May is mental health month and many state and national agencies and organizations are highlighting important mental health topics. In my opinion, among the most critical mental health issues facing Texas today is a mental health workforce shortage that affects both public and private mental health systems.
This looming crisis, and the precarious position in which it leaves Texas, was highlighted in a recent policy brief by the Hogg Foundation for Mental Health and Methodist Healthcare Ministries. The bottom line is that too many Texans can’t get the mental health services they need because Texas doesn’t have enough social workers, psychologists, marriage and family counselors, psychiatrists, psychiatric clinical pharmacists, psychiatric physician assistants, psychiatric nurse practitioners, etc. The crisis is even worse among mental health providers who specialize in working with children, youth or the elderly.
This issue affects all Texans, regardless of age, income, ethnicity, gender or community. I have personally heard from many of you how difficult it is to find a mental health provider who accepts new patients. Many clinics, hospitals and physician groups have told me they are having difficulty hiring mental health providers, particularly those with appropriate cultural and linguistic skills.
This problem has been brewing for a long time and the causes are many. For over a decade, we have watched mental health workforce supply ratio trends in Texas worsen and demand for services increasingly exceed supply. We have long predicted that this gap would widen as baby boomer mental health professionals begin to retire while their generation has increasing mental and physical health care needs. Baby boomers have changed everything in their wake, and it’s no surprise they will influence behavioral health care trends as they grow older.
Ignoring these trends and predictions has been a grave disservice to the people of Texas and past decisions have added to the crisis. For example, in 2003 the Texas Legislature eliminated funding for psychiatric residency training at state psychiatric facilities, even though it is well-known that residents typically choose to remain in the community where they completed their training. Since then, many talented young health care professionals have left Texas to complete their training and never returned.
The current economic downturn further exacerbates the situation as legislators consider draconian cuts in funding that affects the mental health system and workforce. For example, the proposed House budget would eliminate funding for family residency training. This could have a devastating impact given that primary care physicians provide the majority of behavioral health services in Texas.
Legislators also are considering reducing the state’s Medicaid reimbursement rates to help solve the state’s deficit. This will not produce the desired cost savings. Why? Texas Medicaid reimbursement rates already are just 60 cents on the dollar. Last year, only 42 percent of Texas physicians accepted new Medicaid patients, down from 67 percent in 2000. The House wants to further reduce the reimbursement rate by 10 percent, while the Senate budget recommends 6 percent. Either would result in fewer Texas health providers accepting new Medicaid patients because it would not be economically viable.
This further shrinks the availability of services in the public mental health system. Texas already has the highest rates of uninsured and underinsured children and adults in the nation. Texas also has some of the highest poverty rates for these groups. (Check out Texas on the Brink to see how poorly we compare to the rest of the nation.) These patients either can’t afford or can’t find routine physical or mental health care. The cost of care is far more expensive if they seek treatment in a local hospital, emergency room or clinic. This approach is bad for people’s health and simply shifts the state’s health care costs to the local level. Taxpayers will pay the tab one way or another.
Texas has an attractive economy and is a great place to start a business enterprise, as demonstrated by the 20.6 percent growth in population since the last census. This equates to 4.2 million new residents in just 10 years. However, this growth has further outstripped our mental health care infrastructure. In recent years, the number of mental health workers per capita in Texas has been woefully below national and comparable states’ averages, including California, New York, Illinois and Florida.
As a native Texan, I find this trajectory disturbing and appalling. Texas will not remain economically competitive if our workforce can’t get quality, affordable health care. Business ventures, companies and corporations are nothing without the people who bring them to life. Our well-being includes having a healthy mind, body and spirit. Like all things worthwhile, this requires investment and maintenance. We must invest in our state’s human capital, meaning ourselves and our children. Investing now will prevent Texas from resembling a “third world nation,” where the gap between the haves and have-nots is so great that second-class citizenship becomes the norm.
There are many steps that can be taken now to reverse the workforce shortage before it’s too late. Here are some examples of what the Hogg Foundation is doing:
- We are involved in policy discussions about mental health workforce issues and have been invited to testify before legislative committees on the topic.
- We are seeking proposals to create a new pre-doctoral psychology internship program in Texas. To ensure that the programs we fund will be of a high quality, grantees must agree to pursue program accreditation from the American Psychological Association.
- In the past two years, we have awarded 82 scholarships to Spanish-speaking graduate students at 12 accredited social work schools in Texas. The program now allows schools to include other languages, including sign language, prevalent in the community. We have set aside $1.5 million to fund this program for three more years.
- We have awarded a $1 million grant to help launch a new certification program for peer support specialists in Texas. Peer support is an emerging national trend and an important component in mental health recovery and wellness, both for the person providing the services and for the person receiving them. Trained peer specialists can help alleviate the workforce shortage by providing ongoing services and support to consumers in between their visits with other mental health professionals.
These are but a few ways to address the mental health workforce crisis. Solutions will require other foundations, individuals, state policy makers and agencies, institutions of higher learning, health science centers, hospital districts, mental health authorities and other key players working together.
Difficult, yes. Impossible, no. We must invest in ourselves. The alternative is not worthy of the Texas I grew up in or the Texas I want to pass on to my child. We still rally around the cry, “Remember the Alamo!” Let’s not create a new cry, “Remember when Texas WAS great!”