Community treatment services for persons with mental illness and substance use disorders

“The Department of State Health Services (DSHS) has Struggled to Deliver Integrated, Outcomes-Focused Community Mental Health and Substance Abuse Services.”

Texas Sunset Review Commission Final Results, July, 2015

My article last week delved into the lack of treatment services for persons with mental illness and substance use disorders, and the fact that our community has always done the best they could to provide the needed treatment; despite the lack of funding and clear-cut policy and other resources.

Just what services are available, and what is being done to bring equity to these individuals and their families? Very recently the U.S. Senate passed the Comprehensive Addictions and Recovery Act (CARA), by a vote of 94 to 1, authorizing funding for evidence-based prevention, treatment, and recovery programs to help Americans struggling with addiction. The Bill has been sent to the House of Representatives, where it is also predicted to pass overwhelmingly. This bill will authorize $600 million for grants to aid in our battle against opioid addiction and other substances. Just how much of this “pie” will trickle down to Texas is yet to be seen.

The State of Texas Department of State Health Services (DSHS) Sunset Review Commission released a final report in July of last year, on the status of treatment services in our state; findings of inadequacies and recommendations to correct the inadequacies ( RE: Sunset Advisory Commission, Final Results, TDHS, July, 2015). The Review Commission found many inadequacies in our state services, but I want to concentrate on one area in particular which should be of interest to us all; the provision of services to those with mental illness and a co-occurring substance use disorder.

The Commission relates that 2 million persons in our state have a substance abuse problem, and almost 50 percent of persons with a mental illness diagnosis also have a substance abuse disorder; that’s over 200,000 individuals of the 500,000 adults in our state with serious mental illness. The Commission also pointed out that 175,000 of our youth have severe emotional disturbance.

As I pointed out in my previous article however, more than 60 percent of adults and more than 50 percent of our youth do not receive treatment for their disorders. The Commission also pointed out that there is a gross disparity in the mental health funding for regions of our state; some regions only seeing a very small part of the mental health and substance abuse “pie.”

Although I will not go into this report with any length, as it is very lengthy, I believe it is important to point out a few items. Inadequacies in our state services, as given by the Commission, include: DSHS distributes local mental health funding without a rational plan, attempts to more equitable distribute local mental health funding have repeatedly failed, local mental health organizations do not receive the support they need to be effective, most DSHS data requirements provide little information on actual outcomes, outdated regulations for community-based behavioral health treatment facilities stifle innovation and may not adequately protect vulnerable populations, DSHS has not seized obvious opportunities to integrate hotline, screening, and assessment functions for mental health and substance abuse services; and many other issues.

The Commission, in their recommendations they suggest that DSHS be required to integrate mental health and substance abuse hotline, screening, assessment, and referral functions; and require DSHS to focus funding equity efforts for local mental health authorities on targeted capacity needs rather than narrow per capita funding. The persistent disparity in Regional Mental Health Funding is a paramount issue…it always has been.

In 2013, for example, the statewide averages of funding in 28 of the 38 state regions were further away from the $8.61 to $27.34 per capita spending allocated in 2006…and, as I have so often pointed out, this is extremely below the average of 48 other states in this regard.

Historically, we in the Rio Grande Valley communities have seen treatment services come and go, have witnessed the inadequate funding for our region, and the gross miss-management in past treatment services. My colleagues and I whom have worked for many years in the mental health and substance abuse arenas have been witness to this, and have advocated for services for many, many years. With the implementations of the Sunset Review Commission, many changes are taking place within DHSH and in our Legislature. We are starting to see the results in the Valley…The Tropical Texas Behavioral Health agency has implemented Substance Abuse Services in our communities, particularly in regards to the co-occurring disorders of mental illness and substance use disorders.

I really applaud them for this initiative. Their Substance Abuse programs are now in the very capable and experienced hands of a “doubled barreled” Licensed Chemical Dependency and Licensed Professional Counselor, an administrator well trained and experienced in the fields of mental health and substance abuse that I have known for a long time. These type of programs administered by LCDC’s have long been recommended by the Texas Association of Addiction Counselors (TAAP) and other Associations…who better to manage substance abuse and co-occurring programs than an experienced professional trained in the specific area?

Although the initiatives taking place throughout the state are really nothing new, we have been there before when there were many substance abuse and co-occurring treatment facilities and initiatives in the Valley. I would that this not be another cyclic “ca plus change” situation, that the recommendations of the Sunset Review Commission are taken very seriously and live to fruition, and truly not be verbiage but action oriented such as the recent implementation of the substance abuse programs by Tropical Texas Behavioral Health. Are we just going through yet another cycle of program initiatives, or is a real renaissance taking place? Being an optimist and realist, I would surely hope so.

Until next time, Stay healthy my friends!