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COVID-19 and Mental Health Policy/Advocacy

NAMI Texas is dedicated to keeping you up to date on the policy, big picture issues of how COVID-19 (Coronavirus) is impacting not only your day-to-day life, but the entire mental health landscape in Texas.  We are still updating this page, but we will continue to provide you with critical information and action steps to protect and expand the mental health and well-being of individuals and families across the state.

Opportunities for Action

COVID-19 Advocacy: Share your mental health story. NAMI.

COVID-19 Advocacy: Ask your US Senators to support mental health. NAMI.

Sign a petition to ask Governor Abbott to expand Medicaid. #SickofitTX.

Share your healthcare story. #SickofitTX.

Key Mental Health Policy Issues

COVID-19 has been more than a public health crisis: it’s been an economic downturn, an upheaval of social norms, and a mental health crisis.  Individuals who have never experienced mental health issues before are now struggling with anxiety and depression from the crisis, and individuals with previous mental health conditions may have fewer supports and greater stressors than before.

  • Of Americans surveyed, 15% state say their mental health is already suffering as a result of COVID-19 social distancing, compared to their physical (6%) or financial health (9%).
  • This number can worsen based on demographics – 26% of individuals ages 18-44 believe  their mental health is suffering under social distancing, compared to 5% of those ages 65 or older. One in half parents of minor children reported their mental health is suffering, compared to 13% of adults with no minor children at home

Mental Health and the Budget

System Capacity and Access to Mental Health Services

NAMI and other mental health support services

We all know peer support programs have a positive impact on a person’s recovery. When the
emergency order took effect, NAMI Texas acted quickly to ensure our members would still have access to our individual and family support groups by starting statewide online groups. This statewide support group helps individuals across Texas, not just NAMI members, cope during this challenging time.

Resources
Therapy groups can save lives, but how now with social distancing? Austin-American
Statesman.

Personal Protective Equipment (PPE) for Mental Health Providers

As many services as possible should be moved to remote means such as telehealth, telemedicine, and telephonic communication. However, not every mental health service can be provided remotely. Inpatient services, crisis services, Medication Assisted Treatment, and many other services can only be provided in person. Providers are placing themselves at risk to ensure individuals living with mental health or substance use disorders receive the vital services they need to effectively recover. We need to protect the health and well-being of providers, clients, and their families by increasing access to personal protective equipment for individuals who must provide services in person.

Resources

HHSC. March 25, 2020. Personal Protective Equipment Solutions. March 2020 QMP Bulletin.

Telehealth and Telemedicine Services

Telehealth and telemedicine services should be promoted and supported in every area that touches mental health. This may include:

Resources

Jody Barr. March 31, 2020. Insurance companies not paying telehealth claims for mental health care in Texas. KXAN News Austin.

March 25, 2020. The TPA Pro Bono Project: COVID-19. Texas Psychological Association.

Mohana Ravindranath. April 9, 2020. America’s having a nervous breakdown. Can telemedicine fix it? Politico.

Children and Youth Mental Health

K-12 Student Mental Health

The 86th legislative session was a tremendous success for student mental health in our K-12 schools. We expanded access to critical resources for school districts, educators, and students, to learn about mental health and suicide prevention, and provide more counseling options to students. As with Hurricane Harvey, this pandemic has the potential to be a very traumatic event for many children. Not just for health risks, but for the major disruptions they have experienced in their day-to-day lives. For children who were receiving mental health services in schools or engaging in counselor-based support groups, they may lose months’ worth of progress in their recovery.

Sarah Wood. April 14, 2020. Coronavirus Pandemic Has Impacted College Students’ Mental Health. Diverse: Issues in Higher Education.

March 23, 2020. North East ISD offering virtual counseling for students amid COVID-19 closing schools. News 4 San Antonio – NBC.

Valerie Strauss. March 26, 2020. Analysis | A trauma-informed approach to teaching through coronavirus — for students everywhere, online or not. The Washington Post.

Greta Anderson. March 31, 2020. Mental health support systems for coping with pandemic. Inside Higher Ed.

Suicide Prevention and Crisis Services

Suicide prevention and Crisis services

Mental health and suicide prevention hotlines are seeing an extremely high increase in their call volume. Suicide attempt rates tend to increase during times of crisis. High call volumes mean many people may not reach the support they need in time. We were happy to hear about the creation of the Health and Human Services COVID-19 mental health hotline, and we want to make sure that hotline capacity matches the current needs of the public. We need to ensure crisis hotlines receive additional resources during this time to account for the crisis.

Evaluating current capacity of different types of mental health and well-being crisis lines across Texas.
Providing emergency funding to mental health crisis and suicide prevention hotlines to ensure adequate staffing and safe social distancing and administrative practices for staff.

Health Care, Health Insurance, and Medication

Reduce the Uninsured Rate

Access to health is one of the most critical needs for individuals experiencing mental health issues.

Texas has the highest uninsured rate in the country. Individuals who are uninsured may be less likely to seek out screening and treatment, and when they do, are more likely to visit the Emergency Room for services at a time when hospitals are overwhelmed with high-risk patients. To mitigate the burden on Emergency Rooms and ensure individuals can receive the care they need, we recommend the state explore different strategies for expanding access to health insurance.

Criminal Justice and Juvenile Justice

Criminal Justice

Criminal Justice is a mental health issue, especially during this pandemic. Individuals involved with the criminal justice system are disproportionately more likely to have a mental health condition. Individuals involved in the criminal justice system are especially vulnerable during this time for both health risks and stressors.

Competency Restoration

According to Articles 46B.0711 and 46B.072, Code of Criminal Procedures, courts shall release on bail a defendant who is determined to be incompetent to stand trial on a Class B or Class A misdemeanor, and who does not pose a danger to others. The court shall require that individual to be treated in an appropriate outpatient competency restoration program. The court must receive a comprehensive plan regarding the treatment provided to the individual as well as the person who will provide treatment. The provisions apply when care is available and will be provided. Courts may also place people who do not pose a danger to others, and who are charged with felony offenses, into outpatient competency restoration programs so long as the conditions described above are satisfied. Given the danger of extended periods of detention required for jail-based competency restoration, or delays awaiting placement into hospital-based competency restoration, it is imperative that courts maximize the use of outpatient competency restoration.

  • Where outpatient competency restoration program exist, courts should exercise maximum latitude in releasing individuals determined to be incompetent to stand trial who are charged with felony or misdemeanor offenses into these programs.
  • Courts should communicate with outpatient competency restoration providers about the need to continue these programs and receive new clients, recognizing the need for protective distance and precautions to prevent contagion.
Reducing spread of COVID-19 through appropriate releases of inmates

NAM Texas has concerns about the executive order provided on Sunday, March 29th, regarding the prohibition of releasing certain inmates in county jails on no-cost personal bonds. Many criminal justice advocates have noted the importance of reducing our jail population at this time to reduce the spread of COVID-19 in close quarters and to flatten the curve in a high-risk environment. We encourage the state to explore different opportunities to keep these facilities safe. This executive order allows exceptions for health concerns, but not mental health concerns. Individuals living with serious mental illness are more likely to become involved in the criminal justice system, and may be detained under incidents related to a mental health crisis episode. This individual may not actually be a threat to the general public. They may also not have the income needed to be released on a bail bond. Although we appreciate the Governor’s concerns around public safety, we believe it is best to allow local judges to determine what is in the best interest for the jails, the individual, and public safety, in each case. We urge the Governor’s office to re-evaluate this executive order and ease restrictions around judicial discretion to ensure individuals living with mental illness receive appropriate interventions.

Resources

April 14, 2020. Many Texas prisoners have been approved for parole but can’t walk free yet. Advocates say coronavirus should change that. The Texas Tribune.

 April 11, 2020. Texas prisons won’t accept new county jail inmates as coronavirus spreads in lockups. The Texas Tribune.

Michael Barajas. Mar 31, 2020. Families of Sick Prisoners Plead for Compassionate Release as Coronavirus Spreads Behind Bars in Texas. The Texas Observer.

Amalia Beckner. Mar 30, 2020. In a Pandemic, Poor Defendants Could Pay With Their Lives.  The Texas Observer.

Michael Barajas. Some Texas Officials Want to Divert People from Jail Amid Coronavirus Scare. The Texas Observer.

Gabrielle Banks. April 8, 2020. Reports: Children are in 23½ hour-a-day lockup at Harris County juvenile facility amid COVID-19. The Houston Chronicle.

 

NAMI Activities

March 25, 2020. MHLG Statement on State Coverage of Telehealth Service Amid Coronavirus, COVID-19. Mental Health Liaison Group.

April 7, 2020. MHLG Supports the Mental Health of Americans Impacted by COVID-19 through Peer Support. Mental Health Liaison Group.

April 7, 2020. Responding to the Mental Health and Addiction Crisis Caused By the COVID-19 Pandemic. The Kennedy Forum.

April 8, 2020. SMB COVID-19 Letter to Leadership. American Heart Association.

 

COVID-19 Federal Action

NAMI Highlights of the federal CARES Act 

COVID-19 State Action

COVID-19 Governor Executive Orders

All Governor Abbott Executive Orders can be found here.

GA-8 – Relating to COVID-19 preparedness and mitigation (coronavirus) (OUTDATED)
  • Every person in Texas shall avoid social gatherings in groups of more than 10 people.
  • People shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms or massage parlors; provided, however, that the use of drive-thru, pickup, or delivery options is allowed and highly encouraged throughout the limited duration of this executive order.
  • People shall not visit nursing homes or retirement or long-term care facilities unless to provide critical assistance.
  • Schools shall temporarily close. This, executive order does not prohibit people from visiting a variety of places, including grocery stores, gas stations, parks, and banks, so long as the necessary precautions are maintained to reduce the transmission of COVID-19.
  • This executive order does not mandate sheltering in place.
  • All critical infrastructure will remain operational, domestic travel will remain unrestricted, and government entities and businesses will continue providing essential services.
  • For offices and workplaces that remain open, employees should practice good hygiene and, where feasible, work from home in order to achieve optimum isolation from COVD-19.
  • Shall remain in effect and in full force until 11:59 p.m. on April 3, 2020, subject to being extended, modified, amended, rescinded, or superseded by me or by a succeeding governor.f
GA-9 – Relating to hospital capacity during the COVID-19 disaster (coronavirus)
  • Until April 21, 2020, all licensed health care professionals and all licensed health care facilities shall postpone all surgeries and procedures that are not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician;
  • This prohibition shall not apply to any procedure that, if performed in accordance with the commonly accepted standard of clinical practice, would not deplete the hospital capacity or the personal protective equipment needed to cope with the COVID- 19 disaster.
  • At request of HHSC, provisions related to specific aspects of New Construction Requirements and Spatial Requirements for New Construction, and any other relevant regulations or statutes, to the extent necessary to implement increased occupancy in the event of surge needs for hospital capacity due to COVTD-19.
GA-10 -Relating to daily reporting during the COVID-19 disaster (coronavirus, hospital reporting)
  • All hospitals licensed under Chapter 241 of the Texas Health and Safety Code, and all Texas state-run hospitals, except for psychiatric hospitals, shall submit to DSHS daily reports of hospital bed capacity, in the manner prescribed by DSHS. DSHS shall promptly share this information with the CDC.
  • Every public or private entity that is utilizing an FDA-approved test, including an emergency use authorization test, for human diagnostic purposes of COVID- 19, shall submit to DSHS, as well as to the local health department, daily reports of all test results, both positive and negative. DSHS shall promptly share this information with the CDC.
GA-11 – Relating to airport screening and self-quarantine during the COVID-19 disaster (New York Tri-State Area, New Orleans, coronavirus)
  • Every person who enters the State of Texas as the final destination through an airport, from a point of origin or point of last departure in New York, New Jersey, Connecticut, or the City of New Orleans, or in any other state or city as may be proclaimed hereafter, shall be subject to mandatory self-quarantine for a period of 14 days from the time of entry into Texas or the duration of the person’s presence in Texas, whichever is shorter.
  • Does not apply to travel for commercial activity, military service, emergency response, health response, or critical-infrastructure functions, as may be determined by the Texas Division of Emergency Management.
  • Each person covered by this order to self-quarantine shall be responsible for all associated costs, including transportation, lodging, food, and medical care.
  • The Texas Department of Public Safety (DPS) shall enforce this executive order along the Texas-Louisiana border. Using a form to be prescribed by DPS, each covered person shall designate a quarantine location in Texas, such as a residence or a hotel, and provide a full name, date of birth, home address, telephone number, and driver license or passport information. DPS Troopers, or other approved peace officers, will collect a completed form from a covered person and verify it against the person’s driver license or passport. Providing false information on this form is a criminal offense under Section 37.10 of the Texas Penal Code. Questions about this form should be directed to DPS by calling (800) 525-5555.
  • A covered person shall proceed directly to the designated quarantine location entered on the DPS form. Any covered person exhibiting symptoms of COVID-19 shall be escorted to the designated quarantine location by a DPS Trooper. A covered person shall remain in the designated quarantine location for a period of 14 days or the duration of the person’s presence in Texas, whichever is shorter, leaving only to seek medical care or to depart from Texas. During that period, a covered person shall not allow visitors into or out of the designated quarantine location, other than a health department employee, physician, or health care provider, and shall not visit any public spaces.
  • DPS Special Agents will conduct unannounced visits to designated quarantine locations to verify compliance by confirming the physical presence of covered persons. Any failure to comply with this order to self-quarantine shall be a criminal offense punishable by a fine not to exceed $1,000, confinement in jail term not to exceed 180 days, or both.
GA-12 – Relating to roadway screening and self-quarantine during the COVID-19 disaster (coronavirus)
  • Ever person who enters Texas through by road from Louisiana, or from any other state as may be proclaimed hereafter, shall be subject to mandatory self-quarantine for a period of 14 days from the time of entry into Texas or the duration of the person’s presence in Texas, whichever is shorter.
  • Same procedures as GA-11.
GA-13 – Relating to detention in county and municipal jails during the COVID-19 disaster (coronavirus)
  • Suspends Texas Code of Criminal Procedure Article 17.03, Article 17.151, Article 15.21, Article 42.032, Article 42.035, Sections 418.1015(b) and 418.108 of the Texas Government Code, and all other relevant statutes and rules:
  • Any person previously convicted of a crime that involves physical violence or the threat of physical violence, or of any person currently arrested for such a crime that is supported by probable cause.
    • Cannot be released on personal bond
    • Cannot receive automatic release on personal bond because the State is not ready for trial.
    • Cannot receive automatic release on personal bond because the jail of the county where the offense is alleged to have been committed does not take charge of the arrested person before the 11th day after the date the person is committed to the jail of the county in which the person is arrested.
    • Cannot be granted commutation of time for good conduct, industry, and obedience to achieve their release. (Does not preclude the accumulation of credit for good conduct, industry, and obedience during the pendency of this executive order.)
    • Cannot be released to an electronic monitoring program, rather than being confined in the jail.
  • Prohibits any county judge or mayor of a municipality, or any emergency management director, from releasing persons under any circumstances inconsistent with this order.
  • County criminal court judge, district judge, or appellate judge may still consider release on an individualized basis for health or medical reasons, provided that proper notice is given to the district attorney and an opportunity for hearing is given.
GA-14 – Relating to statewide continuity of essential services and activities during the COVID-19 disaster (coronavirus)
  • Except for essential services, minimize social gatherings and minimize in-person contact with people who are not in the same household.
  • “Essential services” shall consist of everything listed by the U.S. Department of Homeland Security in its Guidance on the Essential Critical Infrastructure Workforce, Version 2.0, plus religious services conducted in churches, congregations, and houses of worship. Information found here: www.tdem.texas.gov/essentialservices.
  • For essential or religious services that cannot be conducted from home or through remote services, people and businesses should follow the Guidelines from the President and the CDC by practicing good hygiene, environmental cleanliness, and sanitation, implementing social distancing, and working from home if possible.
  • All services should be provided through remote telework from home unless they are essential services that cannot be provided through remote telework.
  • The use of drive-thru, pickup, or delivery options for food and drinks is allowed and highly encouraged throughout the limited duration of this executive order.
  • Does not prohibit people from accessing essential services or engaging in essential daily activities, such as going to the grocery store or gas station, providing or obtaining other essential services, visiting parks, hunting or fishing, or engaging in physical activity like jogging or bicycling, so long as the necessary precautions are maintained.
  • People shall not visit nursing homes, state supported living centers, assisted living facilities, or long-term care facilities unless to provide critical assistance as determined through HHSC guidance.
  • Schools shall remain temporarily closed to in-person classroom attendance until at least May 4, 2020.

 

Health and Human Services guidance

March 31, 2020. HHS Launches Statewide COVID-19 Mental Health Support Line.

March 28, 2020. HHSC Temporarily Waives Renewal Requirements for Medicaid, SNAP Clients During COVID-19 Crisis.

March 17, 2020. Texas HHS Temporarily Suspends Non-Essential Visits to State Hospitals, State Supported Living Centers.

April 6, 2020. Emergency Rule for Facility Response to COVID-19: Private Psychiatric Hospitals and Crisis Stabilization Units. Health and Human Services.

April 17, 2020. COVID-19 Behavioral Health Services Providers Frequently Asked Questions. Health and Human Services.

April 3, 2020. COVID-19 Response Recommendations Substance Use and Misuse Prevention. Health and Human Services.

Resources from our Partners

Disability Rights Texas COVID-19 Resources.

Texas Criminal Justice Coalition COVID-19 Response.

COVID-19 Resources & Updates for Social Workers.

Texas Counseling Association COVID-19 Resources.

American Foundation for Suicide Prevention COVID-19 Resources

Mental Health Liaison Group Response.

 

 

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