Fund Texas’ Mental Health Services

TMA Testimony of James Halgrimson, DO 

House Appropriations Committee
Subcommittee on Article II 
Behavioral Health Funding  

Feb. 19, 2019

Madame Chair Davis and Committee Members:

My name is James Halgrimson, DO, and I am a psychiatrist from Austin. I’m in group and private practice after several years of caring for patients in the state hospital system. I also serve as a member of the Texas Medical Association’s Task Force on Behavioral Health. On behalf of the Texas Medical Association and its nearly 53,000 members, I am testifying in support of funding services for Texans living with mental health and substance use disorders (SUDs). 

The legislature has dedicated significant resources in previous sessions toward closing gaps in the mental health and substance use disorder continuum of care, and we applaud your sustained commitment to this priority. This session, we have an opportunity to build on success already achieved and address remaining gaps in the behavioral health system. 

Despite recent improvements, current data inform us that only a fraction of those in need of treatment are able to access mental health and substance use care. About one in five adults experience mental illness each year, 57 percent of whom do not receive care for their condition.  Just 12 percent of people who need specialty alcohol and drug use treatment receive it.   

The Texas Medical Association supports funding for measures that will advance Texas’ mental health system toward the goal of helping people access the right care, in the right place, at the right time, including:

1. Expanding access to community mental health services. It is important that the legislature continue to invest in increasing outpatient treatment capacity and diminishing waitlists at local mental health authorities and local behavioral health authorities. The longer a person remains on a waitlist for community-based care, the less likely he or she is to receive an appropriate intervention. If a crisis occurs during the waiting period for treatment, a person whose condition could have been managed effectively in the community may instead end up at a hospital or in jail.
   
   Of note, House Bill 13 passed in the 85th regular legislative session established a matching grant program to support community mental health services. With these resources, local mental health authorities and local behavioral health authorities have been better equipped to divert individuals needing lower levels of care from high-demand inpatient state hospital beds to mental health services in their community. Psychiatric bed capacity for those in need of a higher level of care is preserved. We know these efforts can produce substantial savings and return on investment in behavioral health prevention and early treatment. The program is presently funded at $30 million for the 2018-19 biennium, and Texas physicians strongly support maintaining or even expanding this investment. 
2. Expanding availability of substance use disorder treatment.  Among patients with a mental health disorder, as many as 50 percent also may have a co-occurring substance use disorder. Overdoses are the leading cause of death among postpartum women in Texas. And among children entering foster care, 66 percent have a parent misusing drugs or alcohol.  Yet obtaining treatment for substance use disorders remains difficult. According to the Substance Abuse and Mental Health Services Administration, approximately 1.3 million Texans aged 12 and older need specialty substance use treatment but have not received it.   To treat more Texans with SUDs, we recommend expanding community-based treatments through innovative teleconsulting programs like Project ECHO. Project ECHO connects primary care physicians with specialists to increase expertise in treating chronic conditions like SUDs. 
3. Make medication-assisted treatment (MAT) more widely available. MAT is one of the most effective evidence-based treatments for several substance use disorders. MAT uses both medication and long-term counseling to provide a whole-patient approach to substance use recovery. MAT medications work by taking away cravings and eliminating or decreasing the effect of substances like opioids and alcohol. Withdrawal symptoms can diminish, preventing relapse, overdose, criminality, and death.  Patients receiving medications as part of their treatment are 75 percent less likely to die due to opioid use disorder than those not receiving medications.  MAT restores physiological and social function disrupted by substance use, improves treatment outcomes, and can prevent HIV viral transmission by reducing injecting behavior.  MAT should be available, and paid for, for any substance use disorder for which it is clinically indicated, including alcohol dependence. 
4. Sustaining behavioral health supports for justice-involved individuals. As recently as 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. Senate Bill 292 passed in the 85th regular legislative session made a groundbreaking investment in reducing recidivism, arrest, and incarceration of people with mental illness. TMA hopes the legislature will sustain or expand this matching grant program, currently funded at $37.5 million for the biennium, and include at least $5 million per year in funds for mental health jail diversion in Harris County. Allowing patients to receive mental health services instead of incarceration ensures people get care they need in an environment that promotes their well-being. 
5. Continuing to improve the state hospital system. With the $300 million appropriated last legislative session, significant transformations to the state hospital system are already underway. TMA supports additional appropriations this legislative session to keep planned facility renovations on schedule and bring new psychiatric bed capacity online as quickly as possible. 

Poor access to behavioral health care burdens the state’s criminal justice, school, and child welfare systems, leads to incarceration, and results in misuse of hospital emergency departments. With millions of Texans and their families affected by mental illness and substance use, it is crucial to continue making smart investments in mental health services. These measures ultimately benefit the state through reduced incarceration and emergency department costs. 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. 

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