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Public Policy: Mental Health System Capacity, Workforce, and Continuum of Care

The mental health system does not have the capacity to meet the full range of needs. Funding and capacity are failing to keep up with population growth and other added demands. While considerable investments and improvements had been made in recent sessions, severe ongoing issues – such as waitlists, workforce shortages, and gaps in the continuum of care – remain.  The state should prioritize opportunities to expand access to care, address gaps in the continuum of care, reduce the mental health workforce shortage, and invest in innovative programs.

Gaps in Statewide Behavioral Health Strategic Plan

In the last three legislative sessions, Texas has prioritized state funding for mental health services. The results of these investments have been profound: enhanced services and considerable waitlist reductions at community centers, increased capacity in crisis stabilization and other alternatives to inpatient, and impressive efforts to transform the inpatient care system through increased funding and coordinated planning.

However, Texas still ranks 49th in access to mental health care due to

  • waitlists
  • underserved clients at community centers,
  • hundreds of people waiting in jail for access to inpatient care,
  • criminal justice involvement,
  • homelessness,
  • school failure

As demand for services increases due to a growing state population, Hurricane Harvey, and other issues, we must continue to focus on coordinating services across state government, addressing gaps in the continuum of care, building capacity through increased investment in outpatient services, alternatives to inpatient, and inpatient care. Texas should approve HHSC Exceptional Items 7, 8, 11, 27, and 37 to strengthen mental health infrastructure in the state.

Mental health workforce shortages

Without an appropriate supply of mental health professionals, Texas will not be able to meet the growing demand for mental health care. Over 3 million Texans live in counties without a psychiatrist, and the vast majority of counties in the state both have no psychiatrists and are considered Shortage Areas. Texas ranks 50th in mental health workforce availability. Texas should address this complicated problem by

  • Mental health professional loan repayment funding,
  • Expedited licensing for out-of-state mental health professionals
  • Support for Graduate Medical Education,
  • Peer services
  • Mental health care professionals to practice to the full extent of their licensure.
  • HHSC Exceptional Item 16 to increase pay for frontline staff in state mental health facilities.


NAMI Education and Support Programs

NAMI programs and services are important resources for individuals with mental illness and their family members across Texas. These services offer education, provide support, and promote recovery, without cost to participants delivered by individuals with mental illness or their families. Texas should increase funding for NAMI programs to help address various gaps in the Statewide Behavioral Health Strategic Plan and serve as a critical piece in the continuum of care.

Mental health Clubhouses

Clubhouses are community-based centers for people living with mental illness that provide resources for continuing education and skill-building, finding employment and housing, and provide opportunities for socializing. Clubhouse members are more likely to have strong social support networks and experience more time between recidivism and re-hospitalization than people with mental illness in other intervention programs.

Texas has funded Clubhouses in the two most recent biennia, and over that time, the number of Clubhouse groups in the state has increased from 4 to over 18. With the increased demand for these highly-effective services, Texas should increase its investment to $5 billion and ensure that funds be available for both start-up and existing Clubhouses.


86th Legislative Session Key Bills on Capacity, Workforce, and Continuum of Care

Senate Bill 37 (Zaffirini) and House Bills 218 (Krause)/258 (Blanco)/466 (Hernandez) – Relating to the abolition of student loan default or breach of a student loan repayment or scholarship contract as a ground for nonrenewal or other disciplinary action in relation to a professional or occupational license.

Senate Bill 37 and House Bills 218/258/466 would remove student loans default as grounds for nonrenewal for licensure, which includes mental health professionals.

Senate Bill 37 has been referred to the Senate Business & Commerce committee.  House Bills 218/258/466 have all been referred to the House Higher Education committee and have been left pending in committee.  Testimony was taken on February 27, 2019.

Senate Bill 426 (Lucio) and House Bill 727 (M. Gonzalez) – Relating to the use of public school counselors’ work time.

Senate Bill 426 and House Bill 727 would require that school counselors spend 80% or more of their total work time on duties that are part of the counseling program (not non-counseling administrative work).

Senate Bill 426 has been referred to the Senate Education committee.  House Bill 727 has been referred to the House Public Education committee.

Senate Bill 429 (Lucio) and House Bill 1669 (Lucio III) – Relating to a comprehensive plan for increasing and improving the workforce in this state to serve persons with mental health and substance use issues.

Senate Bill 429 and House Bill 1669 would require the statewide behavioral health coordinating council to develop a comprehensive plan to increase and improve the workforce for serving individuals with mental health/substance use issues.

Senate Bill 429 has been referred to the Senate Health & Human Services committee.

Senate Bill 611 (Nichols) and House Bill 1501 (Nevarez) – Relating to the creation of the Texas Behavioral Health Executive Council and to the continuation and transfer of the regulation of psychologists, marriage and family therapists, professional counselors, and social workers to the Texas Behavioral Health Executive Council; providing civil and administrative penalties; authorizing a fee.

Senate Bill 611 has been referred to the Senate Health & Human Services committee.

Senate Bill 630 (Rodriguez) – Relating to a study and report regarding shortages in certain health professions.

Info pending.

Senate Bill 630 has been referred to Higher Education.

Senate Bill 633 (Kolkhorst) and House Bill 1598 (Lambert) – Relating to an initiative to increase the capacity of local mental health authorities to provide access to mental health services in certain counties.

Info pending.Senate Bill 633 has been referred to Senate Health & Human Services committee, and testimony will be taken on March 5, 2019.

Senate Bill 670 (Buckingham) and House Bill 870 (Price) – Relating to Medicaid telemedicine and telehealth services.

Senate Bill 670 and House Bill 870 would prohibit managed care organizations from denying Medicaid reimbursement for a telemedicine or telehealth service solely because it is not an in-person consultation.

Senate Bill 670 has been referred to Senate Health & Human Services committee and House Bill 870 has been referred to the House Public Health committee.

House Bill 10 (S. Thompson) – Relating to grants and programs for researching and treating behavioral health and psychiatric issues.

House Bill 10 would establish a child and adolescent psychiatric nursing grant program, a behavioral health research and treatment grant program, and an addiction crisis grant program with funding appropriated by the Higher Education Coordinating Board to new or existing medical education program. It would increase the number of residency positions focused on child and adolescent behavioral health, and establish a central institute for managing research, grants, and dissemination of best practices around child and adolescent behavioral health as well as substance abuse and addiction.

House Bill 10 has been referred to the House Public Health committee and has been left pending in committee. Public testimony was taken on February 27, 2019.

House Bill 628 (Thierry) – Relating to an acute psychiatric bed registry to list available beds for the psychiatric treatment of certain individuals.

House Bill 628 would create an online searchable registry of available beds in psychiatric hospitals in county of 4+ million population that is searchable to health and mental health providers and law enforcement.

House Bill 628 has been referred to the House Public Health committee.

House Bill 1070 (Price) – Relating to the mental health first aid training program reporting requirements.


House Bill 1072 (Price) – Relating to mental health and substance use resources for certain school districts.


House Bill 1094 (Moody) – Relating to the provision of counseling services by certain providers under Medicaid and reimbursement for those services.


House Bill 1137 (Price) – Relating to an annual report prepared by the Health Professions Council.

House Bill 1137 would add a requirement to the Health Professions Council annual report to include strategies to expand health care workforce in state, including methods for reducing time to process licensing applications for professions, methods for increasing number of health care practitioners providing behavioral health services, legislative appropriations needed to expand workforce.

House Bill 1137 has been referred to the House Public Health committee.

House Bill 1302 (Davis) – Relating to the creation of the Texas Mental Health Research Institute; authorizing the issuance of bonds.

House Bill 1302 has been referred to the House Public Health committee.

House Bill 1782 (Cortez) – Relating to a plan to increase the use of telemedicine medical services and telehealth services in this state.


Testimony on Mental Health System Capacity, Workforce, and Continuum of Care

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