Senate Health and Human Services Committee

As part of the committee’s interim charge on children’s mental health, Keller shared insights on the critical issue of care and services currently available to Texas families, providing an overview of the “scaffolding” of mental health services that the state has built over the past several legislative sessions.

“We are aware of so many more youth today who need care,” Keller said. “Clearly the number does seem to be increasing. What I’m going to try to do today is lay out a framework to think about the full range of emerging lower-level needs through our most intensive needs.”

Keller began his testimony by praising the state’s historic $11.68 billion investment in behavioral health during the 88th Legislative Session, stating that lawmakers were addressing the mental health crisis in the right way.

“The historic investments in children’s mental health from last session, but also including the last three sessions, have built in Texas the key elements of what I would argue is the country’s best, most-comprehensive system for high-needs youth,” he said. “It’s something we should be proud of.”

Currently, approximately 2 million children and youth in Texas ages six through seventeen—about 35 percent of the youth population—have a mental health need.

Of those, 65 percent can successfully be treated through integrated primary care, a proven, team-based model in which mental health specialists are embedded with primary care providers to identify and meet needs early, when they are most treatable. Integrated care models such as Collaborative Care provide better outcomes for youth while at the same time reducing health care costs and serving as a workforce multiplier.

The remaining 35 percent of youth—approximately 700,000 individuals—require varying levels of specialty care depending on their needs. Most can receive effective treatment through routine specialty outpatient care or more-complex team-based care.

A smaller number of youth, roughly 10,000 young people, have the highest needs and are at the highest risk. For them, several specialty programs are available:

• Youth Crisis Outreach Teams support youth in crisis and their families and reduce pressure on the foster care system and hospital emergency rooms.
• Multisystemic Therapy treats youth who have committed violent offenses, have serious mental health or substance use concerns, and/or are at risk of out-of-home placement.
• Coordinated Specialty Care provides the gold standard of care for people experiencing a first episode of psychosis.

As Texas builds its capacity, the need remains for continued investment to expand our mental health infrastructure.

“We are still not treating most children and youth until ten years after mental health needs emerge,” Keller said. “Our system was not designed to find children in time. Seventy-five percent of mental health needs will emerge before our brains finish developing in our early twenties.”

One way to address this is through leveraging the power of our school system.

“Schools are not health-care providers,” Keller said. “They are education providers. But they are a very good place for us to see needs emerge.”

If a teacher is concerned that a student is at risk, one important option is a school-based service created through the Texas Child Mental Health Consortium called the Texas Child Health Care Access Through Telemedicine (TCHATT). This first-in-the-nation program is now available on more than 6,500 campuses across the state, reaching 4.1 million students. The service can be accessed only with parental consent, and it is a vital link connecting at-risk students with behavioral health needs with quality care from Texas’ twelve medical schools.

Regardless of the intensity of the mental health needs, Keller said that one constant in supporting children is the importance of the support system around them.

“Mobilizing the parents, and having them take the lead, whether those parents are their mom and dad or grandma and grandpa or foster parents or adoptive parents—whoever those adults are who love that child, they are the single most important bulwark for lower-acuity children, and frankly all children,” Keller said.