OPINION COLUMNS

Behavioral health care needs are no myth

By Lance Lunsford | Published Saturday, December 7, 2013

Holiday blues and a spike in suicides are often assumed to occur during the holidays. But according to the Centers for Disease Control and Prevention, the supposed uptick in depression-related issues at this time of year is just a myth.

The challenges facing Texas’ behavioral health care system, however, are not a myth. They include:

  • an insufficient workforce to serve all individuals in Texas with mental health or substance use issues;
  • a high rate of uninsured among individuals with behavioral health conditions;
  • lack of funding for care that will keep people out of crisis, thereby reducing reliance on hospital emergency departments; and
  • lack of supports outside the health care setting to assist those with serious mental illness or substance use disorder.
  • Individuals with behavioral health conditions suffer the most from an underfunded and fragmented system. There are adverse consequences, too, for hospitals, taxpayers, law enforcement, employers and the economy. Texas hospitals experience increased uncompensated care, reduced emergency department capacity and financial penalties from preventable readmissions.

    “The devastating effects of an underfunded behavioral health care system are felt most profoundly by individuals living with untreated disorders,” said Dan Stultz, M.D., FACP, FACHE, THA president/CEO. “But we all pay the price for a system that fails to provide timely and appropriate care. The 83rd Legislature recognized the importance of behavioral health and made an investment that can be built upon.”

    The Legislature invested an additional $300 million in the state’s behavioral health care system for 2014-15. The funding is critical, and communities across the state will benefit. Long-term policy solutions that address insurance coverage, workforce, access to services and funding are also required.

    The most effective solutions include:

    • Accepting federal funds to expand coverage for low-income adults. Many of the adults who are served by the state’s behavioral health care system would qualify for comprehensive coverage if Texas increased Medicaid eligibility as allowed under the federal health care reform law or devised a private-market alternative. State general fund expenditures for behavioral health care services currently exceed $1.1 billion. Providing individuals currently receiving limited state-funded services with access to comprehensive insurance coverage that is paid for almost entirely with federal funds would free up at least $440 million in state funds.
    • Increasing funding to train qualified mental health professionals. Three-quarters of the state’s counties are designated as mental health profession shortage areas; 70 percent of counties have no practicing psychiatrists.
    • Increasing funding for substance use disorder treatment. Often mental health and substance use disorders are co-occurring. Treating just one part of the equation is not effective.
    • Increasing funding for intensive case management for patients who are high utilizers of emergency room services to ensure they are compliant with prescribed medications and have access to transportation, child care, housing and other supports.
    • Increasing funding for after-hours, non-emergent mental health care so that individuals requiring urgent access to medication refills or other interventions can access care in a more appropriate setting.
    • Supporting the use of telemedicine to address the shortage of psychiatrists.

    Lance Lunsford is vice president of advocacy communications for the Texas Hospital Association, based in Austin.

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