Senate Finance Article II Hearing
Jan. 31, 2017
Testimony Submitted on Behalf of:
- Texas Medical Association
- Texas Pediatric Society
- Texas Academy of Family Physicians
- Texas Association of Obstetricians and Gynecologists
- American Congress of Obstetricians and Gynecologists – District XI (Texas)
- Federation of Texas Psychiatry
Good day, Chairwoman Nelson and committee members. My name is Dr. James Halgrimson. I am a psychiatrist from Austin, where I practice at the Austin State Hospital, and in group and private practice. I also serve as a member of the Texas Medical Association’s Task Force on Behavioral Health. Today I am speaking on behalf of TMA, the Texas Pediatric Society, the Texas Academy of Family Physicians, the Texas Association of Obstetricians and Gynecologists, and the American Congress of Obstetricians and Gynecologists. Thank you for the opportunity to comment on Article II of Senate Bill 1.
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 help 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.
Despite these significant and much appreciated investments, Texas’ population is rapidly growing. Yet current reporting informs us that only a small percentage of those in need of care are able to access mental health and substance abuse systems. Poor access to care puts a financial burden on the criminal justice system, schools, hospitals and publicly funded programs — such as Medicaid — as a result of increased rates of incarceration, and higher use of public hospital emergency departments, homeless shelters, and the foster care system. Physicians support working with local mental health authorities to promote access and improve quality of our state and local public health behavioral systems.
To build on the state’s behavioral health investments, we recommend the following:
- Promote increased use of medication assisted therapy for patients with substance abuse disorder;
- Expand availability of the state’s neonatal abstinence syndrome (NAS) program;
- Promote early use of naloxone for opioid overdoses to reduce rates of overdoses and fatalities;
- Expand availability of support services such as housing assistance and peer specialists to avert high-risk patients from repeat incarcerations or frequent visitation to hospital emergency departments;
- Supporting the diversion of competency restoration for those charged with a Class B misdemeanor violation to ensure those with mental illness are getting the services they need, in an environment that supports their success; and
- Renovating state hospitals to protect patient safety while also growing innovative partnerships with community hospitals to expand inpatient mental health capacity.
In order to ensure these populations gain and maintain access to these services, we encourage you to ensure those with substance use disorders (SUD) who are dependent on public behavioral health services have access to evidence-based medication assisted therapy and supportive care. We believe investing in these services, and also expanding support services for women and newborns at risk of neonatal abstinence syndrome (NAS), can provide a lasting impact. DSHS’ NAS program provides resources to help pregnant women, mothers, and their babies get support services to address opioid misuse. These supports can plan an integral role in preventing infant withdrawal symptoms with access to the recommended treatments. The Population Health and Management Journal (2015) studied infants from a large Medicaid plan born with NAS, and found an average length of stay of 21 days in the hospital. They estimated a 55 percent reduction in length of stay would correspond to $396 million saved annually. By investing in these support services, we can reduce incidence or severity of NAS, in turn costing the state less in Medicaid funds for services, and resulting in shorter hospital stays for mom and baby. Keeping children and families close to their support networks only enhances their rates of success in recovery.
About one in four adults is affected by mental illness each year, and almost half of all adults are expected to be affected by mental illness during their lifetime. Keeping the focus on local choice and options for community needs, we have an opportunity to fill gaps and enhance crisis services. For example, as long as the state ensures people in an emergency can access naloxone for opioid overdoses, more lives can be saved. We encourage supporting state hospital-based and community center-based initiatives in partnership with state academic medical centers to improve access to quality care for those experiencing a behavioral health crisis. These partnerships can impact our ability to provide essential repairs, renovations, and new construction for our state hospitals.
Texas public officials have recognized that residents with mental illnesses are disproportionately residing in Texas prisons and jails. In 2012, nearly 20 percent of the adult offenders in Texas state prisons, on parole, or on probation were former patients of Texas’ mental health system. Supporting the diversion of competency restoration, allowing patients to receive mental health care programming rather than incarceration, ensures those with mental illness are getting the services they need, in an environment that supports their success. Moving those individuals from high-demand inpatient state hospital beds to mental health services in their community can result in substantial cost savings and a return on investment (ROI) in behavioral health prevention and early treatment. Savings vary by the type of intervention, such as care in an emergency room versus having access to a community-based crisis stabilization bed — or being in jail rather than in a jail diversion program. However, for those in need of a higher level of care, we must ensure we maintain psychiatric bed capacity across the state.
Lastly, 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. We must continue to work to ensure these needs are met, and that we provide the utmost care to some of our most vulnerable populations.
Thank you for your time and consideration.
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