Congress must expand the Excellence in Mental Health Act

Photo by Siddhartha Lammata

Our nation’s mental health crisis can no longer be ignored. Across Texas, community mental health centers face the reality of unmet needs each day as people with intellectual and developmental disabilities, serious mental illness and substance use disorders seek help.

The 39 organizations that comprise the Texas Council of Community Centers don’t want to lose any more time when so many lives are at risk. And maybe we won’t have to.

Last month, Texas was awarded a one-year planning grant from the Excellence in Mental Health Act Medicaid Demonstration Program, better known as the Excellence Act. We were selected along with 23 other states to share a $22.9 million allocation from the Substance Abuse and Mental Health Services Administration.

Members of the Texas Council of Community Centers are already making a big difference as a result of bipartisan support for investments in mental health services. We welcome this grant as a rare opportunity to advance our goals of providing well coordinated, effective, integrated care for mental health and substance use disorders that frequently co-occur with other chronic health conditions.

Initial funds will be used to develop system transformations that prepare us to apply for a two-year pilot program. The two-year pilot phase will increase access to well coordinated, integrated services while improving Medicaid reimbursement for the eight states that will ultimately selected for the demonstration program.

That’s right, just eight states — out of the 24 that should have the ability to expand and improve behavioral health care delivery.

The lack of ready access to treatment results in nearly insurmountable problems when our emergency rooms, nursing homes, homeless shelters and prisons take on the unassigned role of “mental health provider” in addition to their primary responsibilities. The costs alone speak for themselves: According to a 2011 report commissioned by the Texas Conference of Urban Counties, in jail, behavioral treatment costs $137 per day per patient; in the emergency room, it's $986 per day — until the patient is discharged, often to start the entire cycle over again.

In one of our community centers, that daily cost is just $12.

Prisons, most importantly, shouldn’t be treatment centers, as we understand very well here in Texas. Community mental health centers have the invaluable support of law enforcement across the state. Officials like Limestone County Sheriff Dennis Wilson, who currently chairs our board of directors, recognize that expansion of the Excellence Act would ensure Texas’ ability to help lay an even stronger financial foundation for our communities.

Despite historically low funding for mental health services compared to other states, Texas is emerging as a recognized and innovative leader in this field of health care delivery. During the recession of December 2007-June 2009, when other states cut funding for mental health and other critical services, Texas continued to invest. As the recession “caught up with us” in 2011, we experienced a few incremental delays in funding but in 2013 began investing again as the economy rebounded.

Our forward-thinking legislators know that if you don’t fund early intervention in behavioral health treatment, you’ll pay for it in the criminal justice system. This past session, our Legislature appropriated funds to expand inpatient and outpatient mental health treatment as well as crisis response alternatives to expensive hospitalization, recognizing that people with mental illness and substance use disorders should have access to the right treatment at the right time. 

Texas was the first state in the nation to pass legislation and appropriate funds for training instructors and educators in Mental Health First Aid®. Much like arming the public with CPR training, the law has allowed our member centers to provide mental health instruction for more than 14,000 educators and the general public.

We are ready to collaborate and shape the future of behavioral health in Texas. Congress, please expand the Excellence Act so our community mental health centers can do more of what they do best. So many depend on us — and now, they also depend on you.

Danette Castle

CEO, Texas Council of Community Centers