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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

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

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