Evidence-Based Strategies Key to Fighting Texas Suicide Rates
By Alisa Pierce

As 34.2% of adults in Texas report symptoms of anxiety and depression, Texas physicians are calling for the support and expansion of evidence-based strategies and telemedicine services to bolster mental health care across the state.

That was the focus of the Nov. 17 Distinguished Speaker Series hosted by the Texas Medical Association and Texas Public Health Coalition (TPHC). Moderated by TPHC Chair Jason Terk, MD, an expert panel shared insights on how to improve behavioral health care systems, prevent suicide, and support Texans’ mental health starting as early as adolescence.

Celia Neavel, MD; Thomas Kim, MD, MPH; and Kimberly Roaten, PhD, spoke of multiple evidence-based models, but telemedicine, and its uncertain future as the end of the public health emergency (PHE) looms, was the discussion’s heavy hitter.

Dr. Kim, chief behavioral health officer of Prism Health North Texas, said  telehealth offers a multitude of benefits, increased timeliness of care, cost savings, and an expansion of access to care, to name a few of its benefits.

As time runs out on the PHE and any future extensions, the panel urged for telemedicine’s continued expansion. Dr. Kim said by obtaining long-term telehealth guidance, physicians could treat patients without uncertainty.

“Texas has been a leader in telehealth and telemedicine for a long time,” Dr. Kim said. “First and foremost, we need to have definitive guidance on regulations. PHE has been kicked down the road again, and the rules remain in place for several months. But this creates uncertainty and frankly, hesitancy among the players in health care, telehealth and otherwise. Long-term guidance would help.”

To combat Texas’ mental health crisis, the panel suggested the following strategies to help care for adults and children:

• Improve access to care by encouraging health plans to increase mental health coverage and continue payment parity for behavioral health care telemedicine visits;
• Support school-based health clinics and education programs and offer mental health primary care training to medical professionals and community members;
• Support access to telehealth services and call for continued funding for the Child Psychiatry Access Network (CPAN) and the Perinatal Psychiatry Access Network (PeriPAN); and
• Create a safe environment by reducing access to firearms and other lethal means.

Dr. Neavel emphasized that the ripple effects of childhood mental health conditions can be felt long into adulthood.

“Suicide now is the second leading cause of death in youth,” said Dr. Neavel, medical director for the Center for Adolescent Health at People’s Community Clinic in Austin. “There is a youth mental health crisis.”

Speakers also said that by staying aware of a patient’s adverse childhood experiences (ACEs), physicians can catch suicide risks early on and provide resources, especially for patients who experienced worsened mental health conditions during the pandemic.

ACEs are often linked to chronic health problems, mental illness, and substance misuse in adulthood. These experiences can include physical or emotional abuse, having an incarcerated parent, or being the child of divorce.

And ACEs can create long-term, negative effects for young patients, said Dr. Roaten.

“ACEs are certainly associated with the increased risk of suicidal behavior at the time that the event is being experienced,” said Dr. Roaten, who serves as a professor in the Department of Psychiatry at UT Southwestern Medical Center and a senior fellow for suicide prevention at the Texas-based Meadows Mental Health Policy Institute. “But then it turns out further down the road into adulthood, ACEs are cumulative in terms of suicide risk.”