TMA Testimony by Les Secrest, MD
Senate Finance Committee
Article II, Department of State Health Services
Mental Health and Substance Abuse Funding
Feb. 19, 2015
Good morning/afternoon, Chairwoman Nelson and committee members. My name is Dr. Les Secrest. I’m a psychiatrist from Dallas where I practice at Presbyterian Hospital as chair of its Department of Psychiatry. I also serve as a consultant on the Texas Medical Association Council on Legislation. Today I’m speaking on behalf of TMA, the Federation of Texas Psychiatry, and the Texas Pediatric Society.
Our organizations appreciate the significant investments the legislature made in 2013 to strengthen the state’s mental health and substance abuse treatment systems. Those funds helped to bolster and sustain a foundation for the state’s community-based mental health and “crisis” services, reduced waiting lists, and provided training for educators to better identify children who may need mental health services. You also funded the Medicaid Youth Empowerment Services (YES) waiver to provide intensive individual and family support services for severely mentally ill children and youth at risk for relinquishment. As a result of your leadership, Texas’ behavioral health system has become more humane and effective while also reducing the state’s health care and criminal justice costs.
Despite these significant and much appreciated investments, Texas’ population is rapidly growing, thereby putting considerable strain on mental health and substance abuse systems already struggling to keep pace. Texas continues to lag far behind other states in spending per person for mental health care. As you well know, inadequate state funding puts a financial burden on local resources, and often leads to increased rates of incarceration, and higher use of public hospital emergency departments, homeless shelters, and the foster care system.
More than 4.3 million Texans, including 1.2 million children, live with some form of mental health disorder. Of these, 1.5 million cannot function at work, at school, or in the community due to their illness. Mental illness and substance abuse hurt the Texas economy through lost earning potential, treatment of coexisting conditions, disability payments, homelessness, and incarceration. Mental illness is also strongly associated with high-risk behaviors such as alcohol, tobacco, and illicit drug use, and results in conditions such as obesity. One recent study estimates that Texas state dollars spent on mental health exceed $13 billion each year.
The Texas Department of State Health Services estimates only 30 percent of adults with severe and persistent mental illness and children with severe emotional disorders are enrolled in treatment programs. The rate is much worse for substance abuse treatment: Only about 5 percent of the need is being addressed.
Investing in mental health services ultimately pays for itself through reduced incarceration and emergency department costs. Additionally, of the DSHS figures demonstrating the billions of dollars our state spends on potentially preventable hospitalizations, more than a third have comorbidities in mental health conditions.
In addition to maintaining the enhanced mental health and substance use funding allocated the last biennium, our organizations strongly support the two DSHS exceptional item requests related to mental health and substance abuse prevention, early intervention, and treatment.
Lastly, we would like to comment on and make a suggestion about the proposed coordinated behavioral health strategic and expenditure plan articulated within Article IX. The rider’s vision — that the Health and Human Services Commission, DSHS and other state agencies work together across behavioral health programs to promote best practices and avoid redundant services — is laudable, and we support it in principle. But we also think it would be helpful to discuss how it would work in practice. Respectfully, we also suggest the new behavioral health coordinating council be directed to solicit stakeholder feedback as it develops its strategic plan.
Thank you for your time and consideration.
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