Harris County’s population continues to  Approximately 19,300 children and increase and is projected to reach 4.5 adolescents with serious emotional million residents by 2020. disturbance needed services from the public mental health system in Simultaneously, poverty level is 2012, yet 74 percent (14,335) Mental Illness estimated to increase from 12.5 received none. In percent up to 16 percent. Harris County  Almost 69 percent of the 9,100 Texas has the highest rate of medically children referred to the Harris County Prevalence uninsured citizens among the states. Juvenile Probation Department have a diagnosable mental illness. Issues of Concern Harris County has the second highest  Of those, 70 percent report co- Recommendations rate of uninsured citizens among Texas occurring behavioral health problems counties. of substance abuse and mental illness. Texas is rated last in per capita mental health funding compared to other  About 41 percent have a history of states. trauma exposure, often having witnessed or experienced family or A Report of the Harris County is ranked 30th out of 34 community violence. Mental Health Needs Council, Inc. among local mental health authorities 2013 PREVALENCE OF MENTAL ILLNESS in per capita mental health funding. IN ADULTS

The shortfall in available mental health  Of the 2.9 million adults in Harris services for Harris County residents County (2010 Census), 496,358 have will only worsen as the population mental illness. Of those, 137,219 grows. have severe and persistent mental Mental Health Needs Council, Inc. illness (Major Depressive Disorder, P.O. Box 270205 PREVALENCE OF MENTAL ILLNESS Bipolar Disorder, or Schizophrenia). Houston, Texas 77277-0205 IN CHILDREN AND ADOLESCENTS (281) 575-9001  Of those with severe mental illness, [email protected]  Of the 750,000 children and 86,000 have no public (Medicaid or adolescents in Harris County Medicare) or private health insurance between 6 and 18 years old (2010 and are totally dependent on the Census), nearly 150,000 have a public mental health service system mental illness. Of those, 89,162 have for treatment. a serious emotional disturbance.  In 2012, approximately 69,800 adults resulted in a dependence on crisis readmitted to inpatient services with severe mental illness were services. within one year. unable to access treatment from the  The Mental Health and Mental  In 2012, about 70 children and 237 public or private mental health Retardation Authority (MHMRA) adults entered MHMRA services for systems. NeuroPsychiatric Center (NPC) the first time each month.  Of the Harris County citizens in jail, currently treats over 13,000 crisis  An increasing number of children and 24.1 percent have a current or past episodes per year. adults, previously unknown to the mental illness diagnosis.  Demand for crisis services at NPC public mental health system, request has frequently exceeded capacity,  An estimated 15 percent of services each year. individuals with severe mental illness forcing the facility to close its doors to will be homeless at some point within new admissions more than 75 times  MHMRA’s waiting list for outpatient the year. in 2012. mental health services exceeds 1,600 adults each month.  In the 2012 Point in Time Count of  Ben Taub General Hospital homeless persons in Harris County, Emergency Room treated over 4000  About 15 percent of those waiting for 66 percent reported prior psychiatric with mental illnesses each year in services deteriorate into crisis and hospitalization, needing mental 2011 and 2012. require intervention at psychiatric health treatment, or having to leave emergency centers, inpatient their homes due to mental illness  In 2012, around 250 were seen each hospitals, or in jail. issues. month for psychiatric consultations.  At any given time, MHMRA provides  In Harris County, 38,421 or 28  In 2012, almost 870 were admitted to services to 2,400 children and percent of adults with a severe psychiatric inpatient services at Ben adolescents, 50 percent above its mental illness report co-occurring Taub, up from about 850 in 2011. contracted, state-funded capacity. substance abuse.  The number of mental illness-related  On average, 168 children and 326 ISSUES OF CONCERN calls received by the Houston Police adults were readmitted to MHMRA services each month in 2012. Consequences of untreated mental Department Crisis Intervention Team illness may include school failure or increased from 10,800 in 2003, to dropout, juvenile or criminal justice 25,105 in 2010, to 24,771 in 2011, The Mental Health Needs Council is involvement, victimization, acute and over 27,000 calls in 2012. especially concerned with the psychiatric crises, unemployment,  Of those individuals hospitalized in following issues: homelessness, or suicide. The University of Texas Harris Insufficient Funding for the The limitations in the Harris County County Psychiatric Center Medically Uninsured mental health service capability, (UTHCPC), 22.6 percent were especially outpatient services, have  More children and adults with severe  A larger, better funded, more  Harris County has fewer than 10 mental illness reside in Harris County responsive, and more accessible psychiatric hospital beds per 100,000 than any other Texas county, yet per outpatient system would help to residents, less than the national capita funding is below the state break the crisis-to-crisis cycle. average of 17 per 100,000. average for public outpatient  Increasing numbers of children and  Experts recommend adequate services. adults with mental illness, whose capacity at more than seven times  Reimbursement rates for public illnesses are not severe enough to current Harris County levels. health care programs are so low that warrant inpatient or crisis care, are  Poor access to voluntary public few private providers are willing to forced to wait for services until they psychiatric hospitalization causes participate. are in crisis. increases in involuntary  The private and public sectors must Michael E. DeBakey Veterans commitments. collaborate in order to provide an Administration (VA) Medical  UTHCPC continues to be adequate array of services and Center Mental Health Services insufficiently funded to operate its supports to address these needs.  About half of the eligible returning 250 beds, thus curtailing capacity for Limited Service Capacity Iraq and Afghanistan Veterans in more people to receive timely America and the aging veteran inpatient care.  Each month nearly 270 more population access mental health individuals apply for public mental services from the VA.  About 70 percent of Harris County’s health services than can be served. allocated state hospital capacity goes As the population increases, there  Suicide rates among active military to forensic cases. As a result, Harris will be more. and veterans have risen 80 percent County is pressured to provide since the start of the Iraq War. Fully inpatient services for voluntary and  Access to service is even more 20 percent of US suicides are civil commitment cases. limited to people without public or attributed to veterans. private insurance. Less Access to Private Care  Support is lacking for spouses and Crisis Oriented System children of veterans or active military.  At least 16 of Harris County’s private  Due to significant funding limitations, inpatient facilities have closed within  Federal budgetary support has so far children and adults without insurance the last 10 years, in part, due to funded the rising demand, although a receive few or no services, often restricted access to care for insured collaborative public/private system resulting in decompensation into patients and failure to receive may offer a better response in the crises or incarceration. appropriate, timely reimbursement for future. insurance claims.  Emergency services can meet Loss of Access to State Funded immediate needs, but cannot support  Private psychiatric hospitals have Inpatient Care long-term community stabilization. suffered from an increasing burden of indigent care. Private hospitals often  At least 14,000 Harris County adults with adequate service packages care for the medically indigent and with a mental illness lack appropriate and reimbursement rates. should be commended for their housing.  Expand the range of services and contributions to the community.  Residential treatment services for the reimbursement rates for an  Children and adults who have children and adults with mental adequate array of supports to psychiatric insurance benefits have illness are in short supply. These are address clinical needs. difficulty accessing needed services vital components of the mental health  Maintain a ‘safety net’ for those due to shrinking provider rolls and service continuum. who need psychiatric services and professional workforce shortages. Mental Health Workforce are not covered by other funding Lack of Access to Integrated Care  Portions of Harris County are sources.  Many children and adults with severe designated as federal Mental Health  Establish mechanisms and mental illnesses may abuse (Professionals) Shortage Areas. procedures that promote, expedite, substances. Appropriate behavioral  Due to reductions in the capacity of and maintain enrollment in CHIP health care requires coordinated training programs and continuing and Medicaid programs. population growth, there are fewer treatment for both problems, yet this  Align resources with the prevalence psychiatrists, psychiatric nurses, is rarely available. rates for mental disorders. social workers, and marriage and  People with serious mental illnesses family therapists relative to the 2. Expand Service Capacity have significantly shortened life county population. The supply ratio of expectancies and higher rates of psychologists is only 60 percent of  Support a cost-effective public metabolic disorders (e.g., diabetes, the national average. mental health system by sufficiently hypertension, or high cholesterol). funding community-based  Although coordinated health, mental Resiliency and Disease health, and substance abuse Management. services produce better health RECOMMENDATIONS  Support the use of Medicaid 1115 outcomes, these services are rarely Waiver projects to expand mental available due to economic barriers The Governor of Texas, members of health services. for integrated care. the Legislature, Harris County Commissioners Court, and the  Oppose supplanting current Lack of Access to Residential Health and Human Services funding with Medicaid 1115 Waiver Treatment and Housing Supports Commission should: revenues.  Many people with severe mental 1. Enhance Funding  Authorize legislation to allow Local illnesses lose their jobs, family ties, Mental Health Authorities to utilize and homes.  Under the Affordable Care Act, state funds in support of create coverage for the uninsured uncompensated care and Medicaid 1115 Waiver projects, provided that 5. Expand Current Psychiatric  Support policies that promote contract performance targets are Hospital Capacity collaborative health care and met. medical homes.  Sufficiently fund public psychiatric  Expand public mental health hospitals for care of voluntary and 8. Prioritize Housing and capacity to serve all those with civil commitments, as well as Residential Services functional impairments due to a forensic cases.  Sufficiently fund appropriate living mental illness. options with supports tailored to  Sufficiently fund UTHCPC to clinical needs.  Insure prompt, adequate Medicaid operate at its full 250-bed capacity reimbursement. to locally treat Harris County 9. Support Professional Workforce citizens. 3. Balance Resources Between Development Crisis Services and Ongoing 6. Support Indigent Care by Private  Fund higher education programs Care Providers that will increase the number of mental health professionals in the  Direct all additional mental health  Support continuation of the STAR Texas workforce. General Revenue dollars for and STAR PLUS programs offering outpatient services to minimize the integrated medical and behavioral  Sufficiently fund mental health need for crisis and inpatient care. health to program participants. professional training programs, including psychiatry, psychology,  Fund restoration and expansion of 7. Support Integrated Care for social work, marriage and family behavioral health services in public Individuals with Behavioral therapists, and psychiatric nursing. schools. Disorders  Expand Medicaid  Sufficiently fund Harris County's  End discrimination for behavioral reimbursement for mental health programs to divert people with health (mental health and services provided by advanced mental illness from the juvenile and substance abuse) insurance professional trainees. adult criminal justice systems. coverage.  Offer tuition forgiveness in 4. Ensure Adequate Care for Iraq  Sufficiently fund collaborative and return for public health service. and Afghanistan Veterans holistic rehabilitation services to Support Local Control and  Enhance and supplement federal address social, vocational, 10. (VA) initiatives to provide ongoing psychiatric, and health care needs. Accountability for Public Mental Health Services mental health support to returning  Fund electronic health records and veterans and their families. health information exchanges to  Support accountability in  Explore public and private improve integrated health care, service delivery to reduce costs, collaboration possibilities. promote coordination of care, and improve patient satisfaction, and reduce duplication of services. produce improved patient outcomes.