Setting the Record Straight on Mental Health & Texas

Ongoing criticisms that Texas is lagging behind the rest of the country in mental health, and that our leaders haven’t taken it seriously enough and made it a priority, are not only wrong, they are counterproductive.

— Andy Keller, PhD

When it comes to improving mental health in Texas, the challenge is far too daunting for us to be distracted by misconceptions and misunderstandings, both about the nature of mental illness and the strength of the state’s actions to support mental health care and their efforts to coordinate care in Uvalde.

People generally have only a tenuous understanding of what mental illness is and how it relates to violence. To be clear, mental illnesses are treatable health conditions. While some specific mental illnesses increase the risk of violence, mental illnesses on their own do not cause violence, and violence itself is not a mental illness.

In the aftermath of the Uvalde tragedy, one of the difficulties we face is that young teenage males who plot school shootings share common characteristics: exposure to early childhood trauma and school discipline; a sense of hopelessness and isolation; experience with bullying or abuse from others; a notifiable crisis point with suicidal ideation; and self-hate that turns against a particular group. Perhaps 10,000 Texas youth fit this profile, but almost none will commit mass murder. Yet, nearly all will suffer bad outcomes, like dropping out of school, joining gangs, committing crimes, or taking their own lives.

The only solution then is to identify young people who need help and intervene.

The good news is that this is where Texas has concentrated efforts over the past several years, following the Santa Fe High School mass shooting.

The creation of the Texas Child Mental Health Care Consortium by the 86th Texas Legislature was a national breakthrough, as it brought the most innovative, accomplished minds in mental health together to leverage our resources with a focus on early intervention and treatment.

By implementing programs like TCHATT (Texas Child Health Access through Telemedicine), which connects school districts and parents with experts at Texas medical schools, the Consortium has expanded the ability for schools to not only recognize when a student needs help but to provide access to mental health services. TCHATT, initiated in 2020, continues to steadily expand across the state, assisting school staff, students, and – imperatively – parents and other caregivers.

Texas has also expanded the use of Multisystemic Therapy (MST), one of the most well-established, evidence-based programs for at-risk youth. What is particularly important about this program is that treatment can be positioned to help before juvenile justice involvement. We cannot wait until young people are arrested before we do anything to help.

In late June, in response to the Uvalde, Governor Abbott and legislative leaders approved a budget execution order to expand TCHATT statewide and double the number of MST in Texas. The order also funds two Coordinated Specialty Care teams, the gold standard for treating people with psychosis. These investments build on the legislature’s sustained commitments.

Like all states, Texas has more work to do to advance the state mental health system. But we have to be aware of the significant progress we have made before we determine how best to focus our resources going forward.

The studies that suggest Texas is near last in mental health care and access caution that they are not intended to represent a complete picture, though the media portrays them as such. Further, the studies are based on old or incomplete data, which ignores the significant strategic investments the state has made since funding was last tabulated in 2015. One such overall ranking prioritizes metrics irrelevant to understanding the state of children’s mental health in Texas (e.g. the adult uninsured rate), which ultimately obscures the details underlying those rankings that actually reflect well on Texas’s overall need for care and relatively well on unmet mental health needs. Sadly, the media use of those rankings does not delve into that level of nuance.

Ignoring the investments made toward addressing the problem will only hamper our ability to build on that success and to more effectively reach the young people of Texas who need help the most.

The challenge before us is formidable enough without letting misinformation drive the narrative.