Aiming to address the youth behavioral health crisis, Hawaii experts look towards Texas initiatives

This article was published by State of Reform on March 1, 2024. Read the full article on State of Reform’s website. 

As more states across the nation ramp up efforts to increase and provide access to behavioral health services for youth despite severe workforce shortages and limited funding, Hawaiian children’s behavioral health experts are looking towards recent Texas initiatives for guidance.

Panelists at the 2024 Hawaii State of Reform Health Policy Conference last month discussed ways to creatively implement an integrated system of care and the expansion of healthcare infrastructure.

“We’ve had a problem in Hawaii for a long time with depression and teen suicide. Of course, suicide has always been the second-leading cause of death for children ages 10 up until young adulthood,” said Bart Pilen, PhD, chief of behavioral health for HPH Medical Group.

While the crisis is not new, the COVID-19 pandemic—combined with last fall’s Maui wildfires—have exacerbated this issue. Pilen said the risk of suicidal ideation and suicide attempts have drastically increased over the past several years, and while many affected youths are in their teenage years, Pilen has seen children experiencing distress as early as eight years old. Workforce shortages and the lack of available providers, particularly for those with pediatric experience, exacerbate the issue, he said.

According to Pilen, 77.5 percent of Hawaii communities do not have enough mental health providers.

Roshni Koli, MD, chief medical officer at Meadows Institute—a Texan policy organization that was founded based on the need for a data-driven, nonpartisan policy voice in the mental health field—spoke about ways Texas is tackling its youth mental health crisis.

When we looked at the exacerbation of the mental health crisis in the pandemic, one of the things that we recognized as clinicians was that there’s a lack of infrastructure to really be able to care for children in the way that we needed to.

— Dr. Roshni Koli, Meadows Institute’s Chief Medical Officer 

Koli emphasized that mental health workforce shortages must be treated as an emergency or crisis, because if there are no providers available to assist with the identification and treatment of children’s mental health challenges, the issue goes unresolved and potentially worsens.

“What we have right now is fragmented care; long wait times, (and) primary care physicians oftentimes are bearing the burden of the mental health crisis, but don’t always feel like they have the tools … to be able to help,” Koli said.

Koli said the ideal mental healthcare system would be based on an integrated care model that would empower primary care providers to have effective tools needed to identify, address, and treat mild or moderate mental health conditions. This would create a more seamless pathway to referring patients to specialty care.

“This last legislative session was historic in Texas,” Koli said. “It was a session in which there was more money invested in mental health for Texans than in the history of our country.”

The focus of the 86th Texas legislature was the result of tragedies that occurred there, and including the recognition of many individuals—children and youth alike—struggling with their mental health, Koli said. She noted that the legislature focused on primary care integration and collaborative care.

“We support any model that has integrated care,” Koli said. “We also have to take into account where we have fiscal sustainability, as well.”

Last year, the Texas legislature invested $99 million in youth mental health, and formed the Texas Mental Health Care Consortium. Texas also invested $3 million to expand residential treatment center beds for children, and $5 million for mental health and substance use resources for select school districts.

The Texas Mental Health Care Consortium provides telemedicine and telehealth programs to school districts for the purpose of identifying and assessing behavioral health needs of children and youth, and connects them to mental health services.

Rep. Della Au Belatti, chair of the House Health & Homelessness Committee, said there was a primary focus on adult mental health during Hawaii’s legislative session last year.

“I’m going to continue to drill down on the adult mental health system,” Au Belatti said.

A win from Hawaii’s previous legislative session included the passage of a bill for a pilot project that deploys mobile outreach crisis teams for children and youth—something that Texas is already doing, according to Au Belatti. She said telehealth services for children and teens need to be boosted in order to address mild and moderate mental health conditions.

Au Belatti discussed the state’s lack of inpatient placement facilities—including emergency rooms—and intensive inpatient care.

“We are going to be in a world of hurt in the next three to six months. We are going to have to ask ourselves, are we going to be willing to invest money in … programs for intensive treatment?” Au Belatti said.

“I’m going to be trying a lot of things this session to make sure we shine a spotlight through informational meetings, hearings, (and) conversations that have to be made publicly, because if there’s anything we’ve learned in the last 10 years (it’s) why is mental health so difficult to deal with? Because we’ve left it to linger in the shadows for too long.”

Justina Acevedo-Cross, program director of community grants and initiatives at the Hawaii Community Foundation, is working with governmental and nongovernmental partners to finance strategies and develop an integrated, early childhood behavioral health plan.

“It is a playbook for what we need to do and accomplish across a large number of core components (and) core objectives, so that we actually are making progress for a more cohesive and inclusive mental health system,” Acevedo-Cross said.