Fund the Safe and Healthy Schools Initiative

Testimony Submitted by Michelle Romero, TMA

House Appropriations Subcommittee on Article III

Feb. 20, 2019

Chair Bonnen and Committee Members:

The Texas Medical Association and its nearly 53,000 members are grateful for the opportunity to comment in support of funding to equip Texas public schools with resources they need to improve student mental health.

As physicians, we know that good physical and behavioral health is not only a function of high quality clinical care, but also of the environments where Texans live, work, and play. Given that children spend roughly one-third of each week day of the school year in school, schools are key allies in promoting student mental health by delivering health education, fostering healthy social relationships, and offering academic, creative, and athletic outlets to help build self-esteem. For many of Texas’ 4.9 million public school students,[1]  the school system also serves as a primary access point for mental health services regardless of a family’s ability to pay.

Texas Medical Association supports Texas Education Agency Rider 74 appropriating $37 million in funds with school mental health purposes in the Safe and Healthy Schools Initiative (SHSI). This would provide mental health first aid; telemedicine initiatives; trauma informed care; coordination of access to external mental health providers; grants for mental health and positive school culture initiatives; and mental health support staff at educational service centers. We believe these funds will not only help foster better mental health and well-being for individual students, but also promote safer learning environments for all students. 

Current data demonstrate substantial need for school mental health supports. About 50 percent of people will experience mental illness at some point in their lifetime,[2]  and about half of those will experience first onset of their symptoms during childhood or adolescence.[3]  Among children aged 3-17, current estimates show 7.1 percent have diagnosed anxiety problems, 7.4 percent have diagnosed behavior or conduct problems, and 3.2 percent have diagnosed depression.[4]  Some children experience multiple disorders at the same time,[5]  and many more children live with symptoms of emotional disturbance that have not received clinical attention or a diagnosis. [6]

Recently, Hurricane Harvey amplified the needs of thousands of students experiencing ongoing mental health challenges due to distress and tragedy associated with the storm. While rigorous research on child traumatic stress associated with Harvey has yet to be published, in a study of children with elevated post-traumatic stress disorder (PTSD) symptoms who survived Hurricane Katrina, 75 percent had witnessed something upsetting during the hurricane; 29 percent were separated from their parents or caretakers; 8 percent had to walk or swim through floodwater to escape; 6 percent were trapped in a flooded house; 4 percent had been rescued by boat; and another 4 percent by helicopter.[7]  According to the American Academy of Pediatrics, protective factors such as social connection, supports for building resilience, and social-emotional learning are paramount in determining how children will fare long-term in response to toxic stress.[8]  School mental health initiatives outlined in the SHSI are a key component of fostering resilience and protecting the mental health of a generation of Harvey survivors.

Physicians stand ready to coordinate with schools to strengthen child mental health networks across the state, especially in communities affected by tragedy. We are pleased to see the SHSI includes efforts to connect schools to physicians via telemedicine, and dedicates resources toward creating and maintaining local provider directories to facilitate prompt referrals for students whose challenges require the care of a physician. We are also pleased to see that the SHSI incorporates a public health and prevention approach, putting in place resources to improve school culture and train school staff to recognize and appropriately respond to potential early signs of mental illness. Youth enrolled in Texas public schools will be healthier and safer as a result.

Thank you for the opportunity to comment.

[1]  United States Census Bureau. (2018). Children characteristics, Texas, 2013-2017 American Community Survey 5-year estimates. Retrieved from

[2]  Kessler RC et al. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6(3), 168-176.

[3] Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, and Ustun TB. (2007). Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry, 20(4), 359-364.

[4] Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, and Blumberg SJ. (2018). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of Pediatrics. Published online before print October 12, 2018. Retrieved from 

[5] Ibid. 

[6] Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, and Ustun TB. (2007). Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry, 20(4), 359-364.

[7] Jaycox LH, Cohen JA, Mannarino AP, Walker DW, Langley AK, Gegenheimer KL, ... & Schonlau M. (2010). Children's mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 23(2), 223-231.

[8] American Academy of Pediatrics (2018). The Resilience Project. Retrieved from  

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February 20, 2019

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