This is the fourth story in a series on mental health collaboratives in Texas, which aligns with our strategic focus on communities and collaboration. Other stories in the series featured Bexar County Community Health Collaborative, Mental Health Connection of Tarrant County, and Community Partners for Children.

East Texas Behavioral Health NetworkThe East Texas Behavioral Health Network (ETBHN) was born out of more than a decade of conversations between five community health center leaders who wanted to improve the cost efficiency and connectivity of their service delivery. The first program created under the ETBHN masthead in 2004 was a closed door pharmacy that allowed member centers to purchase bulk quantities of medication at discounted rates.

With the arrival of current Executive Director Gary Bramlett came a rush of new ideas and great ambition—opening the door for unprecedented expansion and innovation. ETBHN now acts as a coordinator between 11 member centers serving 70 counties, while their combined services reach 220 counties across the state.

In addition to facilitating a wider circulation of information and resources, ETBHN helps member centers eliminate cost inefficiencies while deepening impact. A qualitative analysis from 2017 recorded more than $33 million in savings across the network. “What we’re trying to do is improve the quality and save the centers money so they can put that money back into services,” Bramlett says.

One Size Doesn’t Fit All

With a reach as substantial as the network’s comes sufficient capacity and incentive to get creative. “If a center has a question, or if they’re falling down on some measure,” Bramlett says, “they’ll contact me, and I’ll find the expertise at another center. I’m the go-between for that.” ETBHN’s operational structure, which organizes committees of member center CEOs around key issue areas, naturally catalyzes knowledge- and resource-sharing capacity.

That doesn’t mean the agenda of one member center is bound to another—as was the case before Bramlett joined, when decisions were made unanimously. While a set of shared goals keeps the network formally intact and ensures collaboration, a “menu option plan” guarantees members certain autonomy over the projects they choose.

This autonomy is important when considering the unique and complex needs that exist within a region. “What we’ve done is allow them to keep the independence they need to serve their communities,” Bramlett says. “Giving the centers that autonomy has led to our growth, and it’s easier to manage that way.”

Necessity is the Mother of Invention

“Most of our services start small,” Bramlett says, “and as more centers see what we’re doing, they want to join in.” If even just two member centers make a meaningful case for a project, that proposal is considered.

A prime example of a program that followed this path is ETBHN’s 24/7 telemedicine service, which premiered in 2011. Telemedicine utilizes video and phone interfaces to connect clinicians living in Austin, Dallas and other urban centers to residents of rural areas, where psychiatric services are in much lower supply.

Although critics have pointed to telemedicine’s screen-to-screen dynamic as lacking in the warmth of face-to-face communication, Bramlett says participants in the program have been surprisingly receptive—children in particular. “They really feel more free to open up on video,” Bramlett says. “It’s been amazing to watch.”

Another program of the network is the East Texas Coalition for Mental Health Recovery. From 2010 to 2014, ETBHN collaborated with the Hogg Foundation to launch and coordinate related activities. One component of the pilot program was the RESPECT Institute, an intensive and empowering week-long training retreat that teaches 10 individuals living with mental health challenges how to share their story. This process helps peer specialists harness the unique power of their lived experience for work in the mental health system in East Texas where the need for consumer leaders is especially great.

The sessions culminate in a graduation ceremony, during which participants take the podium for the first time. For Bramlett, a former clinician, witnessing the peer testimonies brings it all home. “It’s healing for the person, and it’s healing for the people who provide these services to see that they’re actually making a difference,” Bramlett says. “That’s why ETBHN is here.”