Minding Houston: Episode VIII: Veterans

Every politician will say they think our veterans deserve our best, especially when it comes to their mental health services. One way to do this is to make sure we have a great mental health system for everyone (just so you know, Legislature). But the unique challenges faced by our veteran populations across Texas deserve not just our rhetoric, but our resources and responsibility. Our Veterans Behavioral Health Initiative at MHA of Greater Houston is leading these efforts, and here is why.

This is Minding Houston, I’m Bill Kelly.

First, it makes sense to understand just what is the population of veterans in our area who might need access to services. And the place to find that answer is the City of Houston Office of Veterans Affairs.

Started under former Houston Mayor Bill White, the Office of Veterans Affairs is housed at City Hall has a mission is to assist Houston in becoming the best city in the nation to our serving military, veterans, and their families.

MH08 - CarlCarl Salazar was appointed as Director by Mayor Annise Parker in 2013. Carl received his commission in 1989 from the United States Naval Academy and served on two combat tours that included service on the USS Ford during Operation Desert Storm. Carl is focused on keeping Houston a national leader in providing assistance to transitioning service members and their families by helping veterans gain employment, supporting their mental health needs and ending veteran homelessness.

Bill Kelly: I’m here at City Hall with Carl Salazar. Carl, thank you so much for joining me today. Carl about how many veterans are in the Greater Houston Area?

Carl Salazar: Well, Harris County as a county has the second largest population of vets in the country, only behind Los Angeles, and, while I don’t know exactly how many vets are in Harris County we know there is more than 200,000, so somewhere between 200,000 to 220,000 or so veterans of all eras in Harris County and if you look at the surrounding counties you have over 400,000. So it’s the largest population of veterans in the state of Texas and like I said, nationally we rank right there behind Los Angeles, it’s the only one with more.

Kelly: Perfect. And your office, because of that big population number is really here to connect veterans and their families to resources that are available. Can you talk a little bit about how you do that?

Salazar: Yeah, so we have a mission that is a little bit strategic and tactical at the same time. On the strategic level, what we do is we oversee the community in terms of serving veterans. We’ll work with the VA, we’ll work with Harris County. We also work federally with the VA but also the military itself sometimes, whether it’s guard, reserves. We also work obviously with the city, but we work with non-profits, for profits. There are all these entities, these resources that do something to serve the veteran community and it requires somebody being at the center or at the hub, more or less trying to make sense of everything and trying to coordinate things and so while we have a small staff and not tons of money to offer programs directly, I think our big offer is to coordinate and streamline communication between organizations. I think, obviously I was not here eight years ago when the office got started, but for the past year and a half or so I’ve seen a lot better organization, I’ve seen a lot of organizations coming together and collaborating and I don’t think that happens by accident so I think the city, this office, has played a big role in making sure that people come together, that we are all sort of operating from the same sheet of music and the goal is to serve veterans.

0e2fc09So with the clear need for veteran programs and needed experience in coordinating just how to navigate the various systems, the Veterans Behavioral Health Initiative was formed at MHA of Greater Houston. This effort is led by Tony Solomon, a combat veteran himself who served two tours in Iraq as an Army Scout in the 1st Cavalry Division. I was able to catch Tony in our offices to talk about the VBHI and why it is so badly needed.

Bill Kelly: Tony, thanks for letting me steal some of your time. What are the numbers of returning veterans that are suffering with a mental disorder and what problems do they lead to?

Tony Solomon: Hi Bill. First of all, I’d like to start off by saying not all veterans are returning from war ans suffering from mental health issues or Post-Traumatic Stress, but unfortunately there are some very sobering statistics about the quality of life that veterans and their families face upon transitioning from the military to the civilian world. One in three veterans are being diagnosed with Post-Traumatic Stress Symptoms; less than 40% will seek help. 22 Veterans a day kill themselves in America and one in three homeless [people] are veterans.

Billy Kelly: Wow. Well, what does MHA of Greater Houston do to help coordinate those agencies to really offer help to these veterans?

Solomon: Our focus in on two issues: jail diversion and peer support. We are the official mentoring partner of the Harris County Treatment Court where we focus on jail diversion initiatives and mentoring to help these veterans and their families successfully graduate from the treatment program with one-on-one mentoring and wellness activities. Our second big focus is we are the regional coordinator for the Military Veteran Peer Network, working with three organizations – the Lone Star Veterans Association, Grace After Fire and US Vets Houston – and together our mission is to engage the veteran of Greater Houston and Harris County through peer support, outreach and engagement, wellness activities and suicide awareness and behavioral health training

One of the VSOs that Tony works with is Grace After Fire, which plays a key role in providing badly needed support for female veterans.

First, a little background that might surprise you:

  • There are 1.8 million American female veterans
  • 230,000 women have deployed to Iraq & Afghanistan and have been awarded 600 Purple Hearts
  • 1 in 3 female veterans suffer from PTSD
  • Female veterans are 3 times more likely to be at risk of suicide and 4 times more likely to be at risk of become homeless

MH8 - Grace After Fire

Grace After Fire looks to use Peer to Peer mentoring to help female veterans successfully transition back into civilian life for women who are struggling. A testimonial from US Army Specialist Amber Wilson & retired US Army Staff Sergeant Tish McCullough on what the group means to them.

Tish McCullough: You know “Grace After Fire” – it’s just so meaningful to me. That after not being very graceful, after being not such a good mom, after not being the stellar soldier for a while to really be part of something special, to be a part of something I didn’t get when I got back so that another woman does not have to go through the same thing that I had to go through. It’s talking to veterans, taking those stories and provide them with the special care and needs that women veterans have that are different from our male counterparts. We made it and we’re here to help you make it and I really feel like that’s the heart of what Grace After Fire is.

Amber Wilson: Grace After Fire to me is a second chance.

The difference between the services needed for male and female veterans is often experienced by female veterans struggling to get the support they need. Fortunately, the good work done by the Texas Veterans Commission has recognized the need for programs to assist the over 170,000 female veterans in Texas. But that support isn’t codified in state law.

MH8 - Ana HernandezRep. Ana Hernandez has a bill doing just that in order to ensure groups like Grace After Fire have a dedicated female staffers at the Texas Veterans Commission so that their perspective is mandated in TCV programs.

Our favorite Texas Tribune reporter Alana Rocha has this story about the bill and the services needed by our female veterans.

Alana Rocha: Casandra Melgar-C’de Baca, who served more than a decade with the Air Force and Air National Guard says these types of gatherings are a chance for women in the F7 Group she founded to open up and resolve trust issues they developed while serving in the military.

Adria Garcia: Male and a female will be in combat, go through the same exact experiences but when they come back, they don’t come back with the same – the outcome is not the same.

Rocha: Without a dedicated state program to serve the 177,000 female veterans in Texas, many whom are working through emotional and physical ailments, they have to seek help from the back-logged VA, a few staffers within the Texas Veterans Commission or outside groups like F7, that is if they seek help at all.

Garcia: As women we take care of everyone else around us, we don’t want to tell them our problems, we don’t want to tell them what we’re going through. We just get up in the morning, put our mommy hat on and take care of everyone else.

Rocha: The Veterans Commission employs three full time women focused on assisting women veterans, file claims, find jobs and have access to services, but their assistance is not mandated by the state and could go away. A bill in the state house by Representative Ana Hernandez would require their efforts stay in place.

Rep. Ana Hernandez: We hope that this permanent, long-term program will be able to develop policy and also identify factors that female veterans face.

Rocha: As a couple of the female veterans here put it to me ‘you can’t just paint something pink and call it a women’s program.’ You need a dedicated resource created by women, for women.
Melgar-C’de Baca: Even the most well-meaning guy that’s running a program he’s not going to understand the way a women is going to understand so we need those women veteran coordinator in there because there is just that level of trust.

Rocha: After two sessions attempting to pass such legislation there is hope the shades of state politics won’t shadow the need this time.

When we talk about the need for successful transition, the unfortunately reality is that too many of our veterans end up in the criminal justice system instead of getting the help they need. Sound familiar? Why can’t we provide the help to these veterans instead of incarcerating those who have served our country?

That’s exactly what 60 Minutes wanted to know and when they went searching for answers. Scott Pelley was introduced to the Harris County Veterans Court in October of 2012 to visit with Judge Marc Carter.

MH8 - 60 minutes

Scott Pelley: Two and a half million Americans have served in Iraq and Afghanistan; many of them, more than once. The VA tells us about 20 percent come home with post-traumatic stress disorder, known as PTSD. So, that comes to about 500,000. For some, returning is harder than they imagined. The suicide rate for the Army is up 15 percent over last year. For the Marines its up 28 percent. A few of our troops return to become something they never thought they could be: criminals, for the first time in their lives. Around Houston, in Harris County, Texas, 400 veterans are locked up every month. We met a judge there who saw them coming before the bench, fresh out of the warzone and he thought a lot of them were worth saving. Judge for yourself once you meet some of our troops, coming home. It turned out another military brother was also in the criminal justice system. An Army veteran named Marc Carter.

Bailiff: All rise…

Scott Pelley: Texas State District Judge Marc Carter.

Marc Carter: I will give you some options, and you will tell me whether or not you want to be here or whether or not you just don’t want to deal with it. And if that’s the case, then I know where to send you. Prison.

Scott Pelley: Carter was watching fellow veterans, broken before the bench. Afghanistan. Iraq. Post-traumatic stress, addictions, pretty much the same story a few hundred times a month. Carter also knew that the VA hospital a few miles away had plenty of empty seats in programs for PTSD and addiction.

Marc Carter: You have to put them in a program that’s going to help them, that’s going to make them be successful. If you just put them out there on probation they are going to fail. If you put them on probation that is tailored to deal with their problems, PTSD and drug use, then they’ll be successful. They won’t have to go to prison.

Scott Pelley: Do some of these veterans not want to believe they have PTSD or not want to admit that they have that kind of problem?

Marc Carter: There is an interest– a vested interest in them not to admit that they have PTSD while they’re serving. There’s a lot of self-destruction in that because you know you need the help and you’re not getting it. And you have others that are just in denial, “Everybody else is wrong, not me. The whole world is wrong, I’m right.” That’s denial.

Scott Pelley: In 2009, Carter and other volunteers opened a court just for vets who’ve committed first time felonies, things like assault, robbery, drunk driving, spousal abuse. After arrest, vets have a choice, go through the regular system or come to this court with its mandatory two years of treatment and supervision. About 40 vets a year chose Judge Carter.

Marc Carter: They do more programs on this probation than they would ever do on any other probation in the state.

Scott Pelley: Are you saying this is a harder road?

Marc Carter: It’s tougher for them. They make a commitment to me and that is, “I’m going to do what it takes. I’m going to go to all the programs and treatment programs.” And my promise to them is, “I will be patient and I will give you time to change back to that person you were.”

Marc Carter: Kevin Thomas. Another Marine. How are you, sir?

Kevin Thomas: Outstanding, sir.

Marc Carter: I just want to tell you, it takes a lot of courage to go back in there and face those monsters.

Kevin Thomas: Yes, sir.

Marc Carter: Good job, sir.

Scott Pelley: Every two weeks, the vet reports to the judge. Troublemakers are kicked out and sent to the regular probation system. But there haven’t been many of those, only nine out of 100 vets so far. Because of that, veterans’ courts like this have sprung up in 27 states. There are 100 already with another 100 planned.

LOGO_VBHI 2013_4

Bill Kelly: Tony, since this 60 Minutes episode the Veterans Court in Harris County has established an official peer mentoring program dedicated to serving that docket of justice-involved veterans. Why is peer mentorship so important in having a successful veterans court?

Tony: Personally, I believe every veterans treatment court should be accompanied by a strong mentoring program and that’s what we are trying to do here and create for the state of Texas through our VCAMP Program and other trainings that we do. Prepping veterans who have successfully transitioned to engage veterans in treatment court and veterans suffering from mental health issues to make them see the light and understand that there are other people who have walked in their shoes. They are not alone. If you’ve got issues with depression, if you’ve got family issues, these veterans have been there and done that they’ve walked downrange and came back and struggled just like you did and understanding that you’re not alone and you can talk to somebody about these issues that have received proper, formal training. It can save lives and it has saved many lives and we are very proud of that, we are proud of the direction that the state is going in supporting and increasing peer capacity for peer mentoring.

There are a number of issues and bills we are watching during the legislative session that affect our veterans including the following:

  • Senate Bill 55 by Jane Nelson and it’s House companion House Bill 1429 by Susan King that creates a grant program to support community mental health programs for veterans with mental illness.
  • Expansion of the 20 existing veterans courts in Texas and establishment of evidence based peer support programs to assist our justice involved veterans
  • House Bill 1048 by Rep. Joe Farias that looks to expand the eligibility of Veteran Treatment Court to include Military Sexual Trauma (or MST)
  • Protection of the educational benefits in the Hazelwood Exemption allowing veterans to share their benefits with dependents
  • And the afore mentioned House Bill 867 by Rep. Hernandez establishing the Texas Women Veterans Program

The strong bipartisan support that veteran services enjoys includes the new Chair of the House Committee on Defense and Veterans Issues Representative Susan King of Abilene as well as veteran court advocate Rep. Joe Farias who traveled the state during the interim to learn how each veteran court model was working. We will need their support this session in order to make good on our promise to get our veterans the support they have earned.

Bill Kelly: For the last word, I wanted to let Tony give his take. I’d say his earned it, not only because of his courage in serving our country, but for his dedication to making a difference in the level of service our veterans receive. Tony, if there is one thing that people listening need to know about getting veterans the help they need, what should they take to heart?

Tony Solomon: Most Americans will never join the military or fight for their country but what I would like for all of you to take to heart is that the battle isn’t over just because the war is declared over. We’re dealing with brain injuries, combat stress, substance use, access to reliable health care, homeless, underemployment, justice involvement. All of these things become the new battlefield. It’s up to us, our community to build strong partnerships and implement innovative outreach and engagement strategies; educate employers universities, elected officials on resources, transition assistance, crisis intervention and jail diversion. We need to help these veterans make a connection for help, first and foremost, and we need to challenge government to do right by our veterans, hold them accountable to this. The average veteran brings so much resilience and leadership to the workplace and to their community that America really needs to get past these Hollywood stereotypes. At the end of the day the modern veteran is a volunteer that believed in something greater than themselves and that loyalty will never go away.

This is Minding Houston, I’m Bill Kelly.

Music From this Episode: “Train,” “Carried on Wind,”  “My Song for January,” and “Positive Feeling” by Dexter Britain; “Break Bread (Ninety-Four Drums of Death Instrumental)” by Deadly Combo; and “Noah’s Stark” by krackatoa

Thank you to Carl Salazar and Tony Solomon for being a part of our show. To see the full 60 Minutes “Coming Home: Justice for our Veterans” special, go visit CBSNews. To learn more about Grace After Fire, watch their introduction video here. For the full Texas Tribune video, watch “Solidifying State Support for Female Veterans.” 

In loving memory of Kevin Thomas, a proud Marine Corps veteran. He is survived by his his sons, Jaden and Kaleb Thomas; mother, Bernadette Auguste; father, Emerson Thomas; brothers, Shawn Thomas and Mark Thomas; sister, Britney Auguste; nieces and nephews, Trinity, Zoei, Raegan, Elijah and Jesus and numerous other family and friends. 

September 12, 1976 – May 26, 2013

Minding Houston Episode VI: The Appropriate Appropriators

Last week we talked about the consequences about not investing in mental health. It makes sense to ask: So who are the investors? Or more accurately, who is making the decisions about how and how much our state spends on mental health care? It turns out, for those of us in Greater Houston, we have Legislators in positions of leadership in the Texas House and Senate. In this episode, we look at the Legislators in position to make the financial decisions we will be watching in 2015.

This is Minding Houston, I’m Bill Kelly.

There is always a lot of focus on the “Big 3” of Texas Government. The Governor, the Lt. Governor, and the Speaker of the House get most of the press when it comes to big legislative initiatives. However it is the individual legislators who make up the committees who play a very large role in determining which areas of the budget are funded and which policy are passed.

Greater Houston is very fortunate to have a number of our elected officials in well placed position to affect what the Legislature does for mental health. To start off, newly appointed House Appropriations Chair John Otto now holds one of the most powerful positions in the entire Legislature. Elected to Represent Dayton, Texas in House District 18, the heart of his district is only 35 miles from downtown Houston. Rep. Otto is the first CPA to ever head the budget writing committee and clearly wants to let the numbers do the talking. When laying out the budget to the new members of the Appropriations Committee, Chairman Otto had the Legislative Budget Board feature mental health funding during the Overview on House Bill 1.


“… moving on to page nine on mental health funding. House Bill One as introduced includes $2.6 billion in general revenue and $3.4 billion in all funds for behavioral health and substance abuse services. That goes to 17 agencies across five articles …”

Below, you can see the slides lawmakers were looking at detailing where House Bill 1, first one showing how mental health services are funded across 17 state agencies. The next slide deals specifically deals with the mental health and substance abuse funding in the Department of State Health Services.

Chairman Otto can choose whatever portion of the budget he would like to present when it comes to these overview hearings. The fact he included mental health funding shows his own focus on the issues and will hopefully resonate with members of his committee.

Sitting beside Chairman Otto is the Vice Chair of the Appropriations Committee Sylvester Turner. Rep. Turner is a 25 year house veteran and is regarded as one of the most knowledgeable members of the Legislature when it comes to the Appropriations Process.

During the testimony from staff with the Legislative Budget Board, Rep. Turner noticed that the base funding in House Bill 1 is predicted to generate a waiting list of over 900 adults statewide for mental health services.

speakerTurnerRep. Turner:  “So in comparison to what we did in the last biennium to this biennium what is the increase or decrease or are the things the same?”

“Across all of the agencies, again on slide 10, you can see is a $200,000 dollar general revenue increase so approximately the same as 1415 and then the $61 million dollar decline in all funds.”

Rep. Turner: “And then there is a waiting? Because last time we eliminated the waiting list for juveniles and adults, did we not?”

“Yes sir, I believe the waiting list for adults and children were funded last time.”

Rep. Turner: “Okay and with regards to where we are today the waiting list is returning?”

“Yes sir.”

Rep. Turner: “And the necessary cost to eliminate the waiting list there would be what?”

Shannon Sabine: “The estimated amount to fund the adult waiting list would at the moment would be about $13 million.”

Remember from our previous blog entries how Harris County is very much affected when the state is unable to serve those on the waiting list, having almost 30% of the wait list before services were funded in the last session.

Turner has filed House Bill 1393 that helps counties like Harris in funding Home and Community Based Services that provide medical assistance to persons with severe and persistent mental illness who are at the greatest risk of institutionalization. I spoke with Rep. Turner about this in Austin:

Bill Kelly: “I just caught Representative Sylvester Turner, Vice Chair of the Appropriations Committee walking off the house floor. Representative Turner, thank you for talking with us. You filed a legislation that is going to help Harris County really target the number of individuals who are at the risk of institutionalization by providing more medical assistance for health services. Could you talk a little bit about that bill?”

Rep. Turner: “Yes, there is such as tremendous need. People want to stay at home. They want that independence, that independent living and it enhances their own quality of life. So what is intended by the bill is to provide the necessary resources to keep them at home, to provide them with that support that’s needed to keep them at home, so we don’t have to put them in an institutionalized setting. That really cuts against their own quality of life and also not even beneficial or advantageous for the family members as well. And what I have found in my own personal experiences is that if you can keep people at their homes, in their communities, within that environment it’s just better for everyone around, for them as well as their family members and friends. “

Last week, subcommittees were named so that the 27 member House Appropriations Committee could focus closely on specific topic areas, often called Articles, in the budget. The Subcommittee for Health and Human Services that makes up Article II of the budget contains some very familiar faces for Harris County.

davisRep. Sarah Davis returns to this committee for her second straight session. Last session, she oversaw the Department of State Health Services budget that increased funding for behavioral health services by over $300 million. Rep. Davis represents the Texas Medical Center and has many constituents that work in health related fields. I spoke with her in Austin at a Subcommittee meeting on Wednesday.

Joining her is Rep. Armando Walle who will be serving on the Appropriations Committee for the 1st time since being elected in 2008. Rep. Walle meet with MHA in our offices during the interim to discuss state mental health policy and understands the needs of his district in getting access to services.


Kelly: “I’m here with Representative Armando Walle before the sub-appropriations committee meeting for Article II. Representative Walle, you visited with us this summer and talked about your concern with your constituents about access to services, not only for the people of your district but particularly with Veterans and your personal experiences that you have. Now that you are on the committee do you look forward to being able to address a number of those issues?”

Rep. Walle: “That is correct. Being on the committee, reviewing all the budget, PowerPoints, looking at where the money is going, item by item. Mental health is a huge issue, particularly for access in my district. Obviously, we’ve done better recently, but I think we can do a lot more to help folks access mental health because sometimes it is a taboo in a lot of our communities where they don’t want to seek out help. And we need to inform our folks, particularly low income communities, that it is okay to seek help. One example is the military, matters where military personnel come from combat, suffering from PTSD and they might not know it. Dear friends who have suffered from it, family members who come back from war and need mental health services; that is a huge issue for my district, particularly young kids that have disciplinary issues or be overrepresented in the juvenile justice system. So it runs a gambit, but we do need more access to effective treatment, diagnosis for our young kids.”

Over on the Senate side of the building, we have a number of Legislators from Harris County looking to use their experience to help shape policy as members of the Senate Finance Committee.

First, we previously mentioned Senator John Whitmire’s service as Chair of the Criminal Justice Committee. Known as “The Dean” as the longest serving State Senator, Whitmire has represented Harris County in the Senate since 1982. His experience huffmanwill be key in securing the needed funding for community based programs.

Senator Joan Huffman has a background as a prosecutor and as Vice Chair of the Criminal Justice Committee and as Chair of the Senate State Affairs Committee. Last session, she authored SB 1185 with Senator Whitmire to create the Harris County Mental Health Jail Diversion Program.

During the October 2014 Texas Tribune Tribfest panel entitled “What’s Next for Mental Health?”, Senator Huffman talked about how she was able to work with her colleagues, including Finance Chair Jane Nelson, about providing more resources for mental health.

Texas Tribune Pic

Senator Huffman: “I think it really got us thinking, what can we do in Texas to address these issues? Clearly we’ve fallen behind in treating those who are mentally ill and providing services that they desperately need. And I just think sometimes it’s an issue that everyone can understand. People want to be more informed about the issue and we had really good leadership. I served with Senator Nelson, who was the Chair of Health and Human Services. She made it a top priority and many of us followed her and made it our priority and resulted in good things happening in Texas.”

Senator Larry Taylor serves not only on the Senate Finance Committee but chairs the Senate Public Education Committee. Senator Taylor will be a key player in seeing mental health funding, such as Mental Health First Aide, is distributed to educators across the state. Last session, $5 million was allocated to train educators in Mental Health First Aide, and 8 hour program that teaches how to help people developing a mental illness or in crisis. In Harris County alone, that means 400 teachers trained in Mental Health First Aide.

Freshman Senator Paul Bettencourt is serving his first term in the Texas Senate, taking over the seat previously held by Lt. Governor Dan Patrick. Senator Bettencourt has meet with our office and from his seats on the Senate Public Education and Higher Education Committees has a very unique position to help with mental health initiatives, especially the mental health loan assistant repayment program in SB 239.

This impressive lineup has a difficult task in front of it in securing the needed resources for mental health. They will need to hear from people across Texas to make sure that mental health isn’t ignored or pushed to the side. So when and how are people reaching out to thank, educate, and persuade legislators? More on that, next time.

This is Minding Houston. I’m Bill Kelly.

Music from this episode: “Badass” and Funky Suspense” by Bensound, “Motown ton” by Ton, “Einsame Verfolger” by Melophon and Premium Music

Thank you to the Texas Tribune. To listen to the complete “What’s Next for Mental Health?” panel, visit their Soundcloud.

Minding Houston Episode III: The 1115 Medicaid Waiver in Houston

What if I told you the State of Texas and the federal government are working together, on an $11.4 billion partnership to help increase access to care for Texans? There are no lawsuits, political posturing, or name calling. The program is praised by Republicans, Democrats, and every healthcare organization across the state. Sound impossible? Well, let me tell you: it’s all true. And when it comes to increasing behavioral health services, it’s even better.

This is Minding Houston, I’m Bill Kelly. 

Today, we wanted to talk about the biggest expansion of behavioral health services in Texas. Ever heard of the 1115 Waiver? Well, if not, maybe it’s because it hasn’t generated the, let’s call it the “heat” that other federal initiatives have here in Texas.

So first things first, what is the 1115 Waiver? Simply put, it is a 5 year agreement between the federal Center for Medicare & Medicaid Services, or CMS, and the Texas Health and Human Services Commission, or HHSC. Together, CMS and HHSC have negotiated a plan to combine state dollars spent on healthcare to draw down matching federal funds all in an effort to expand the footprint of healthcare services in Texas.

1115 Medicaid Waiver made easy

       1115 Medicaid Waiver made easy

So what does this really mean for us in Greater Houston? As it turns out, quite a lot. Over our nine county Regional Health Partnership (one of 20 organized throughout the state), we stand to gain over $2.3 billion dollars in expanded healthcare services.


So, what do these programs look like? Well, let me introduce you to two programs funded
by the 1115 Waiver. First, in a report by Houston Public Media’s Carrie Feibel, is a look at Mental Health Crisis Clinics set up by Memorial Hermann.

Now, as we’ve noted before, the lack of access to mental healthcare leaves an increasing number of cases to be handled by law enforcement. That’s where our second example, the Crisis Intervention Response Team comes in. In this story by KHOU reporter Jeff McShan, you can see first hand the difference having both a mental health professional and law enforcement training has in dealing with a mental health crisis.

Both the Memorial Hermann mental health crisis clinics and three CIRT details are funded by the 1115 Waiver using Delivery System Reform Incentive Payments, or DSRIP funds. In our area, there are 55 projects specifically for Behavioral Health totaling $457 million dollars. Now, remember from last week, our state spends just over 1 billion a year in mental health services through DSHS for the entire state, and DSIRP dollars put almost half a billion right here in our own backyard.

This badly needed expansion of access for mental healthcare represents a huge step forward for the State of Texas. But it also brings a number of challenges. Like, do we have enough of a workforce to staff this expansion? What is the mental health workforce shortage and what we can do about it? More on that, next time.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

Music from this episode: “Rollin at 5 – 210” by Kevin MacLeod and “Sand Castle” by Pitx.

To hear Carrie Fiebel’s full report about the Humble Crisis Center, listen here at Houston Public MediaTo hear more about the HPD Crisis Intervention & Response Team (CIRT), watch here at KHOU.com.

Minding Houston Episode II: Mental Health Money

As the 84th Legislative Session begins, our lawmakers are only constitutionally required to do one thing: pass a budget. While likely to pass over 1,000 other pieces of legislation, the Legislature is legally bound to determine the funding for state services for the next biennium. And that bill, the Appropriations Bill, is where questions about the financing for mental health services are answered.

Before looking at this biennium, it is worth looking at were we started. Historically, Texas has not funded services on the level with other states. The best study of this was done by the Kaiser Family Foundation in comparing per capita spending on mental health services.

From an interview I gave with Houston Public Media’s Craig Cohen on an episode of “Houston Matters” in June of 2014,

“For the Fiscal Year 2010, Texas ranked 49th in terms of per capita spending on mental health with right at $39. Keep that 39 dollar figure in mind for comparison sake. Our neighbors to the east in Louisiana spend $62 per capita, and further down the road, Alabama spends $78. Mississippi, who we are often compared to for social services, spends $114. The national average is $120.”


So with that historical under investment in mind, what does Texas spend on mental health now? To best show the answer, our friends at the Meadows Mental Health Policy Institute produce the following slide that breaks down the figures.


The vast majority of state spending on mental health comes from the $1.16 billion spent yearly by the Department of State Health Services. Roughly $160 million a year is spent on substance abuse.

Getting your head around those big numbers helps to show just how successful the last legislative session was for funding. A chart from the House Appropriations Committee hearing this summer outlines the additional $312 million in increased spending within DSHS. A breakdown of these additional expenditures is listed on the attached chart.Click for larger photo

While badly needed, last session’s invest won’t solve the problem of serving Texans with mental health needs. Aside from continued investment from lawmakers, Texas needs to expand the footprint of services so more people can have access. Thanks to a partnership between Texas and the federal government, and yes you heard that right, we are doing just that. More on that next time.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

We would like to thank both Houston Matters and the Meadows Mental Health Policy Institute. To hear the rest of the interview, listen here at the Houston Matters website.

This episodes music included “Never Let it Go” by Bluesraiders, “Strange Sensations” by Anitek and “Plethora” by Anitek.

Minding Houston Episode I: Moving Forward in 2015

Welcome to the 84th Legislative Session! My name is Bill Kelly, the Director of Public Policy & Government Affairs here at Mental Health America of Greater Houston. With the start of new year comes 140 days of governing, and that means our advocacy will be kicking into high gear.

We invite you to keep up with our work by following our new Legislative Blog, “Minding Houston” where we will share the latest on issues and bill movement. 

I’ve been a Chief of Staff for a State Legislator and worked for the Mayor’s Office at the City of Houston. I’m very proud to work for the issues and policies that Mental Health America of Greater Houston has endorsed and look forward to using this blog to keep you updated on legislative progress.

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[Transcript below]Cap Dome Lighter

Since the last Legislative Session ended, there have been a number of press reports about the progress made in Texas in mental health funding. The purpose of this blog is to help keep you updated with what policies Mental Health America of Greater Houston will be working on during 2015 and the stories of real people that these policies impact.

Recently, the Mental Health America of Greater Houston Board has approved series of Legislative Priorities. It is our hope to help tell the stories of how and why policy changes have dramatic impacts for the quality of life for those with loved ones suffering from a mental illness or substance abuse problems. By highlighting our priorities in press stories, we hope to raise the attention of lawmakers and hope they continue their efforts to invest in mental health.

To help set the stage, check out this article from our friends at the Houston Chronicle on July 12th.

Advocates are urging Texas lawmakers to remember the problems in the state’s mental health system after a couple of hearings in which progress on mental health has been cast as one of the Legislature’s greatest recent accomplishments.

Last session’s roughly $350 million increase in funding for mental health and drug abuse services helped reduce the number of Texans on a waiting list for psychiatric treatment from 5,515 last February to 790 this February, including from 1,750 to zero in Harris County, and 194 to 11 among children. The reductions were hailed at a state House Appropriations Subcommittee meeting last month.

“That’s an extraordinary outcome,” said Rep. John Zerwas, R-Richmond, the panel’s chairman.


Still, Zerwas said the waiting-list reductions represent a “very solid first step.”

“We have made steps forward in the past,” the lawmaker added. “But every time we would make a step forward, we would next time make a step backward. So, a real focus of mine is making sure that we take another major step forward next year.”

This is where we hope to help Rep. Zerwas and the strong bipartisan coalition that wants to reduce the expensive consequences of failing to invest in mental health services. We need to move forward, and we know that we can by showing the solid return on investment that come with funding.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

Music from this episode: “The 3rd” by Anitek and “Looping Guitar Improv in Em” by Steve Combs.