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Jelynne LeBlanc Jamison makes the same impossible choice every month, when hundreds of children she cannot afford to treat show up at her state-funded mental health agency in San Antonio, desperate for help. help, in severe mental and behavioral distress.
Turning them down would leave her money for more robust staff at the Center for Health Care Services, where she is the director of one of 39 local mental health authorities in the state — and the only one in Bexar County.
This could reduce wait times for children already in the care of his agency, most of whom are uninsured or do not have access to a wide range of providers. This would expand its treatment options and solutions for children if services were not so restricted.
But Jamison chooses to serve all the children anyway – luring them into his already overcrowded system of state-funded providers and thereby risking employee burnout, long wait times and waiting lists or desperate families on borrowed time bouncing between overburdened providers in order to access the help they need.
“Many times we are the only source for [behavioral health] service,” she said. “Therefore, we are still serving children.”
An additional $730,000 a year would help the center — which averages about 1,800 children but was only funded for about 1,600 in the last budget cycle — better absorb the cost of their treatment.
But Jamison is still waiting for a sign from state health officials that they will consider adding new dollars to her budget for the 2024-25 biennium, as she expects the trend continues: more adults and children need help than its clinics have the funding. treat.
In less than three months, Texas lawmakers will meet to draft the new budget after sifting through more than 100 budget requests from state agencies, including nearly $20 billion in new money proposals.
But so far, state health officials have declined to talk specifics beyond a promise to prioritize children’s mental health. So for health care providers like Jamison, it’s not yet clear how much additional funding might be available over the next two years to handle the projected surge in patients.
“We’re frustrated because we haven’t seen any specific dollars mentioned,” Jamison said. “We had no indication.”
The Texas Department of Health and Human Services, according to a recent budget proposal, already provides a 5% decrease in federal funding for counseling and medical services for children who are seen in the 39 mental health authorities in the state. ‘State. Department officials did not include any specific dollar amounts for additional funds for children’s mental health services for the 2024-25 biennium.
Over the past year, the agency has spent about $3.6 billion on behavioral health services for children and adults. But Texas still ranks 51st among states and Washington, DC, in mental health spending per capita.
Agency officials and lawmakers say they are still trying to determine what kind of funding might be needed to bolster services for children, both from local mental health authorities and other programs from other agencies. . The final budget bill is usually passed in May, near the end of the session, and takes effect in September.
What the omission does not signal, they say, is a lack of priority and attention to mental health services.
Following the mass shooting at the primary school in Uvalde in May, Republican House Speaker Dade Phelan offers nearly $100 million in new funding to improve children’s access to mental health services, including the expansion of a new telemedicine program and an increase in the number of pediatric psychiatric beds. Governor Greg Abbott dedicated more than $10 million to mental health efforts immediately after the shooting, including $5.8 million to develop telemedicine for children and $4.7 million to increase the use of a treatment program for youth at risk.
It’s a response that a Republican budget official said should be pursued in the next biennium.
“For me, and for other members of the Legislature, this is one of the top priorities,” said State Rep. Giovanni Capriglione, a Republican from Southlake and chairman of the appropriations subcommittee of the Chamber on health and social services. “There is so much need for these services, and we also hear about it from many of our constituents.
A spokesperson for the state’s Department of Health and Human Services said funding applications for mental health services are “a starting point” and will be updated, as they were during previous sessions, with more details on their goals for children’s programs before the start of debate on the budget bill.
“We needed more time to analyze the state’s needs for mental health services for adults and children,” said spokesman José Andrés Araiza. “Improving mental health services for all Texans, including community mental health services, inpatient services, and other behavioral health services paid for by Medicaid are among the [the agency’s] top priorities.
Agencies are limited by rules that determine how much they are allowed to increase their requests each year, and may also be reluctant to ask too little too soon.
Leaving an amount out of initial funding requests does not always communicate low priority. Abbott did not specify a dollar amount in its request for funding to continue one of its foundational programs, the $4.4 billion Operation Lone Star, which is a clear priority.
But as public debate intensifies over how the state will allocate a $27 billion surplus, the perceived silence by state agencies in the name of additional funding for children’s mental health has put the spotlight on the public. community that serves these stressed children.
Health care providers and advocates say it’s hard to compete when so many other groups and organizations are already very public and specific about how they want taxpayer dollars spent.
“Given the increase in children’s mental health issues over the past decade and all the comments from Heads of State on the importance of addressing children’s mental health, we are disappointed that it’s not identified as a priority in budget requests,” said Josette Saxton, director of mental health policy at Texans Care for Children.
Texas’ 39 local mental health authorities partner with local schools, governments and community programs to treat adults and children with serious mental illnesses, especially low-income or rural Texans who have less access to services. or providers in their area.
Children receive therapy or medication or both. Where a diagnosis requires intensive treatment, authorities may provide the child with more comprehensive treatment in a hospital facility or long-term home care, either publicly funded or through a provider partner.
On average, 28,000 children are treated by local mental health authorities in Texas each month, a number that has steadily increased as the state has increased their funding over the years, according to a 2019 analysis. of the Texas Legislative Budget Board.
But even those budget increases aren’t keeping pace with the state’s rapid population growth and rising demand, Jamison said.
And in the wake of the pandemic, mental health providers across Texas say they are more understaffed and overwhelmed than ever before, leading families to languish on waiting lists or cut backs. services because there are not enough staff to handle the workload.
According to several studies and the Centers for Disease Control and Prevention.
Since 2019, a large portion of the new dollars invested in youth mental health services in budget bills have gone towards creating and expanding the Texas Child Mental Health Care Consortium, which has received approximately $330 million. dollars in state and federal funding since the legislature created it nearly four years ago.
The Texas Higher Education Coordinating Board, which manages the consortium’s funding, includes $124.3 million in its request for consortium funding for the next cycle — the same base budget as last year, with no new money.
Overseen by Dr. David Lakey, vice chancellor for health affairs at the University of Texas, the consortium brings together providers and experts from higher education institutions across the state to identify students from schools who have need help, connect them with providers via telemedicine and regularly consult on cases to ensure that the child receives the necessary treatment.
Lakey, a former state health commissioner, said that despite omitting new dollars from the higher education board’s request, he anticipates a “substantial increase” for the next biennium after Abbott , in response to the shooting in Uvalde, led the program. to expand statewide. Currently, the program operates in 365 of the state’s 1,200 school districts.
But Lakey said the consortium also didn’t get a specific amount for any new dollars it might need.
“We are not a state agency, and our requests are not made through statutory appropriations requests” such as those filed by the Texas Department of Health and Human Services and other agencies, said Lakey. “It’s talking to lawmakers and working with them to make sure they feel comfortable with the work that’s being done and the price to be paid for that work. I’m a bit hesitant to throw in a number, simply because I want the Legislative Assembly to be able to reflect on those conversations and what it will take to get us to where we need to be.
Disclosure: Texans Care for Children and University of Texas System financially supported The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the journalism of the Tribune. Find a full list here.
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