The current state of mental health care services in Texas is “dire”, according to Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation. Despite a promising era of mental health care reform during the mid-twentieth century, Texas currently ranks last among all fifty states in access to mental health care services.
In this episode of Into the Fold, we sit in on a previously recorded conversation between Dr. Martinez and Dr. William Bush, historian and author of Circuit Riders for Mental Health: The Hogg Foundation in Twentieth Century Texas. They discuss the Hogg Foundation’s role in the emergence of Texas’s public health approach to mental well-being, the state’s current lack of investment in mental health care, and the imperative to remember and learn from the history of mental health care of Texas.
Hogg Foundation and the Mental Hygiene Movement
Prior to the early twentieth century, mental health was poorly understood and poorly treated. Met with stigma and isolation, people with mental illness rarely had access to therapeutic support in their communities. If they received treatment at all, it came after a mental health crisis led to their placement in state-run mental institutions notorious for negligent and abusive conditions.
As a public health approach to mental well-being began to take hold during the Mental Hygiene Movement of the early 1900s, the Hogg Foundation was at the forefront of change in Texas. In his book, Circuit Riders for Mental Health, Dr. Bush chronicles the foundation’s work to reduce stigma, raise awareness around mental health, reform the state hospital system, and advocate for more community-based services to support mental well-being.
Beginning in the 1940s, traveling lecturers played a notable role in familiarizing Texans with the concept of mental health. Trained by the Hogg Foundation, a contingent of mental health “circuit riders” traveled throughout the state, ultimately reaching 135,000 people through 456 outreach sessions in just 18 months.
In the 1950s and 1960s, investment in mental health services continued to reflect the growing public health approach to mental health and well-being. Federal spending on mental health began to shift away from large institutions and toward the community, the Texas Mental Health Code was established, and the federal Community Mental Health Act was passed.
Since the 1970s, however, this preventative approach faced increasing and unique challenges in Texas. The state’s rapid population growth quickly outstripped available resources and infrastructure; a diversifying population presented broader and more complex needs; large numbers of Texans lacked health insurance or parity in coverage for mental health treatment; rural communities struggled in isolation; the state hospital system remained a work in progress for decades; and an insufficient public health workforce was overworked and underpaid.
Not surprisingly, a more reactive approach to mental illness re-emerged. Texans today increasingly lack adequate continuity of care, unable to access the mental health care services they need in their community.
Lessons From History
By 2021, Texas’ progress had stalled to such a degree that, according to Mental Health America’s annual report on the state of mental health in America, it ranked last among the states for access to mental health care services. At present, the majority of mental health care services in Texas are currently provided not by community clinics or service providers, but through county jails and the state prison system.
“We’ve come full circle in many ways,” said Dr. Bush.
Dr. Martinez agrees.
“It’s so important for us to realize that if we don’t learn from history, we’re doomed to repeat it,” he says. “And unfortunately that’s what’s happening.”