Public Policy: Integration of Care, Innovative Mental Health Care Projects, and Specialty Populations
The mental health care system and other systems are historically separate from one another, causing certain health needs of individuals with mental illness to go unaddressed. The mental health care system and other systems should both be equipped to address mental health and other health care needs.
Coordinated Specialty Care Programming
Approximately 3,000 new cases of early psychosis occur in Texas every year among people from ages 15 to 34. Texas should expand Coordinated Specialty Care programming for early psychosis, which is proven to improve quality of life, provide a pathway to recovery, support independence, and engage families.
The programming provides young people experiencing early psychosis with a team of specialists who work with them to develop a personal treatment plan, including
- case management services
- family education
- medication management
Texas should approve HHSC Exceptional Item 19 to fund Coordinated Specialty Care programming for First Episode Psychosis.
Integration of mental health services
The primary care setting is often the first place where individuals with mental illness go for help or are identified. Adults with serious mental illness have higher rates of other chronic illnesses than the general population. Primary care settings can implement a holistic approach to an individual’s wellbeing by utilizing Collaborative Care Model teams that include mental health professionals.
Collaborative treatment planning can ensure an individual’s mental health and other health needs are effectively being addressed. Texas should prioritize integrated health care programs, including turning on a Medicaid billing code for the Collaborative Care Model and incorporating integration as a value-based care outcome metric or incentive strategy in Medicaid Managed Care.
Co-occurring mental health and substance use disorders
Half of adults nationwide who experience a substance use disorder have a co-occurring mental illness. Youth who have mental illness are at high risk of developing a substance use disorder, especially if they have experienced trauma. Treatment facilities for substance use disorders commonly do not address the untreated mental health issues that may have led to self-medication.
Texas should incentivize the integration of mental health and substance use treatment services and address the waitlist for Co-Occurring Psychiatric and Substance Use Disorder (COPSD) Services. The state should invest in prevention and treatment of co-occurring substance use disorders for a variety of youth populations. Texas should approve HHSC Exceptional Item 21: Substance Use Disorder Treatment.
Innovative mental health care projects
The 1115 Waiver DSRIP projects have been instrumental in transforming healthcare delivery systems, improving health, and lowering costs. Local Mental Health Authorities are the most common type of DSRIP provider and roughly one third of DSRIP projects have a mental health and/or substance use disorder focus. Per the most recent renewal of the 1115 Waiver, federal funds for DSRIP projects are set to expire in 2021. These projects have been very effective in treating mental illness for individuals who would otherwise not have access to care. Texas should develop strategies to continue effective DSRIP projects.
People with intellectual/developmental or non-mental health disabilities, women with perinatal mood and anxiety disorders, people with a history of incarceration or long-term hospitalization; and veterans and military service members are more likely to develop mental illness than people in the general population.
Texas should address mental health disparities within these populations by integrating mental health services into spaces in which they are located. Texas should approve HHSC Exceptional Item 22: enhanced mental health services for people with intellectual/developmental disabilities.
86th Legislative Session Key Bills on Integration of Care, Innovative Mental Health Care Projects, and Specialty Populations
Senate Bill 47 (Zaffirini) – Relating to the establishment of a task force on ensuring an appropriate care setting for a person with a disability.
Senate Bill 47 would create an interagency task force to ensure appropriate settings for individuals with disabilities, with special focus on helping individuals in institutions transition back into the community.
Senate Bill 340 (Huffman)/House Bill 1449 (P. King)– Relating to the creation of a grant program to assist law enforcement agencies with the purchase of opioid antagonists.
Senate Bill 340 and House Bill 1449 would create a grant program within the criminal justice division of the governor’s office that will allow law enforcement agencies to apply for financial assistance purchasing opioid antagonists (naloxone, naltrexone, etc.) to treat an opioid overdose.
Senate Bill 435 (Nelson) – Relating to recommendations by local school health advisory councils regarding opioid addiction and abuse education in public schools.
Senate Bill 435 would require local school health advisory councils to develop recommendations on age-appropriate curriculum and instruction for students on opioid abuse and addiction, and how to administer an opioid antagonist.
Senate Bill 436 (Nelson) – Relating to statewide initiatives to improve maternal and newborn health for women with opioid use disorder.
Senate Bill 437 (Nelson) – Relating to prohibited practices by a life insurance company relating to an individual’s prescription for or obtainment of an opioid antagonist.
House Bill 746 (Rose) – Relating to the establishment by certain counties and hospital districts of disease control pilot programs to reduce the risk of certain infectious and communicable diseases; authorizing fees.
House Bill 746 would allow counties or hospital districts in Bexar, Dallas, Harris, and Travis counties to develop a disease control pilot program, including a needle exchange program, education on relevant infectious diseases, and assistance obtaining health and mental health services, including substance use disorder treatment and bloodborne disease testing.
House Bill 1111 (Davis) – Relating to maternal and newborn health care.
House Bill 1585 (M. Gonzalez) – Relating to a study on interest or other waiting lists maintained for certain Medicaid programs providing services to persons with intellectual and developmental disabilities.
Testimony on Integration of Care, Innovative Mental Health Care Projects, and Specialty Populations