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.
Testimony on Integration of Care, Innovative Mental Health Care Projects, and Specialty Populations