We must address Texas' behavioral health emergency

Voters and health care stakeholders are watching the 84th Texas State Legislative session with great interest. As our legislators consider options to reorganize the state’s health and human services agencies, the job will be incomplete unless they also address the critical workforce shortage for behavioral health professionals – a shortage that we at the Meadows Mental Health Policy Institute consider a public health emergency.

We know the impact that mental health disorders have on the people and financial resources of our state. Our own surveys have found that 76 percent of Texans have a close friend or family member who has experienced a mental health need. Approximately 50 percent of all mental health disorders begin by age 14, affecting one-in-five Texas children in a given year and nearly half of Texans across their lifetime.

A significant challenge in getting care to everyone who needs it is that the majority of Texas mental health providers are clustered in just five counties: Bexar, Dallas, Harris, Tarrant and Travis. Of Texas’ 254 counties, 207 are designated as Mental Health Professional Shortage Areas, and 241 counties have some level of shortage of behavioral health professionals. The most drastic shortages are in non-metropolitan areas, including East Texas, West Texas, the Panhandle, the Rio Grande Valley, and El Paso.

There are also wide gaps for different types of providers. Texas is the second most populous state with several of the fastest-growing communities in the nation. Yet the overall number of behavioral health professionals falls far short compared to national averages. Texas has 76 psychologists per 100,000 residents, compared to the national average of 129. Similarly, Texas has 253 licensed social workers per 100,000 residents, compared to a national average of 402. The shortages are similarly acute for psychologists, licensed professional counselors, and licensed marriage and family therapists. The shortages grow even more acute when it comes to specialists for children, older adults, minority communities, and people who do not speak English as their first language.

To improve the wellness of Texans, an adequate and comprehensive workforce of skilled behavioral health professionals is essential. A key strategy to help bridge the gaps in both geographic coverage and provider type will be to rethink education and training for physicians and other health care professionals, as well as incentivizing practitioners who are in scarce supply to relocate and practice in Texas. Texas ranks 31st in the nation for psychiatric residency slots on a per capital basis, and is one of eight states that does not offer reciprocity or endorsement of physicians’ licenses from other states.

There are several bills before the Texas legislature offering potential solutions. HB 2434 and SB 239 seek to provide assistance with student loan repayment for mental health professionals that commit to practice in underserved regions of Texas. SB18 expands graduate medical education capacity in Texas. HB 661 and SB 190 would authorize participation by Texas in the Interstate Medical Licensure Compact for eligible physicians who voluntarily elect to participate.

The costs of mental health disorders on Texans and their families and for Texas taxpayers are too high to ignore. Building an integrated system of prevention and early intervention services will help reduce those costs; but it will take a robust and skilled workforce to accomplish. As people who call Texas home and pay its taxes, it is incumbent on all of us to care.

Andy Keller, PhD, Meadows Mental Health Policy Institute

Dr. Andy Keller is President and Chief Executive Officer of the Meadows Mental Health Policy Institute

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