💡 What’s Happening?
Imagine a patient with diabetes or a fractured femur leaving a hospital, and having no access to medication, follow-up appointments or a stable place to live. Most people recognize that another hospitalization is due to happen – it’s only a matter of time.
Behavioral health in Texas works much the same way.
Texas’ behavioral health crisis is no longer confined to emergency rooms or psychiatric units. While recent closures have drawn attention to a growing shortage of inpatient beds, healthcare leaders say the bigger concern is the weak behavioral health continuum itself. From crisis intervention and outpatient treatment to recovery support, there’s a pressing demand for services patients rely on. The ripple effects can be costly to patients, systems and counties alike, and extend across communities statewide. As one executive warned, “This is coming like a freight train, and it’s going to affect you.”
“Epley described his vision for addressing serious mental health issues in Bexar County as a three-legged stool that’s anchored first by a dedicated, locally owned psychiatric hospital, second by a center to divert people in crisis away from jail, and third by wraparound services like transitional and permanent supportive housing, prescription drug assistance and food security. ‘If we build a hospital, we’ll fill it up, and it’ll just be full in two weeks,’ Epley said. ‘We’ll be right back where we are. We need wraparound services like food care and prescriptions and things like that. It’s not sexy, but it’s what’s going to actually fill the gap.’”
San Antonio Report: More psychiatric beds alone won’t fix San Antonio’s mental health challenges, experts say
“Gonzalez said those costs have become harder to absorb amid recent funding cuts that have placed additional pressure on an already strained department in a medically underserved community, especially when it comes to mental health. ‘We’re being loud,’ he said. ‘We’re having conversations with our representatives to make sure we get that funding down here because the already limited funding that existed is no longer there.’”
Officer: Texas Police: Mental Health System Gaps Stretch Resources Thin
✅ Treatment Round-off
Psychiatric hospitals certainly need more beds, but as with patients facing physical ailments, being discharged without an effective off-ramp almost nullifies the impact of hospital treatment. A successfully – or an effectively – treated patient necessitates interconnected behavioral health services:
- Prevention and early intervention services that help people access care before reaching a crisis point;
- Outpatient therapy, psychiatry and medication management that provide ongoing treatment close to home;
- Crisis response programs and diversion centers that offer alternatives to emergency departments and jails;
- Inpatient psychiatric care for individuals experiencing acute episodes;
- Step-down programs, peer support, supportive housing and recovery services that help patients remain stable after discharge.
“A key aspect of BasePoint’s model is that it provides transportation to any client who lives within 25 miles of the clinic locations. ‘We wouldn’t have 80% of our clients if we weren’t able to help them access care by way of transportation,’ Hicks said. BasePoint is expanding into a strained mental health system in Texas. …When the Serpas started working in mental health treatment, they found a field that was the “stepchild” of health care, Serpa said.”
Fort Worth Star-Telegram: Teen’s suicide sparked a North Texas movement to expand mental health care
💫 A Dream Come True
Here’s the good news: Building a complete behavioral health continuum is not a theoretical exercise or a policy headache. Many of the solutions are already operating successfully in Texas communities.
From the Gulf Coast, where Galveston County put up a Mental Health Wellness Center with more beds and resources to support local patients in crisis and alleviate pressure on ERs and county jail transports; to the step-down services following inpatient stay offered by the Transitional Care Clinic or NOW Clinic in partnership with University Health and UT Health San Antonio in Central Texas; all the way up North Texas, where Parkland launched the RIGHT Care program to specifically respond to mental health-related 911 calls involving minors between daily in the afternoons and evenings, communities are striving to close the gaps to receiving comprehensive care for mental health.
These approaches are often less expensive to taxpayers than repeated hospitalizations, emergency department visits or incarceration – all while producing better outcomes for patients, families and communities.
The lingering question is whether more communities have the resources and state support to build complete systems that address local needs.
“‘People thought we were crazy cause we had the session that had already ended, there was no way to get any more money because it was gone. We thought that the figure for 40 million, and you know, and it kept building where it got better and better, and then the people in Midland, Odessa, and all the Permian basin gave these dollars that met more than we thought we could write,’ said State Representative Tom Craddick.”
“‘When a child or teen is in crisis, families deserve a team trained to assess the situation, de-escalate safely and connect them to appropriate care,’ Glaz said. She also noted the common challenge families face. ‘Too often, families call 911 because they don’t know where else to turn,’ Glaz stated. ‘This new focus allows us to meet children and teens where they are, reduce trauma during emergencies and connect them to care that can support long-term stability.’”
CW33: Parkland Health pilots youth mental health crisis response program
🚫 No Deductible, No Service
Beyond trying to navigate gaps in the system, even patients are cluing in on what providers already know; coverage doesn’t always equal access. There’s a disproportionate impact on insured Texans from the fall out of behavioral health infrastructure. In fact, many of the patients struggling to find complete care are covered through private insurance plans, not just public programs or safety-net systems.
As awareness of mental health needs increases and more people seek care, patients need equal financial reassurance throughout the continuum, particularly as they balance rising expenses elsewhere for their health – and mental health treatment is one of the most cost-effective investments in healthcare. Yet many health plans still offer barebones coverage for behavioral health treatment or make it incredibly difficult to process claims, causing severe barriers to access. If insurers are committed to improving health outcomes while controlling costs, comprehensive behavioral health coverage should be viewed as an investment, not an expense.
“‘In many ways, if you’re a client, patient, whatever we want to call, of the public system, you have better access than you do if you have an insurance card in your wallet. …I think [in] the state, it’s mixed because people would often presume the opposite. They’d presume that there’s big waits in the public system and lines to get in, but that’s not what happens. What happens is it’s very hard to get into the private system.’”
KERA News: Outgoing Metrocare CEO reflects on time with community mental health center, future of care in Texas
“‘For people who have mental health conditions, they sometimes struggle with ensuring that their insurance company authorizes enough services for them and that they have access to a provider to deliver those services,’ [Susan Garnett, CEO of My Health My Resources of Tarrant County] said. ‘It can get complicated.’”
Fort Worth Report: Tarrant, Texas struggle with access to mental health care. Leaders will explore solutions
⭐ Without access to adequate continuum of services, patients often cycle through emergency departments, hospitals, jails and shelters. But there are solutions – realistic and feasible ones.
📖 Learn More
Strengthening Continuum of Care is Non-Negotiable
What Does Mental and Behavioral Crisis Response Look Like in Texas?
Behind the Headlines will not be published on July 6 in honor of the July 4 holiday. Look for the next edition of Behind the Headlines in your inbox on Monday, July 13.
