Testimony by Les Secrest, MD
Senate Finance Committee
Texas Progress in Coordinating Behavioral Health Services
Jan. 26, 2016
Good day, 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, and I chair TMA’s Task Force on Behavioral Health. Today I’m speaking on behalf of TMA, the Federation of Texas Psychiatry, and the Texas Pediatric Society.
Our organizations appreciate the legislature’s significant monetary investments over the last several sessions to address the personal and social impact of untreated behavioral health concerns in Texas. You have acted to strengthen the state’s mental health and substance abuse treatment systems. The funds are helping to bolster and sustain a foundation for the state’s community-based mental health and “crisis” services, reduce waiting lists, and provide training for educators and others to better identify children who may need mental health services. Funding for the Medicaid Youth Empowerment Services (YES) waiver is providing 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 almost all other states in spending per person for mental health care, averaging less than $41 for every resident. 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, 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. DSHS estimates that it is serving a large proportion of adult Texans with severe and persistent mental illness, but thousands are still in need (<200 percent of the federal poverty level) but are not receiving services. Similarly, only about a third of the children with several emotional disorders are estimated to be receiving publicly funded mental health services. The gaps in services for persons with substance use disorders is equally concerning. Only a fraction of the more than 1.6 million Texans with alcohol and/or substance use dependency are able to access our publicly funded treatment services, which must consist of a broad continuum of clinical services and community-based support services.
Addressing these gaps by investing in mental health services will ultimately pay for itself through reduced incarceration and emergency department costs and healthy development of some of our most vulnerable children. 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. Our organizations supported the two DSHS exceptional item requests related to mental health and substance abuse prevention, early intervention, and treatment, and we encourage you to again consider urgent improvements to the state mental health hospital facilities that DSHS has also prioritized.
Lastly, we would like to comment and make a suggestion on the coordinated behavioral health strategic and expenditure plan articulated within Article IX. The vision of the rider — 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. But we also think it would be helpful to discuss how any proposed plans will work in practice. Quality, patient-centered care not only must have coordinated behavioral and physical health care but also must provide access, continuity of care, effective administration, and meaningful accountability measures. Respectfully, we offer our assistance to the behavioral health coordinating council as it develops its strategic plan.
Thank you for your time and consideration.
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