Mental health, as defined by the World Health Organization (WHO), is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” Mental health and well-being are essential to an individual’s ability to properly think, interact and have a quality life. Therefore, mental health inevitably has a direct impact on economic productivity, educational attainment, and public health and safety. Ultimately, the promotion of mental health should be prioritized for individuals, communities and societies throughout the world.

Meeting the mental health care needs of Texans requires critical policy analysis and decision-making to ensure a coordinated system of supports and services that are effective, appropriate and fiscally responsible. The maze of behavioral health services in Texas is complex, making it difficult to understand and, consequently, difficult to improve.

Behavioral health is the term typically used when referring to mental health and substance use conditions. The goal of behavioral health policy should be recovery. Recovery from mental illness and substance use is possible. Recovery is not synonymous with a cure. It is an ongoing process that enables individuals experiencing mental health challenges to become empowered to manage their illness and take control of their lives. Recovery does not happen in isolation but requires holistic support from peers, family, friends and other stakeholders in the healthcare system, especially mental health professionals and the supports provided through the public mental health systems.

Although the recovery journey will look different for each individual, effective supports, interventions and evidence-based treatments are widely recognized as beneficial in the recovery process. While crisis intervention often relies heavily on the support of mental health professionals, long-term recovery focuses on personal responsibility, peer and family support, and self-direction of services and treatment. Psychosocial supports such as assertive community treatment, peer support and Wellness and Recovery Action Planning (WRAP®) often provide longterm stabilization and increased quality of life beyond the short-term impact of medical interventions.

Public behavioral health services in Texas are dispersed among many programs and agencies. Individuals needing treatment may receive care through a variety and combination of state agencies, including:

  • Health and Human Services Commission
  • Department of State Health Services
  • Department of Family and Protective Services
  • Department of Aging and Disability Services (to be eliminated 9/1/17)
  • Texas Department of Criminal Justice
  • Texas Department of Juvenile Justice
  • Texas Education Agency
  • Texas Department of Housing and Community Affairs
  • Texas Veterans Commission
  • Texas Workforce Commission

A discussion of behavioral health supports available at each agency is provided in the Public Behavioral Health Services in Texas section.

In addition to state entities, behavioral health services are provided at the local level in jails, hospital emergency departments, schools, local mental health authorities, various nonprofit agencies, public health clinics and other settings, with people frequently moving between service systems. While the Harris County Jail is often referred to as the “largest mental health facility in Texas,” this is not the case.  The Harris County Jail is a correctional facility that offers minimal mental health services often limited to pharmacological treatment. This is not mental health and substance use care and does not aid an individual in working toward their recovery.

Insufficient access to mental health treatment, supports and services remains one of the most pressing policy issues in Texas. Many Texans are unable to obtain services due to lack of access to private or public insurance coverage and insufficient public mental health safety net services. Over time, these shortages have led to persons receiving services through a confusing, uncoordinated and inefficient system of state and local agencies, often resulting in poorer health outcomes at greater expense.

Fortunately, the current Texas policy environment offers new options for expanding and improving the delivery of behavioral health services in Texas, providing opportunities to develop a system that is less fragmented and more accessible to consumers of behavioral health services. The federal Patient Protection and Affordable Care Act (ACA), Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver, the expansion of Medicaid managed care, and the recent increases in behavioral health appropriations all could lead to the development of a more comprehensive, integrated, and coordinated approach to the delivery of behavioral health services. With multiple initiatives in play, the potential for improvement is significant.

Behavioral health services in Texas are provided through a complex maze of programs that vary widely across the state. The range of available services may be different depending on an individual’s location, age, individual and family income, access to private or public insurance, type of symptoms, severity of condition, and the availability of health care providers who can provide the needed care within a reasonable distance. Navigating this system is often frustrating even for the most informed providers and clinicians who support individuals on a daily basis. For policymakers, family members and individuals receiving mental health services, especially those with little experience or knowledge of this system of care, understanding the complexities of the patchwork of behavioral health care services can be particularly challenging.

The purpose of the guide is to provide a general overview of the behavioral health care delivery system and the services provided under various state agencies that are funded in full or in part with state appropriations. To ensure this document is a useful reference tool, it does not provide significant detail on the various programs but instead focuses on the general infrastructure, funding and services provided. This guide is designed to provide the reader with a basic understanding of how behavioral health services are provided, the populations that are served, and the challenges of meeting the growing and often unmet needs of Texans with mental health or substance use conditions. For policymakers, advocates and other stakeholders who struggle with many complex matters and decisions, we hope this report will be a useful guide, providing practical and accurate information on mental health services in Texas.

The report is divided into the following four categories:

  • The Texas Environment: A discussion of current issues and recent developments at the state level, including a description of new programs and organizational approaches to care, some of which are being implemented and others of which may require further legislative action during the 2017 session of the Texas Legislature.
  • National Context: A basic overview of national activities and initiatives related to behavioral health care services, including a discussion of federal requirements that impact the types of benefits provided and the populations served under the Patient Protection and Affordable Care Act (ACA).
  • Public Behavioral Health Services in Texas: An overview of the multiple Texas state agencies and programs that provide a wide range of behavioral health services for clients, including programs provided by Health and Human Services agencies and services administered by juvenile and criminal justice agencies, school districts and the Texas Education Agency, the Texas Department of Housing and Community Affairs, Texas Workforce Commission and the Texas Veterans Commission.
  • Appendices

This third edition of the guide was somewhat more challenging to develop due to the major transformations taking place in the Health and Human Services System. We have attempted to include organizational structure and program alignment in place as of October 1, 2016, but are fully aware of the fact that changes will continue for the next several years.

Included in the Appendices of the report is a list of figures, a list of acronyms, additional resources, advisory committees, and a glossary of commonly used behavioral health terms. Some programs are subject to very specific, technical definitions in state or federal statutes that may vary from the more commonly used definitions included in this report. For that reason, readers may want to refer to additional resources noted throughout this document for more comprehensive information about a specific program.

The Hogg Foundation wants to emphasize that this report focuses primarily on state programs for treating behavioral health care needs in Texas. Many communities and providers throughout the state are equally engaged in the development, implementation and oversight of locally operated (and often locally funded) programs and services that are more specifically designed to serve the needs of local residents. Due to the variations in programs and the lack of a central database that identifies these various resources, this report generally does not include programs created at the local level unless funded by the state. However, we recognize that there are many valuable and effective programs that provide critical services that supplement the programs described in this report.

The Hogg Foundation offers this guide to help policymakers in Texas understand the array of behavioral health services currently available, the multiple access portals and the numerous funding streams. We want to reiterate that this area of health care is extremely complex and constantly evolving. While the information in this report is the best available at the time, new innovations in health care, and new legislation and programs, are continually changing the landscape of behavioral health care services in Texas. We hope that this report serves as a useful introduction, reference and guidebook illustrating the critical need for a long-term, coordinated, sufficiently funded approach to providing effective behavioral health care services.