Horton: Lawmakers must address mental health workforce shortage


We have a mental health workforce shortage in Texas.

Just look at the numbers. Last year, 185 Texas counties out of 254 did not have a single psychiatrist, which left more than 3 million Texans without access to a psychiatrist. Worse, 40 counties didn’t even have a licensed clinical social worker.

This issue is not something that just sprang up. Five year ago, the Hogg Foundation for Mental Health published a report on this shortage in Texas. We called it “Crisis Point.” When we updated the report this year, we decided to change the name. Why? Because it doesn’t make sense to call it a crisis anymore. It’s just a chronic reality.

Like someone living with a chronic illness, we should be honest with ourselves about the costs of doing too little to treat it. But we can also be strategic and optimistic about the opportunities for getting healthier.

The economic value of providing appropriate mental health services can be measured in the avoided costs of hospital admissions, emergency department visits, criminal and juvenile justice involvement, homelessness, and more. Providing appropriate mental health services has also been shown to reduce lost workdays and improve workplace productivity.

More importantly, access to the right services at the right time offers hope to individuals that they can achieve recovery and live meaningful lives. Meeting the mental health needs of Texans requires an adequate mental health workforce.

A lot of factors have converged to create this chronic problem. They include an aging mental health workforce, the unwillingness of mental health providers to accept patients with Medicaid, inadequate reimbursement rates, and outdated education and training practices.

These issues will need to be addressed collectively in order to make a significant impact. And it begins with the Texas Health and Human Services Commission formulating a comprehensive plan that outlines short-, mid- and long-term objectives.

The process should include active participation from agencies responsible for higher education, public education, criminal justice, juvenile justice, the Texas workforce, child welfare, public health, insurance, housing, and others.

Fortunately, Texas doesn’t need to start from scratch. There are common-sense reforms that can dramatically improve care.

For starters, we need improved integrated health care. Effective integrated health care is the comprehensive coordination of mental health, substance use and primary care services. Sixty-eight percent of adults with a mental health condition also have one or more chronic physical conditions such as high blood pressure, heart disease, or diabetes. The integration of primary care and behavioral health services allows health professionals to better coordinate treatments.

We also need to improve the mental health reimbursement rates. Only half of Texas psychiatrists accept private insurance, compared with nearly 90 percent of other physician types. And only 21 percent of Texas psychiatrists will accept Medicaid patients, according to the Texas Medical Association. The state should increase reimbursement rates to increase the number of practicing mental health care providers willing to provide services to consumers with Medicaid.

The state would also be wise to increase access to services provided by certified peer specialists where “peers,” who have a history of lived experience with mental illness or substance use, rely on their personal recovery and specialized training to help guide other individuals experiencing a behavioral health condition in their own recovery.

And finally, we need to expand the use of technology. Technology can be useful to support individuals in rural areas of the state that have significant shortages of mental health professionals.

The challenges facing the mental health workforce are real, and the solutions are not always easy to implement. They require additional resources and funding. But the cost of ignoring the problem is greater. The growing Texas population coupled with the aging workforce will continue to strain mental health professionals. If we start now and think long term, the future can and will be healthier.

Horton is the policy program officer in the Hogg Foundation for Mental Health at The University of Texas at Austin.


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