Johnathan Silver reports from the hearing about the popularity these savings could have with both lives and money:

Diversion, the overwhelmingly preferred treatment for low-level offenders with mental health problems would work best with coordination among mental health authorities, law enforcement, jails and courts, lawmakers said.

If an inmate has a mental health problem, all those entities should work together to move them into treatment as soon as possible, Whitmire said, adding that it shouldn’t be an issue in rural areas where officials likely know each other well and can use that as a benefit to help with seeking treatment.

{…}

Ultimately, Whitmire said, the state has a responsibility to address this issue because if it denies someone their freedom, there are constitutional responsibilities involved in caring for people in custody.

“A lot of it gets down to attitude and cultural awareness,” Whitmire said. “You have to recognize mental health and emotional problems.”

Sen. Charles Perry, R–Lubbock, injected caution throughout the hearing, warning that the state risks having a knee-jerk reaction to high-profile cases such as Bland’s and not seeing that protocol is not the enemy. He asked Wood what ultimately led to Bland’s death.

“People not following through, first and foremost,” Wood said.

CHRONICLEWell, to follow through on the local end, this report from the Houston Chronicle’s Mike Ward notes the testimony of someone we know quite well from the City of Houston:

Houston Police Chief Charles McClelland detailed how his agency has implemented a program to do just that in the city jail, which, as a municipal lockup, is not regulated by the state.

Whitmire and other lawmakers have suggested that municipal jails should be regulated by the state, like Texas’ 242 county jails.

McClelland said the Houston jail that handles about 75,000 low-level offenders annually has had only two suicides in recent years, including this year, and has beefed up mental health screenings, supervision and interventions.

Chief McClelland testified about the fabulous work done by the Mental Health Division of the Houston Police Department. From the Homeless Outreach Team to the Chronic Consumer Stabilization Initiative, McClelland was very proud of the work done but emphasized the training that new HPD cadets receive as part of the academy.

MCCLELLAND

Houston Police Chief Charles McClelland

As we’ve mentioned, Houston is recognized by the Department of Justice for having one of six national training sites for Crisis Intervention Training (or CIT) in the country. As Senator Whitmire has said, your programs are only as good as the people implementing them. In Houston, we are lucky to have some of the best.

Now, neither of these two issues will be solved any time soon. But they will need people to advocate for them: for their importance on the agenda and in the budget. That’s exactly what we hope to do in the lead up to the 85th Legislative Session in 2017.

For now, this is Minding Houston.
I’m Bill Kelly.

Minding Houston: Episode XII – I say hey! What’s going on?

August is supposed to be a quiet month in Houston. The constant hum of everyone’s air conditioning running as we try and avoid the triple digit heat just as the fire from the last legislative session starts to die down is normally a time when Houston settles down and gets ready for the fall. However at Mental Health America of Greater Houston, we’ve never been busier. From integrated care, to veterans’ mental health, and mayoral politics, it is a crowded event calendar in August. In Episode XII of Minding Houston, we will let you know exactly what’s going on, and how you can be a part of it.

This is Minding Houston, I’m Bill Kelly.

So first things first, integrated care is one of the primary buckets of work we engage the community in here at MHA of Greater Houston. Our efforts are led by Alejandra Posada, Director of Education and Training. Using the MHA of Greater Houston systems change model that has previously been used with efforts like public safety reforms with the Houston Police Department, Ale is brining quite an impressive group of local and statewide leaders together for the kick-off this Thursday at 9am at the Baker Institute at Rice University.

I spoke with Ale about the initiative earlier this week:

Bill Kelly: What is the systems change initiative model you are following?

Alejandra Posada: We are following a systems-change model that MHA has successfully used to address other important systemic issues – issues such as law enforcement interaction with mental health consumers; the trajectory of youth with mental health needs in the juvenile justice system; veterans’ behavioral health; and the prevention, early identification and treatment of behavioral health issues among school-age children.

We call the process “Interest Based Negotiation,” IBN for short, and it is influenced by consensus-building approaches and Appreciative Inquiry. Basically, it’s a process of bringing together the diverse stakeholders concerning a particular issue to undertake an intensive process of information-gathering and analysis, and ultimately to come to a consensus on recommendations to address the issue. During this process, MHA works very hard to ensure that our role remains that of a coordinator for the initiative and does not develop into a role where we are “in charge,” so to speak. For the process to be successful it’s very important that the stakeholders around the table fully own the process. We get the process going, but the stakeholder group then takes the reins to make it happen.

Kelly: Okay, the kickoff event is this Thursday. Who are you bringing together?

Posada: We are very excited about the kick-off event this Thursday, for which we are very fortunate to be partnering with the Center for Health and Biosciences at the Baker Institute for Public Policy at Rice University. We’ve brought together representatives from key stakeholder groups, including health care providers, third-party payers, institutions of higher education, public officials, and others with a stake in the issues. From interested parties in this group, as well as others who join us, we will form the core group of stakeholders who will collaboratively undertake the IBN process.

Kelly: If people want to be involved that cannot attend, what’s the best way to do so?

Posada: I’ve told a few people who are interested in the initiative but cannot attend on Thursday that this event, as fantastic as we expect it to be, is just a kick-off. The real work will happen subsequently. Anyone who is interested in participating can contact myself or Bill; our contact information in on the MHA website.

Also if anyone out of town or who can’t make it to Rice on Thursday would like to view the event, it will be livestreamed. To view the livestream, just go to the event page on the Baker Institute’s website at the time of the event. We’ll also make the livestream available afterwards.

The success of this initiative depends entirely on the collaborative participation of stakeholders, so if you’re interested, please do contact us!

The invitation to the forum is listed below. It should be a very engaging conversation on the policies that can lead to better trained and better financed behavioral healthcare for all Texans.

Making Together Work

Aug 13 – Policy Solutions for Integrating Care

Next, and by that I literally mean the next DAY, MHA of Greater Houston proud to once again partner with the Michael E. DeBakey VA Hospital to host the 2015 Veterans Mental Health Summit. On Friday, August 14th at the University of St. Thomas starting at 8:30am, the 2015 Southeast Texas Gulf Coast Veterans Mental Health Summit builds on relationships spawned by the previous two Summits and aims to stimulate new connections that are necessary to promote Veteran-centered, recovery-oriented care. Active collaboration and coordination of care with partners across our community is critically important to facilitate awareness and use of VA mental health resources, help Veterans gain access to community services, and build healthy communities that provide an integrated network of support for Veterans and their families.

I was able to steal a few moments from Tony Solomon, Director of our Veterans’ Behavioral Health at MHA of Greater Houston, about the summit:

Bill Kelly: How many times as Mental Health America of Greater Houston helped with the Veterans Mental Health Forums?

Tony Solomon: Bill, this will be out third time working on the Veterans Mental Health Summit with Michael E. DeBakey VA Medical Center and this year we brought on some new partners like Lone Star Veterans Association, Harris County MHMRA, Playsmint, ViaHope and some others.

Kelly: What is the real content that people could expect to hear and learn?

Solomon: The purpose of this event is to improve collaboration between the VA and community agencies in the service of Veterans and to understand better the needs of Veterans and their families. We have built in networking and presentations of community collaborative work, issues, and training available for service providers to add to their tool kit when serving veterans and their families.

CEUs will be available for behavioral health professionals, including social workers, licensed marriage and family therapists, licensed chemical dependency counselors, and peer support specialists.

Programming includes:

  • Veterans Accountability Act 2014
  • Needs of Family, Caregivers, and Veterans
  • Providers Panel
  • The Military Veteran Peer Network Volunteer Awards

The event is open to the public and we would love to see you there. The invitation is below:

Veterans Mental Health Summit 2015

Aug 14 – Veterans Mental Health Summit 2015

Finally, for those of us in Houston, you just might be aware of an election coming up in November. We’ve partnered with three great advocacy organizations: National Alliance on Mental Illness, the Houston Recovery Initiative, and the Council on Recovery in hosting a Mayoral Forum on Behavioral Health.

The Forum is scheduled for Monday, August 31st at the University of St. Thomas’s Jones Hall at 6:30pm.

Now, unlike just about every other forum during the campaign, we will not be talking about transportation, pension reform, or spending caps. We will be very focused on the behavioral health programs that the City of Houston directly funds.

It is vital to good advocacy that we show the seven candidates for mayor just how many people care about these programs. We hope that you will attend and even bring a friend or two. Advocacy matters, and in this case, making sure the next Mayor of Houston understand the vital importance and political popularity of these programs .

To give you an idea of what we will be discussing, I invite you to check out the link below to see a history of the Mental Health Division at the Houston Police Department. There, you can see a timeline that shows the progress and now national leadership that HPD has in training officers and deploying mental health professionals to help in times of crisis.

By no means are these three events the totality of what MHA of Greater Houston is working on during August. Numerous Mental Health First Aid trainings coordinated by Janet Pozmantier are ongoing during the summer when classroom teachers have flexibility. Tony’s recently completed VCAMP helped train over 20 Military Veteran Peer Network leaders from across Texas just last week. Ongoing women’s mental health and other trainings continue to provide the badly needed skill in screening and referral of mental health services throughout the month of August.

But I highlight these three events as some of the best ways you can personally attend and see how Mental Health America of Greater Houston is affecting policy change on the ground.

And that’s really what Minding Houston, is all about.

This is Bill Kelly.


To attend Making Together Work: Policy Solutions to Integrated Care or observe the livestream on August 14, visit our event page at the Baker Institute for Public Policy website. To RSVP for our Mayoral Forum for Behavioral Health on August 31, register at our Eventbrite.You can find more information about the Houston Police Department’s Mental Health Division and the history of our Crisis Intervention Team at HoustonCIT.org.

Music from this episode: “I love the Blues” by the Bluesraiders, “Hotel Rodeo ft. D Spliff” by Anitek and “Flutey Funk” by Kevin MacLeod.

Minding Houston: Episode XI – They are done! Wait, what did they do?

On Monday, June 1st, both the Texas House of Representatives and State Senate adjourned Sine Die, bringing an end to the 84th Legislative Session. The next time either chamber can consider changes to Texas law isn’t scheduled until January of 2017. So in the last 140 days, what did our lawmakers do to address mental health and what funding did they put behind it? The legislative review for mental health policy, next on Minding Houston.

I’m Bill Kelly.

The Legislature does a lot during a session, and to give the full recap of what really happened on mental health policy, I’d like to start by talking about the “Big 4” bills that we at Mental Health America of Greater Houston supported, then move to the budget and see how funding was appropriated, and finally to a numerous bills that deal with mental health services to targeted populations. With this perspective, a clear picture of what was (and wasn’t addressed) can develop.

For listeners of this program, we have highlighted a number of bills that are important to mental health advocates. There were four that were particularly important to us at MHA of Greater Houston that dealt with workforce, access, peer support, and veterans’ programs.

Schwertner

Sen. Charles Schwertner

First off, Senate Bill 239 by Sen. Charles Schwertner sets up a Mental Health Loan Repayment Assistance Program. We have gone in depth on the bill in a previous episode on the Mental Health Workforce, but wanted to report the exact details of the bill. Under provisions of the bill, the total amount of repayment assistance received for mental health professionals is as follows:

  • $160,000 for assistance received by a licensed physician;
  • $80,000 for assistance received by a psychologist,
  • $80,000 for a licensed clinical social worker (LCSW) that has received a doctoral degree related to social work,
  • $80,000 for a licensed professional counselor (LPC) that has received a doctoral degree related to counseling;
  • $60,000 for an advanced practice registered nurse;
  • $40,000 for assistance received by a licensed clinical social worker or a licensed professional counselor who has not received a doctoral degree.

Based on the criteria established in the bill, the Higher Education Coordinating Board estimates 100 medical health professionals would receive loan repayment assistance beginning in fiscal year 2016.

The type of professionals and award amount is as follows:

  • 25 psychiatrists at $16,000,
  • 25 psychologists, LPCs, or LCSWs with a doctoral degree, at $8,000,
  • 25 advanced practice registered nurses at $6,000,
  • 25 licensed clinical social workers without a doctoral degree at $4,000.
speakerTurner

State Rep. Sylvester Turner

Based on these assumptions, the 100 awards in fiscal year 2016 would result in a total General Revenue cost of $850,000. The cost for the 100 medical health care providers would increase to $1.3 million in fiscal year 2017.

That’s putting real dollars behind expanding our mental health workforce. And speaking of dollars, that brings us to our second bill. Our audience will remember our interview with State Representative Sylvester Turner about his bill promoting Home and Community Based Services he championed in House Bill 1393.

Unfortunately, Turner’s bill died in the Calendars Committee, but that didn’t stop him from using his position as Vice Chair of the Appropriations Committee to insert a Rider into the Department of State Health Services budget that does the following:

Rider 61

Rep. Turner’s Rider also mandates that a report detailing target populations that are diverted from jails and emergency rooms, the associated cost per recipient, and possible cost sharing with local communities that benefit from diversions.

This was a big priority for our area, and we can’t thank Rep. Turner (and his very diligent staff) for working hard not only on their bill but on getting this language in the final budget. Sometimes, it is good to be the Vice Chair!

jane nelson

Senate Finance Chair Jane Nelson

Now speaking of Chairs, Senate Finance Chair Jane Nelson helped pass what could potentially be a $20 million infusion of veteran mental health programs with her Senate Bill 55.

SB 55 requires the Health and Human Services Commission (HHSC) to establish a grant program for the purpose of supporting community mental health programs providing services and treatment to veterans with mental illness.

The bill requires HHSC to contract with a private entity to support and administer the grant program with HHSC and the private entity each providing one-half of the money that will be awarded under the grant program along with eligibility and approval criteria. The cost of this to the state will be $10 million per year, but because of the public private partnership in funding it will provide $20 million worth of services to veterans. A big shout out to House Chair of Defense and Veterans Affairs Susan King for her work getting this bill through the House side of the Legislative process.

cindy_burkett

State Rep. Cindy Burkett

Finally, the last of our “Big 4” that didn’t make it through: Rep. Cindy Burkett’s House Bill 1541 on Certified Peer Support Services. Now, our audience may recall this bill was featured, along with Turner’s Home & Community Based Services, as one of the bills to watch for mental health services this session. The reason it was highlighted was the multiple ways that peer support services can help with mental healthcare: issues from access, workforce, and relapse & recidivism in the criminal justice system are all addressed with these services.

Hogg Foundation for Mental Health

Our friends at the Hogg Foundation for Mental Health in Austin had the following on one of their white papers explaining how HB 1541 would benefit patients:

Peer support services are not intended to replace other mental health services, but the frequency of other services can be reduced when an individual is supported by a peer, often resulting in lower costs and better outcomes. When peer support services are included within the continuum of community care, the mental health system expands quantitatively by reaching more people, and qualitatively by helping people become more independent.

Peer specialists assist individuals experiencing mental illness by helping them focus on recovery, wellness, self-direction, responsibility and independent living. Certified peer specialist services could be provided in a myriad of environments such as emergency rooms, FQHCs, consumer operated service centers, criminal justice facilities, and many more.

And finally, they state:

Current initiatives to address the mental health needs of Texans are being met head-on with a critical mental health workforce shortage. It is in the best interest of the state to find effective and economically feasible ways to ensure that needed mental health services are provided. Expanding the use of certified peer specialists is a promising way to begin addressing the expanding need for services and the co-occurring shrinking of the mental health workforce.

Rep. Burkett was able to have her bill pass out of the House, but it died in the Senate Health & Human Services Committee. This is an unfortunately loss for the session, but rest assured, we aren’t going to stop until quality mental healthcare legislation on peer support services is passed and funded.

Now we turn to the one bill that had to pass this session, the budget. How did mental health services get funded at the state level this year? Did the momentum from last session continue? In a word, yes, yes it did.

A summary for the increases for 4 funding strategies was detailed by a June 10th article in the Community Impact News. The article quotes some guy named Bill Kelly in talking about the amounts each area was increased and how that compares to previous bienniums.

However, I’d like to share the really story behind those numbers and what they mean as far as services go for Texas and in Harris County.

Starting off, you can see an increase of almost $34 million in mental health services for adults in funding strategy line B.2.1. But what does that mean for access? Well, it means that with another $34 million, over 10,000 more adults will have access to mental health services in 2016 & 17 than in the previous two years.

With $33 million additional dollars in crisis services, the numbers are event better. Over 31,000 more people will receive crisis residential and outpatient services this biennium than that last.

All told, it looks to be over $150 million increase for behavioral health services from the previous budget, which is certainly good news. This should be seen as Legislature really putting its money where its mouth is on mental health in the last two sessions.

However, I want to make sure everyone knows where we are coming from on these programs and the population served.

From another great Community Impact News story from November of 2014 –

“Across the state, an estimated 894,000 residents have a severe mental illness, such as schizophrenia, major depression or bipolar disorder,” MHMRA Executive Director Steven Schnee said. Of that amount, 163,724 adults in Harris County—one of the state’s fastest growing areas—are believed to have a severe mental illness, he said.

“We have less than 10 percent treating capacity on an ongoing basis of what the need is,” Schnee said. “Every day, every week and every month there are young people between ages 16 and 24 who are beginning to manifest symptoms that could be indicative of a major mental illness. It is not a static population.”

Through the restoration of millions of dollars in state funding, MHMRA was able to hire several new employees and plans to continue increasing staff levels in 2015, Schnee said. The facility has also increased its monthly patient base by 1,600 to reach 9,800 individuals in the past year and anticipates the capacity to treat 11,000 adults in the near future, he said.

Prior to 2013, MHMRA maintained an external waiting list of an estimated 1,800 people who were screened and determined eligible for treatment by the Department of State and Health Services. Schnee said the facility was able to expand its outpatient services to eliminate the external waiting list entirely and address the need for five new treatment teams to serve 2,500 patients with psychiatrists, nurses, caseworkers and rehabilitation staff.

Community Impact

So, to be clear, after a terrific session in 2013 for mental health funding, we are able to treat 11,000 of our Harris County friends and neighbors per month with a severe and persistent mental illness. However, as the article notes, we have over 160,000 friends and neighbors in need. That’s the less than 10% number Dr. Schnee notes. While this year’s increases will no doubt add to this number receiving treatment, we have such a long way to go before mental health care in Harris County is accessible to those who need it. We have a very long way to go, but the good news is we are headed in the right direction and we are not slowing down.

When it comes to this budget success, we have some very specific thank yous to hand out. Appropriations Chairman John Otto kept mental health funding as a priority and we congratulate him on his first session as the Appropriations Chair. Appropriations Vice Chair Sylvester Turner was a consistent ally in fighting for more funding and the final budget shows his effectiveness. Finally, a big thank you to Rep. Sarah Davis, who helped debate the House investments as a member of the Budget Conference Committee and who worked to make sure Harris County received its fair share of dollars. In addition to these lawmakers, a big thank you to their diligent staffs as well. Thank you for putting up with the constant calls and visits!

So aside from the “Big 4” bills and the budget, Mental Health America of Greater Houston was involved in a number of pieces of legislation. In order to report on them, I’ve tried to organization them into four categories: veterans, public education, criminal justice, and overall access. We were very happy to work with the bill authors on this.

Locally, the Houston area was well represented by several legislators looking to expand access for our veterans.

SRG speaking on the floor

Sen. Sylvia Garcia

First, Senator Sylvia Garcia’s Senate Bill 1474 dealt with one of our major programs at Mental Health America of Greater Houston: Veterans Treatment Court. SB 1474 expanded the eligibility for veterans’ court to include both Military Sexual Trauma (MST) and non-combat service. We were proud to work with our Judge Marc Carter in his strong support for this bill, and want to give both Senator Garcia and her outstanding staff a big thank you. We should also mention Chairman John Whitmire and his staff were terrific and getting this bill moving.

State Rep. Ana Hernandez

State Rep. Ana Hernandez

Secondly, we had previously featured Representative Ana Hernandez’s House Bill 867 establishing in the Texas Women’s Veteran Program inside of the Texas Veterans Commission. The bill was signed by the Governor on June 4th and will make permanent many of the programs currently assisting the 177,000 female veterans in Texas. Congratulations to Rep. Hernandez on this important piece of legislation.

Finally, the last bill affecting veterans was the failure of a bill constricting educational benefits of veterans under the Hazelwood Act. Rep. Joe Farias, himself a Vietnam Veteran, speaking against efforts to cut Hazlewood, said, “If the Legislature decides to roll back its promise to Texas Veterans and their families, what does that say about us as a state? When we talk about the Veteran we must remember that with them comes their family. I will fight for them until I cannot fight any longer.”

State Rep. Joe Farias

State Rep. Joe Farias

As initially presented to the Texas House, SB 1735 would have deeply scaled back the Hazlewood program, which exempts Veterans from tuition at Texas colleges and universities and allows Veterans to pass on their unused benefits to their children. After heavy resistance from Reps. Farias, Blanco and a group of bipartisan lawmakers, a compromise was reached to keep current benefits in place for Texas Veterans and their families.

garnet coleman

State Rep. Garnet Coleman

The next set of bills had to deal with expanded mental health coverage within the public education system. Senate Bill 133 by Senator Charles Schwertner seeks to expand the availability of Mental Health First Aide training to more school district employees, including educators, school resource officers, secretaries, school bus drivers, and cafeteria workers.

Secondly, Senate Bill 674 by Senator Donna Campbell amends the Education Code to sync up the curriculum regarding mental health, substance abuse, and youth suicide as the instruction a person must receive as part of the training required to obtain certain educator certification. This bill was carried in the House by Rep. Garnet Coleman and helps to clean up the mandates created in Senate Bill 460 from the 83rd Legislative Session.

rodriguez

Sen. Jose Rodriguez

Finally, Senate Bill 1624 by Sen. Jose Rodriguez expands access to university students to valuable mental health and suicide prevention information. It requires a general academic teaching institution to provide to each entering full-time undergraduate, graduate, or professional student, including transfers, information about available mental health and suicide prevention services offered by the institution or by any associated organizations or programs and about early warning signs that are often present in and appropriate intervention for a person who may be considering suicide.

Unfortunately, I spend a great deal of time in the Criminal Justice Committees in the Legislature. We’ve talked about the connections in previous episodes, but these three bills where highlights on mental health access within the criminal justice system.

State Rep. Elliot Naishtat

State Rep. Elliot Naishtat

First, there is House Bill 1908 by Rep. Elliot Naishtat that updates the continuity of care for offenders with mental impairments defined by the Diagnostic & Statistic Manual of Mental Disorders (DSM 5) to include: major depressive, PTSD, schizoaffective, psychotic, anxiety, delusional, or any other mental health disorder that is severe or persistent. Congrats to Rep. Naishtat for this bill that will enhance the mental healthcare of offenders.

State Rep. Marisa Marquez

State Rep. Marisa Marquez

Next, House Bill 1083 by Rep. Marisa Marquez deals with mental health concerns around solitary confinement. It requires that a mental health assessment be performed on an inmate before the Texas Department of Criminal Justice (TDCJ) may confine an inmate in administrative segregation, and also prohibits TDCJ from confining the inmate if the assessment indicates that type of confinement is not appropriate for the inmate’s medical or mental health.

Lastly, a bill that did not pass: House Bill 2523 by Rep. Naishtat that would suspend, rather than end, Medicaid coverage for inmates incarcerated for longer than 30 days. Now, we should also credit Sen. Jose Menedez for his efforts on this change in law as well.

As a quick refreshed, Dr. Andy Keller from the Meadows Mental Health Public Policy Institute spoke in support of this change at a conference by the Texas Public Policy Founding saying “– if we are going to take the time to give someone Medicaid, the least we can do is let them keep it if they get in trouble and not make them go through all of these hoops again. Not because, you don’t even have to be a decent person, but you just have to not be stupid. I mean, it’s a waste of resources to make these folks go through that again so if we could get behind that, and to allow Medicaid benefits to be suspended a reasonable amount of time – actually as long as we possibly can – because we would like people if they are still eligible to be able to keep that when they come out because we would like to keep them out.”

I love that quote because it boils down to simple pragmatism, which isn’t liberal or conservative. It is about good policy, and I hope both Rep. Naishtat & Sen. Mendez will keep at it next session. Thank you both again!

Overall access for mental health services can be a catch all of policy. For example, Senate Bill 1507 by Sylvia Garcia deals with coordination between the Department of State Health Services & forensic commitments (people who enter mental health services through the criminal justice system). Garcia’s bill seeks to appoint a forensic director to better coordinate services for what we now know is the majority of commitments in Texas. Thanks again to Senator Garcia for making this happen.

Our friend Rep. Naishtat makes a return appearance with his House Bill 838, which looks to classify post-traumatic stress disorder as a serious mental illness for the purposes of statutory provisions governing group health benefit plan coverage. I testified for this bill in the House, but unfortunately it died in the Senate Business & Commerce Committee. People are familiar with PTSD from returning veterans, but they are only part of the community of patients that PTSD affects. Making this part of all insurance coverage would increase the access for services, and we hope to pass it next year.

Governor Greg Abbott

Governor Greg Abbott

The last bill increasing access was Rep. Garnet Coleman’s House Bill 3115, which looked to expand services for new Medicaid mothers with Post-Partum Depression. We featured an interview with Rep. Coleman on this bill and he was encouraged by the bipartisan support. The bill was mentioned by Governor Abbott in his State of the State Address:

I think we all know in this chamber it’s not just our veterans that need better access to health care. We also need to provide more funding for women’s health programs. For more access to care like cancer screenings and checkups. My budget provides that additional funding. My budget also increases funding for the treatment of Post-Partum Depression.

Well, aside from declaring May Post-Partum Depression Awareness Month, the Governor doesn’t have another bill on his desk to increase PPD resources. Rep. Coleman was passionate in his layout and we were happy to testify and lend our support, but it seems Governor Abbott will need to back this bill more vigorously next session.

So that’s it . . . or so we thought. Given that a number of great bills passed this session, on June 1st I was ready to relax and start my wrap ups when this happened:

scott braddock

Scott Braddock, journalist and Editor of the Quorum Report

Health care advocates shocked by Abbott’s vetoes so far

by The Quorum Report

Just barely into this maiden veto period, Gov. Greg Abbott has flexed his pen three times to kill a set of bipartisan measures related to mental illness that were considered uncontroversial exactly until their sudden death. Stakeholders say they were blindsided by the vetoes, at which they claim Abbott never so much as hinted.

Two of the doomed bills, Senate Bill 359 and House Bill 225, enjoyed strong support from multiple medical groups and mental health advocates. SB 359 also had backing from law enforcement in the form of the Sheriff’s Association of Texas. A third item, vetoed Monday, was a House Concurrent Resolution commending mental health professionals, was so apparently benign as to appear on the Local and Consent Calendar.

House Bill 225 would have extended the state’s Good Samaritan law to cover overdoses by intoxicants other than alcohol. Abbott’s veto statement said that, as written, the bill could be misused by drug dealers and habitual users.

But more disturbing to the health care community was Abbott’s veto of SB 359 on Tuesday. It would have allowed emergency room doctors detain a patient for up to four hours if the person seemed to pose an imminent threat to themselves or others because of severe mental illness. Under current Texas law, patients who self-admit for non-psychiatric causes but show signs of dangerousness can only be asked to stay at the hospital. Doctors can call police, but, “That person’s already out the door by the time police get there,” says Greg Hansch of the National Alliance on Mental Illness, Texas branch.”

The Houston Chronicle piles on as well:

Two bills filed in the 84th Legislature pertaining to mental health were considered uncontroversial until their recent veto by Gov. Greg Abbott.

If a governor is communicating his legislative priorities effectively, a veto should not come as a surprise. Yet some supporters of the proposed legislation claimed to have been blindsided by the opposition.

{…}

The Legislature meets for only a few months every two years. As with this recent action, the public suffers when carefully crafted bills are vetoed after lawmakers have left Austin. And this time, it is some of Texas’ most vulnerable residents who will suffer most.

So, what do we know? Well, we do know a number of good things happened this session and very good money was added to expand the accessibility of mental health services. We also know a number of crucial measures didn’t make it into Texas law, and we have to be vigilant until they are.

image004Mental Health America of Greater Houston will continue to monitor state policy on mental health. And there will be various legislative report cards, best and worst list, and comments on vetoes produced by a number of organizations. We will post what matters to you, and that’s what matters to mental health policy in Houston.

In fact, we wanted you to Save the Date for an upcoming an event. We will be hosting a Mayoral Forum on Monday, August 31st at St. Thomas University with our partners from NAMI of Greater Houston, the Houston Recovery Initiative, and the Council on Recovery. We look forward to seeing you there!

But from now until then, this is Minding Houston. I’m Bill Kelly.


Music in this episode: “Can’t We All Get Along?” by copperhead, “Plethora” by Anitek, “Slow Motion Strut Version Two” by Dexter Britain, “Finally Home (Before Dawn Cypher Beat)” by Ryan Little, “Vacate the Premises” by Deadly Combo, “Beyond the Finish Line” by Dexter Britain and New Midnight Cassette System by Frank Edward Nora (host of The Overnightscape).

Minding Houston X: Legislative Update

Chances are, you have heard that the Texas Legislature is in session. This is actually unusual, because the Leg only meets for 140 days every 2 years. They started in January, and after a lot of waiting, hearings, debates, and of course press conferences, the Leg is now in the final sprint of the last 30 days. Legislation is moving so fast, sometimes it is hard to keep track. In this episode, we will look at the flow of legislation, and what that means for mental health policy.

This is Minding Houston, I’m Bill Kelly

Trying to explain the deadlines and procedures can be tough. So, I wanted to share with you a sample calendar for the month of May. You can download this one page PDF by clicking here.

2015 calen

So, why is this so complicated? Well, we’ve all been taught that the Legislative Process is supposed to look and sound like this:

However, it is really more like this (via Houston Public Media):

The Texas Legislature began its session on Jan. 13. With bemused expressions, representatives and the House clerk barely spoke as bills got their final passage and Angleton Rep. Dennis Bonnen, acting as speaker, spoke so rapidly that he sounded like an auctioneer.

University of Houston political science professor Brandon Rottinghaus said the problem comes from having a legislature that only meets for 140 days every two years.

“The other problem is that they’ve got to get it through both chambers and get it to the governor and have some consensus on it, publicly. So that’s going to be the kind of thing that really makes them rush,” he said.

Committees have already done a lot of the heavy lifting. And Rottinghaus said the House is playing a bit of catch-up to the Senate.

“Because they’ve got to be able to get their agenda, in addition to being able to play defense against the Senate agenda. So that’s, I think, why we’re seeing a bit more motion here in the last few weeks in the House,” he said.

Gov. Greg Abbott has until June 21 to sign or veto bills passed during the regular session.

Navigating the legislative process is always tough, but luckily there are very experienced advocates who dedicate themselves to understanding the process and pushing for better policy.

Before we get into the weeds of the legislative process, I thought it best to start with the one bill that has to pass every session: the budget. As we’ve examined on previous episodes, the recent investments by the State Legislature in mental health services is set up against the backdrop of an underfunded and overburdened system.

Last legislative session, an increase of over $350 million was put into our mental health system, marking one of the largest increases in mental health in the state’s history. This session, the Legislature is poised to continue that progress, and a recent article in the Texas Tribune looks to illustrate the point.

TTslide

The article looks at the Senate and House versions of the budget known as “CSHB 1,” which stands for the Committee Substitute (or amended version) of House Bill 1. It’s the big appropriations list that is debated in House and Senate Committees and finally by the entirety of each chamber. Not surprisingly, the House and Senate don’t always agree on budget priorities. And by “always agree,” I really mean they both have strongly held & very different opinions about how state government should be funded.

The article shows that in the House budget, mental health services are funded at $3.8 billion for the biennium, and increase of $304 million from last session. Over in the Senate, they fund the same services at for $3.7 billion, increasing investments by almost $250 million.
The first thing bit of good news out of this is that both chambers realize our state needs to spend more to increase access, and the debate now turns to exactly how. The primary difference is how chambers differ on funding NorthStar, a Medicaid service unit for mental health and chemical dependency services in North Texas that was hotly debated by the Sunset Commission report.

And when you look closely at the numbers, despite the overall totals, the Senate Budget actually offers more investments in three key funding strategies:

budget slide

The Senate version of CSHB 1 actually offers $8.4 million more than the House version for mental health services for adults, $1 million more for children’s mental health services, and $4.2 million more for community crisis services.

My point in this is you have to look deeper than just the headlines if you want to really understand how these budget numbers can affect mental health policy in Houston. Another way to see this aside from these strategy totals is to look at the riders contained in each version of the budget.

A rider directs how the state should spend money allocated within an agency. And there are a number of riders within the Department of State Health Services budget that tell DSHS how to allocate money for mental health services that affect Harris County. Among them are:

rider slide

$32 million for Home and Community Based Services
$10 million for mental health assistance for veterans though the Military Veteran Peer Network
$25 million for community collaborative homeless initiatives
$10 million for the Harris County Mental Health Jail Diversion Pilot Program
$30 million for Equity among local mental health authorities & NorthStar

Each of these rides helps specifically address a funding stream that will help Harris County and our local Mental Health Authority to provide more access to mental health services.

Now, just to make sure everyone is on the same page, I’ll include a slide from our friends at the Meadows Mental Health Public Policy Institute that talks about the Cross-Payer Funding Challenges with mental health funding so you can see why these strategies and riders are so important to services in Harris County.

cross payer

Finally, I’d like to share some good news for folks in Harris County. Because the passed versions of the House & Senate budgets are different, each chamber will appoint 5 conferees to negotiate on behalf of the chamber.

On the House side, Chairman John Otto, Vice Chair Sylvester Turner, and Appropriations Member Sarah Davis are all House conferees from the Houston area. That’s a big win.davis turner and otto

photos2

On the Senate side, Finance Chair Jane Nelson, Health & Human Services; Chair Charles Schwertner; and Senator Juan “Chuy” Hinojosa are all big mental health supporters who are set to fight for better funding.

These conferees have the biggest say so on the budget, and fortunately we have a great line up to fight for mental health dollars.

ligonCPPPNow, I’d like to turn from the budget to other pieces of legislation. As I mentioned before, we are lucky to have some great advocates who monitor and report on the progress of legislation and work tirelessly during the interim to build support for new initiatives.

The Center for Public Policy Priorities is one of the organization that is most respected in it’s tracking and data analysis. I was able to set down in their offices with Katharine Ligon to talk about her role and how she sees mental health policy moving in the 84th Legislative Session:

Kelly: Sitting here today in Austin, Texas with Katherine Ligon who is a policy and budget analyst with the center of public policy and priorities. Thank you so much for taking time out for us. I know you have been monitoring the legislative process quite closely as it goes on. Everybody that studies health policy in Texas knows how good CPPP is with regards to data, research, policy analysis. What role do you play here with CPPP?
Ligon: Like you said in my introduction I concentrate on mental health and policy budget issues so that ranges from what the state appropriates for the mental health funding, for the public mental health system all the way to policies that impact the public and private markets for health insurance and access to health care specifically to mental health

Kelly: Perfect, perfect. And I have seen you at every single hearing that I have been to in Austin since this session and I know sessions before. How is it, just from your perspective as someone who studies this really intently, has the legislative mood changed when it comes to how they address and how they talk about, rather than just a single piece of legislation, just over all given you deal a lot with those state of budget matters about it. Does the legislature feel differently about mental health than they used to?

Ligon: Absolutely. I think that there’s been a tremendous recognition that mental health and substance use is really important in ensuring that have access to appropriate care and that really comes with partnering with some unusual suspects, in particular with the Sherriff’s Association, with Texas Association of Counties and Conference of Urban Counties. Those groups have been really a strong force in ensuring that the state maintains the responsibility in ensuring that the public mental health system is well-funded and that we have good public policies to ensure that the money is used appropriately and effectively but also that there is good public policy for quality services. We’ve come a long way in that conversation as you likely are aware that the state has been categorized as being 49th as far as per capita funding foe expenditures for many years. We are really far away from the median and that’s what been most disconcerting but we are getting closer to the median.

Kelly: Good deal. As you look at it with a perspective of someone that is involved in it day in and day out if there was one thing this legislative session that the legislature is really looking to focus on and has that opportunity here in the last month what would that one thing be?

Ligon: I think that there is a lot of concentration on the workforce. There is a lot of concentration in particular because as a result of some studies, interim charges that looked at workforce issue it was highlighted that there is a significant workforce shortage and so there are several efforts trying to ensure that providers are practicing at the highest level of their practice act and that they are opportunities for loan reimbursement for providing Medicaid related services or services within low income areas and also that the workforce is robust, that we are concentrating on everyone from psychiatrists to social workers but also ensuring that primary care physicians have a good understanding and knowledge base of mental health and substance abuse issues.

So now let’s talk about specific bills and where they are in the process:

Senate Bill 239: The Mental Health Loan Repayment Bill by Sen. Charles Schwertner
Passed in the Senate, in the House Public Health Committee

House Bill 1393: Home & Community Based Services Bill by Rep. Sylvester Turner
Passed out of House Human Services, in House Calendars Committee

House Bill 1541: Certified Peer Support Services by Rep. Cindy Burkett
Passed the House, now in the Senate

Senate Bill 55: Establishing a Public Private Partnership for Veteran Mental Health Programs by Sen. Jane Nelson
Passed the Senate, passed out of the House Defense & Veterans Affairs Committee, in House Calendars

In addition to these priorities bills, MHA of Greater Houston has testified and worked for the following bills:

House Bill 3115: Extension of Post Partum Depression Coverage by Rep. Garnet Coleman
Left pending in House Public Health

House Bill 838: Addition of PTSD to Serious Mental Illness under group health benefit plans by Rep. Elliot Naishitat
Passed out of the House, in the Senate

Senate Bill 1474: Extension of Military Sexual Assault and Non-Combat Service for Veterans’ Court by Senator Sylvia Garcia
Passed out of the Senate, in the House Defense and Veterans Affairs Committee

House Bill 867: Establishment of Texas Women’s Veteran Program by Rep. Ana Hernandez
Passed House Committee, on the House Floor Monday, May 11th

House Bill 2523: Allowing Correction facilities to re-activate Medicaid coverage for released inmates by Rep. Nicole Collier
Passed Public Health, in House Calendars

Senate Bill 133: Expanding Mental Health First Aide eligibility to other school personal by Sen. Charles Schwertner
Passed the Senate, in the House Public Education Committee

Senate Bill 674: Aligning curriculum for current teacher & teachers in training on mental health signs and symptoms by Senator Donna Campbell
Passed out of Senate Education Committee

As you can see, there has been good progress on a number of bills, but from the earlier calendar we posted, I would point out one big upcoming deadline: If a bill is not heard on the House floor by Thursday, May 14th, then it’s stand alone status is dead. While it can still be offered as an amendment on another piece of legislation, the upcoming deadline does tend to kill stagnant bills.

Over in the Senate, Senate bills can be heard up until May 27th and the system of rules is much more flexible, but the point remains the clock is running out.

MHA of Greater Houston will continue to work to monitor and advocate for these bills along with further budget negotiations. There are going to be late nights and tough calls, but remember the Texas Legislature only meets once every two years. So now is the time to get things done.

For Minding Houston, I’m Bill Kelly.


Music from New Midnight Cassette System by Frank Edward Nora (host of The Overnightscape). To listen to the Houston Public Media podcast used in this episode, listen here at HoustonPublicMedia.org.

Minding Houston Episode IX: Women & Children

The compassion to provide needed mental health services to women and children is something that almost everyone shares. But each comes with unique needs and challenges that requires being strategic about how to get the most out of our limited resources. At MHA of Greater Houston, we work diligently to leverage support for their needs, and have a history of success. Now we need the Legislature to step up and be our partner. Fortunately, they are starting to listen.

This is Minding Houston, I’m Bill Kelly.

Mandi KimballWhen we talk about women’s mental health, one focus is on perinatal mental health. One of the best partners we have worked with has been our friends with Children At Risk, who recently completed a Postpartum Needs Assessment for Houston last fall as well as collaborated with MHA of Greater Houston and our friends with Doctors for Change to host a public policy conference on PPD.

I sat down with Mandi Kimball with Children At Risk to talk about their findings:

Bill Kelly: I’m here at Children at Risk with their director of Government Relations and Public Policy Mandi Kimball. Mandi, thank you so much for meeting with me today. Talking about postpartum depression and the work your organization has done, what are some of the statistics that really led you to dig into this area?

Mandi Kimball: Well, mental disorders are the second leading cause of hospitalization of women of child-bearing age, which is 14 to 44 years old, in Harris County and in Texas. So the most common cause of hospitalization is child birth then you have mental health disorders. Approximately 12,000 to 15,000 women in Harris County experience PPD each year and 69,000 to 79,000 women in Texas experience PPD each year.

Kelly: Wow, so your organization using these statistics went out and did a comprehensive needs assessment Greater Houston area on PPD. What were some of the highlights from that needs assessment?

Kimball. Sure. Well Children at Risk wanted to do a needs assessment because we realized the impact that post-partum depression had on children and family and some of the key things that we found working with 40 different organizations from Harris County and service provider s is that it was really clear that there was a lack of screening, that there needs to be more awareness, more tools, education to service providers so that patients are screened. And some of the reasons that they don’t screen is that they don’t know which organizations to refer them to if postpartum depression is identified. We also saw that they was a lack of knowledge of available services so even if there are services available families, even other doctors don’t know where to access those services. Then of course we have to look at health coverage, right? And many times if these women are identified they have lost their health coverage, it’s been past the 60 days that they have been on Medicaid and they are not able to receive the needed services. But a major obstacle for families and the community is stigma around post-partum depression, stigma for the parents, the mother in particular, but also other family members so there really needs to be a concerted effort to really destigmatize post-partum depression and make sure that people know that it is okay and that they should get help and where to get help. And then also we have limited services available and this is particularly looking at the mental health workforce shortage. Part of that is because of lack of coverage and how do you pay for them, but it definitely needs to be addressed

Kelly: Great, great. And looking at that assessment you guys didn’t just detail the problems and the specifics out there; you also met with policy makers. Can you talk a little bit about your public policy summit that we were proud to partner with you with back in on October?

Kimball: Sure, it was a great partnership. You know it’s really important. A lot of people collect data, they do studies, we did a needs assessment and it’s important that it doesn’t just sit on the shelf. And so we partnered up with folks and we had a policy event. We were privileged to have Representative Coleman and Representative Zerwas join, two wonderful champion, historically have been great champions and are really working at this session and we are gratefully appreciative. But talking about this is the data, this is what is going on in Houston and what are the steps that can be taken during the 84th legislative session to break down barriers and to improve access to health and awareness as well. We are also really excited to see that Governor Abbott has made this issue one of his priorities as well.

George ParnhamSince 2002, Mental Health America of Greater Houston has Yates Children Memorial Fund (YCMF) was established with mission “to raise awareness about postpartum illness for the benefit of mother, child and family.” Houston Public Media spoke with George Parnham, the Public Policy Chair for MHA of Greater Houston, about Post-Partum Depression back in 2008:

Postpartum depression gained national notoriety as a serious illness after Andrea Yates drowned her five young children in 2001.

Her conviction, retrial and ultimate verdict of not guilty by reason of insanity brought attention to a disease that is still frequently misunderstood.

George Parnham was Yates defense attorney.

“I’m struck by the fact that it is so easy for us in the criminal justice system to condemn an act such as Andrea’s acts without going behind the surface in trying to understand why.”

Parnham says out of that tragedy has grown a better understanding of women’s mental health.

In that effort to better educate both the public and medical providers about postpartum depression, the Yates Children Memorial Fund has trained over 3,000 medical providers about how to recognize and screen for PPD as well as produced and distributed over 600,000 PPD brochures entitled “Your Emotions After Delivery.”

However, one of the biggest obstacles in treating PPD remains access to care. Many providers tell us of the importance of screening and identification is clear, but coverage for low income women is too often difficult to access and all too often expires before it can be used.

For example, the eligibility of services for a mother on Medicaid ends 60 days after the birth of the child. Given that PPD onset is typically within 4 to 6 weeks of delivery but may be recognized anytime during the first year, the window for eligibility of services quickly closes as the threat of depression increases. It is worth noting in the first month after delivery (when half of the time for service eligibility is already expired) childbearing women are at three times greater risk for depression compared to non-childbearing women.

garnet colemanIt is no surprise to learn that Rep. Garnet Coleman is right in the middle of trying to address this problem with a bill, House Bill 3115, to extend postpartum depression treatment for a year after delivery to Medicaid and CHIP Perinatal programs. However, it might be surprising to see the strong bipartisan support his bill has gathered, support that goes all the way to the top of Texas state government.

I sat down with Rep. Coleman in Austin last week to talk about his bill:

Bill Kelly: I’m here with Representative Garnet Coleman, chairman of the County Affairs committee here in Austin in his office. Representative Coleman you laid out a bill yesterday in committee about postpartum depression and extending those services, HB 3115. Can you talk a little bit about your history in dealing with postpartum depression and how this bill could really expand services?

Rep. Coleman: Well, what’s most important for people to know is that both depression and psychosis after having a child are both serious issues. And so with the bill that I am working on with Gov. Abbot does is extend treatment for postpartum depression all the way for a year on women who have had a child either through our perinatal program under CHIP or Medicaid. So what’s important is that women who have less money have access to care. Really, I got involved in this after Andrea Yate, who had postpartum psychosis and unfortunately drowned her children and had she been continued in treatment and with the number of children she had (because she was having postpartum depression with every child) she wouldn’t have been in that situation. I worked with TDCJ and other to make sure she was placed in the right environment after her conviction. I also have a colleague whose daughter in law was having a really hard time and we talked about it and it was very important because the family was really rocked by this because she had to be hospitalized. So it’s something that is more common than people think and very difficult to deal with

Kelly: Absolutely. And one of the things, Rep., that everyone that goes to our blog is going to know about your longtime advocacy and really been a state wide leader for issues on it. For this bill, Senator Joan Huffman, a Republican in the senate; you’ve got the support of Republic Governor Greg Abbott. I think that really speaks to – or what do you think that really speaks to in seeing the support?

Coleman: Well, I think it’s important for us to work in a bipartisan way and Governor Abbott mentioned this bill during his State Address and it shows that he has a serious commitment. He’s committed to this. The Chairwoman Myra Crownover is committed to this bill. So I think that’s important because our legislature works better when we work together and things we can agree on: it just makes for better policy making

Kelly: Absolutely. Thank you somuch for your time today, Rep.

PrintWhile Rep. Coleman works his bill to help expand coverage access for new mothers, another bill he is working on focuses on children. In this case, it is a program called “Mental Health First Aid,” an 8 hour in-person training that teaches how to help people developing a mental illness or who are in a crisis. The training highlights ways to identify, understand, and respond to signs of mental illnesses and substance use disorders.

If someone cuts their finger or bumps their head, you get out your first aid kit. But what do you do if your loved one has a panic attack? Or symptoms of depression? Do you have a mental health first aid kit? You should and you can get the tools to fill your at a mental health first aid course.

“So when we take medical first aid and we have CPR, this is the CPR for mental health. This is the CPR for the mind, the CPR for the soul.”

People with mental health issues should never be labeled as crazy or odd. These are real health issues that require treatment and understanding and they are common too. One in five Americans will struggle with a mental health issue at some time in their lives. Labels don’t help, learning does. And that’s what a mental health first aid course is all about. At the course you’ll learn the signs of many common mental health issues.

“We see the ADHD, we see bipolar, eating disorders, the depression, some psychosis then also too substance abuse disorder.”

You’ll also learn the five steps to take if a crisis does occur using the acronym ALGEE

A: To Assess for risk of suicide or harm.
L: Listen non-judgmentally.
G: Giving reassurance and information.
E: Encouraging appropriate professional health.
E: Encouraging self-help strategies and other support strategies.

Learn about mental health and you can help prevent a crisis or deal with one.

“I have been confronted before with a situation in the past with a family member who attempted suicide and at the time I really didn’t know how to handle that. The training would have made me more prepared to help.”

Stack your mental health first aid kit by taking one of these courses. Training is available for dealing with adult or youth mental health issues.

To put a local face on what Mental Health First Aid right here in Houston, I’m proud to introduce my colleague Janet Pozmantier.

Janet-PozmantierJanet is a licensed professional counselor, marriage and family therapist, and play therapist. She began her career in primary prevention in 1982 at Mental Health America of Greater Houston (MHA) as the first director of WHO (We Help Ourselves), a child abuse prevention program, followed by 20 years at ChildBuilders, where she created Parents Under Construction, a nationally recognized, research-based, award-winning program teaching children and youth today the parenting skills they will need in the future. She currently leads the Harris County School Behavioral Health Initiative at MHA of Greater Houston.

Janet sat down with our own Erika Lyles to talk about Mental Health First Aid and what she does here at MHA of Greater Houston.

Erika Lyles: Hello Janet. Thank you so much for joining us today on Minding Houston.

Janet Pozmantier: It’s a pleasure to be here, Erika. Thank you for inviting me.

Lyles: In teaching MHFA how many teachers have you been table to train and what has been the response been so far?

Pozmantier: Well that’s a great question, Erika. (With) Mental Health First Aid: the Youth Version we have trained approximately 500 to 600 teachers and school support people like administrators etcetera and it has been a fabulous experience. We have trained people all over the City of Houston, Harris County area, school districts, people that work with school-based programs such as Communities in Schools and the response has really been overwhelmingly positive. The training is kind of long, it’s an eight hour training, but we get less complaints about the length of the training and more compliments about the content and about how valuable the training has been to the participants. Many of the people who come to the training really don’t know that much about mental health. On the other hand, we do have some people who are trained professionals in mental health and it’s a really good refresher for them and it gives them a bit more of an insight about what is happening that they haven’t thought about before with the students that they work with. The feedback just brings tears to my eyes and I see how an eight hour training can really impact people and make them feel more confident that they can recognize signs and symptoms and help the children that they work with.

Lyles: Considering that, what would you say to legislators who are considering whether or not to fund Mental Health First Aid?

Pozmantier: Well, my hope is that they would not de-fund it because it is already funded to some extent and I think it’s fabulous that the state has allocated funds to do that. I would love to meet with them if they were considering de-funding it because I would like to show them the feedback that we have gotten from these teachers and counselors and other support people. It’s always a mistake in my opinion to go backwards. I think it’s so important to keep going forward and we’ve found something that works and Mental Health First Aid is an evidence based program, we do know that it works from a number of studies that have been done all over the world, not just in America. Why would you not go forward?

michelle-obamaJanet has seen first-hand the difference education and training can have for teachers. And she is certainly not alone in her praise for Mental Health First Aid. Recently First Lady of the United States Michelle Obama talked about importance of this training and the need for more understanding when it comes to mental illness.

First Lady Michelle Obama: For behavioral health we’ll be training three million people in mental health first aid. I went through some of this training a few weeks ago, a shorter version of it I have to say. But even in that short time I saw just how useful these tools were. It really gives you the skills you need to identify and ultimately help someone in need because you never know when these skills might be useful.

Mrs. Obama gave her remarks at the national kick-off event for the Change Direction campaign, an initiative designed to shift the public conversation and cultural attitudes about mental health. The Change Direction initiative includes concerned citizens, nonprofit leaders, and leaders from the private sector and was inspired by the discussion at the White House National Conference on Mental Health in 2013, which came on the heels of the Newtown tragedy.

Back in Texas, our Legislature has made real progress on helping teachers receive the needed Mental Health First Aide trainings. Last session, the legislature passed a measure to provide voluntary, no-cost MHFA training to educators with $5 million was allocated to pay for training through local mental health authorities.

However, when making the funds available, the eligibility was to “educators” only. This session, Senate Bill 133 expands the availability of free MHFA training beyond teachers to include school counselors, nurses, teacher’s aides, school bus drivers, principals, assistant principals, and school resource officers.

With Senator Charles Schwertner already passing the bill through the Senate, Rep. Garnet Coleman stands ready to pass it through the House and on to Governor Abbott’s desk.

While the state continues to make progress on children’s mental health, MHA Houston is rolling out a new campaign that looks to go even further. For more info on the Children’s Art Contest, my colleague Traci Patterson joins us.

HTxMentalHealth

May is Mental Health Month.  It is also Children’s Mental Health Week (May 3-7th) and Children’s Mental Health Day on May 7th.

I am excited to share that on May 1st Mental Health America of Greater Houston will launch its public awareness campaign, “Your Child’s Emotional Backpack”. Children carry a backpack almost everywhere they go. Most never go anywhere without it.  Through a series of public service announcements in English and Spanish, a diverse group of children and young people share a message about the importance of filling a child’s emotional backpack so they will also carry with them everywhere they go with the tools, skills and strategies they need to stay mentally healthy and well.

Most childhood mental illnesses emerge by the time a child is 14. That’s around the 8th grade. The campaign is a community effort to help parents, kids and those who work in child and family support roles become more aware of children’s mental health facts, issues and local resources.

In addition to the campaign, MHA Houston in partnership with the Nick Finnegan Counseling Center, students from the University of St Thomas,Rice University and about 25 local nonprofits, businesses and agencies is promoting children’s mental health through its first  #HTxMentalHealth Children’s Art Contest.

The Art Contest encourages children in grades K-8 to share their understanding of mental health through art and helps parents and other adults learn more about mental health facts, issues and resources.

On May 5th the winning entries will be announced and a proclamation read at the Houston City Council Meeting by council member Ellen Cohen proclaiming May 3-9 Greater Houston Children’s Mental Health Week.

On May 3-7 Houston City Hall will glow green, the awareness color of mental health, in observance of children’s mental health and as a tribute our young artists.

On May 7 contest winners will be honored at an awards ceremony Children’s Mental Health Art Gallery at Gallery Furniture

At this time, winners will receive an award certificate and about $125 in gift cards and prizes from Kroger, Children’s Museum of Houston, Texas Art Supply and the Youth Football and Cheer Federation

The winning art and contestant art will also be displayed in a digital art gallery beginning May 3 and can be found on the contest website: http://www.htxmentalhealth.weebly.com and on the MHA Houston and Finnegan Counseling Center’s sites.

As part of the campaign, we are also encouraging kids, with permission and adults to share and show how they are celebrating the mental health of children by posting pictures on social media to the #HTxMentalHealth throughout May.

As friends, families and caring adults, it’s up to us to learn about children’s mental health and behavioral health strategies to help keep all children healthy and well. If there is a change in the behavior or wellness of our children, we must learn to recognize the signs of trouble, know the resources and how to get help if it is needed before there is a crisis situation.

Being informed, aware and knowing what to do could potentially change the trajectory of a child’s life.

This is Minding Houston, I’m Bill Kelly.


Music for this episode: “Kitchen Suite” by Spiedkiks, “Your Pulse” by Little Glass Men, “Sketch (vlad)” by Jahzzar and “Chasing Butterflies into the Snow” by krackatoa

View the full commercial for Mental Health First Aid here. To read Children At Risk’s Postpartum Needs Assessment visit here