State health officials estimate that more than 488,000 adult Texans are living with serious, persistent mental illness [PDF]. Among children, roughly 154,000 are living with a severe emotional disturbance. While more Texans are being diagnosed with mental health problems every year, advocates say treatment costs are rising [PDF] and there aren't enough behavioral health professionals available to meet the demand for services. This includes psychiatrists, psychologists, social workers, licensed professional counselors and advanced practice nurses. Use our interactive maps below to see how dire the shortage is in each county in Texas, as well as how the percentage of Texans who rely on the state for mental health services has changed since 2005.
Mental health experts say the state is simply not producing enough psychiatrists — professionals who hold a medical degree and are able to prescribe medications for patients who suffer from severe mental illnesses like schizophrenia and manic depression. Since 2003, when lawmakers first cut Medicaid reimbursements and residency training to meet a budget shortfall, 10 residency programs statewide have struggled to increase the number of training slots. For each year between 2008 and 2011, the state reports, between 306 and 351 medical school graduates have undergone psychiatry training. Though children and seniors are considered two of the highest-need populations in Texas right now, there are only 49 residents training in adolescent psychiatry and not a single geriatric psychiatry resident. The Tribune's Thanh Tan spoke with a Texan living with anxiety and depression, the executive director of the Hogg Foundation for Mental Health at the University of Texas and the head psychiatrist for Austin Travis County Integral Care, to find out the reasons behind the shortage.
Federally-Designated Mental Health Professional Shortage Areas (As of September 2011)
Use the map below to see how the mental health professional shortage (MHPS) affects each county in Texas. It is based on federal data from the U.S. Department of Health and Human Services.
Number of Clients Served by DSHS-Funded Community Mental Health Service Centers (2005-2011)
Scroll over the map and click on a county to see how mental health client numbers have changed since 2005 in each county. Data from the Texas Department of State Health Services.
Health Professional Shortage Areas (HPSAs) in Mental Health by County, September 2011
Entire county
Partial County
Not designated
Number of Clients Served by DSHS-Funded Community Mental Health Service Centers - 2011
No clients
0 to 100
100 to 500
500 to 5,000
More than 5,000
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Well, Georgetown in Williamson county has a precinct that votes 90% Republican, so I'm guessing there's a pretty dire shortage of mental health practitioners there.
What else TX sucks..they only thinkof themselves & forget the people who really need help... people need to start to write to their Congress People for help...at if they get any at all for the child who really need it chances are slim.. good old TX...
Texas is a Bible Belt state. Here, many still believe that mental illness is related to demon possession and/or straying from the straight and narrow, God's path. Consequently, the ignorance extends from many households into the legislative body. The ignorance of one impacts the other & vice versa.
When MHMR succumbed to the almighty dollar, I knew it wouldn't be too long before the quality of treatment took a second seat to the "bottom line." In essence, profits and mental health treatment are not the best of friends.
As a function of inept politicians in Austin attempting to appease their egocentric constituents, the numbers of untreated mental health patients soared. Many were incarcerated. What a novel idea. Let's incarcerate patients with severe mental illness, particularly Schizophrenia, paranoid type & PTSD.
Many were turned away due to long waits for appointments. Typically, those with serious mental illness will self-medicate when treatment is denied or they cannot tolerate the side effects of some medication. Compliance is a difficult problem in the best of conditions.
If you believe that prison is a conducive environment to treat mental illness, you are a fool. After nearly twenty-three years of working in TDCJ-ID as a mental health professional, I can assure you I've seen some horror stories.
Some county jails, in order to save money, refuse to treat those with severe mental illness. They tend to pass the problem to the state of Texas. Some, may over-medicate these patients. The most severe case I ever observed was a patient who came to the Woodman State Jail from McClennan county.
When a clinician receives warnings from the officers transporting the patient to prison, you'd better watch out! According to informants, this patient had not bathed in an entire month. Gosh, what a blatant symptom! The jail in question treated this woman with Ativan, not anti-psychotic medication.
When she arrived, she would not get out of the patrol car. My social worker had to interview her inside the cruiser. One officer approached the vehicle, but he stopped short when he detected the overwhelming stench coming from the back seat. This tough & seasoned guard vomited right there on the spot. When I attempted to obtain a mental status examination, this woman attempted to communicate in some bizarre sign language.
Eventually, she was moved into the facility where my staff arranged emergency transfer to the Skyview Inpatient facility for stabilization. I never saw this patient again. One day, I am going to write a book about all of this. For now, I am still trying to put these memories behind me.
So, to those of you who are responsible for this mess, screw you!
December 20, 2011 @ 12:46 p.m.
Robert Domitz
Health care, under the best of circumstances these days, is expensive. This is true of both physical and mental health. It is not just the cost of the clinicians (that is, doctor, nurse, or other person who cares for clients or patients). For every so many clinicians, you need a supervisor, a compliance person, records clerk and a billing clerk. Because of the conversion to electronic health records, for every so many staff people, you need a computer person. You also need janitors, groundskeepers, etc. These support people may be part of the practice or may be outside contractors, but they all need to get paid. Oh, yes - to house the practice, you need one or more buildings, which adds mortgage payments or rent to the cost. The cost to the practice per patient visit or client visit is approximately the same for either mental or physical health.
Private insurance companies and government insurers refuse to pay the same rates. Why should a doctor, nurse or other health professional go into one of the mental health specialties, knowing that the pay will be lower? Of course, there is a shortage! Fix the payment system and more clinicians will "magically" become available.
Leave the payment system broken, less clients will get the help they need. More will self-medicate, using illicit drugs or alcohol., This will lead to more people being incarcerated for doing things, such as robbery, to afford their self-medication or because, while under the influence of their self-medication, they broke some law, such as driving under the influence, felony assault or homicide. It is far more expensive to warehouse a prisoner for years than to treat a patient.
December 20, 2011 @ 3:03 p.m.
Frank Lane
I am a psychiatrist in private practice for 25 years in Dallas, TX. I've worked in the county hospital, Parkland's psychiatric emergency room, I've taken shifts in what were once known as "MHMR clinics" and for 3 years, devoted 25 hrs/ week seeing those mentally ill people incarcerated in the Dallas Co. jail. I believe that I've surveyed the full spectrum of clinical care available and have observed the steady decline, overall, in quality and quantity of psychiatric care available to the general public. On August 19, 2001, the Dallas Morning News published an editorial I'd written in response to the horrendous case of Andrea Yates, a mentally ill registered nurse who drowned five of her children in June of that year. I pointed out all of the problems mentioned above and warned that we, all of us, will suffer the consequences of neglecting our most impaired citizens. Since then, the state of Texas, one of the richest states in the union, has slipped from 46th... to 50th, last place, in per capita funding for the mentally ill. Apparently, we lack the political will to make a better showing. I recently returned from visiting the community in Tucson, Arizona, where representative Gabriel Giffords was grievously wounded and six others killed, when a neglected mentally ill young man shot them under the influence of his paranoid delusions. The reminders of the tragedy there were quite obvious and their grief continues. Meanwhile, we in Texas, pride ourselves on the ease with which each citizen can carry a concealed handgun. I can only conclude that some Darwinian force is working at the social level here. Writing about it has certainly failed to change anything in ten years.
Comments (6)
Robert Rister via Texas Tribune on Facebook
Well, Georgetown in Williamson county has a precinct that votes 90% Republican, so I'm guessing there's a pretty dire shortage of mental health practitioners there.
Dave Mundy via Texas Tribune on Facebook
Well, Georgetown in Williamson County has a precinct that votes 90 percent Republican, so they probably don't NEED mental health practicioners there.
Lisa Coffey via Texas Tribune on Facebook
What else TX sucks..they only thinkof themselves & forget the people who really need help... people need to start to write to their Congress People for help...at if they get any at all for the child who really need it chances are slim.. good old TX...
David Whitten
Texas is a Bible Belt state. Here, many still believe that mental illness is related to demon possession and/or straying from the straight and narrow, God's path. Consequently, the ignorance extends from many households into the legislative body. The ignorance of one impacts the other & vice versa.
When MHMR succumbed to the almighty dollar, I knew it wouldn't be too long before the quality of treatment took a second seat to the "bottom line." In essence, profits and mental health treatment are not the best of friends.
As a function of inept politicians in Austin attempting to appease their egocentric constituents, the numbers of untreated mental health patients soared. Many were incarcerated. What a novel idea. Let's incarcerate patients with severe mental illness, particularly Schizophrenia, paranoid type & PTSD.
Many were turned away due to long waits for appointments. Typically, those with serious mental illness will self-medicate when treatment is denied or they cannot tolerate the side effects of some medication. Compliance is a difficult problem in the best of conditions.
If you believe that prison is a conducive environment to treat mental illness, you are a fool. After nearly twenty-three years of working in TDCJ-ID as a mental health professional, I can assure you I've seen some horror stories.
Some county jails, in order to save money, refuse to treat those with severe mental illness. They tend to pass the problem to the state of Texas. Some, may over-medicate these patients. The most severe case I ever observed was a patient who came to the Woodman State Jail from McClennan county.
When a clinician receives warnings from the officers transporting the patient to prison, you'd better watch out! According to informants, this patient had not bathed in an entire month. Gosh, what a blatant symptom! The jail in question treated this woman with Ativan, not anti-psychotic medication.
When she arrived, she would not get out of the patrol car. My social worker had to interview her inside the cruiser. One officer approached the vehicle, but he stopped short when he detected the overwhelming stench coming from the back seat. This tough & seasoned guard vomited right there on the spot. When I attempted to obtain a mental status examination, this woman attempted to communicate in some bizarre sign language.
Eventually, she was moved into the facility where my staff arranged emergency transfer to the Skyview Inpatient facility for stabilization. I never saw this patient again. One day, I am going to write a book about all of this. For now, I am still trying to put these memories behind me.
So, to those of you who are responsible for this mess, screw you!
Robert Domitz
Health care, under the best of circumstances these days, is expensive. This is true of both physical and mental health. It is not just the cost of the clinicians (that is, doctor, nurse, or other person who cares for clients or patients). For every so many clinicians, you need a supervisor, a compliance person, records clerk and a billing clerk. Because of the conversion to electronic health records, for every so many staff people, you need a computer person. You also need janitors, groundskeepers, etc. These support people may be part of the practice or may be outside contractors, but they all need to get paid. Oh, yes - to house the practice, you need one or more buildings, which adds mortgage payments or rent to the cost. The cost to the practice per patient visit or client visit is approximately the same for either mental or physical health.
Private insurance companies and government insurers refuse to pay the same rates. Why should a doctor, nurse or other health professional go into one of the mental health specialties, knowing that the pay will be lower? Of course, there is a shortage! Fix the payment system and more clinicians will "magically" become available.
Leave the payment system broken, less clients will get the help they need. More will self-medicate, using illicit drugs or alcohol., This will lead to more people being incarcerated for doing things, such as robbery, to afford their self-medication or because, while under the influence of their self-medication, they broke some law, such as driving under the influence, felony assault or homicide. It is far more expensive to warehouse a prisoner for years than to treat a patient.
Frank Lane
I am a psychiatrist in private practice for 25 years in Dallas, TX. I've worked in the county hospital, Parkland's psychiatric emergency room, I've taken shifts in what were once known as "MHMR clinics" and for 3 years, devoted 25 hrs/ week seeing those mentally ill people incarcerated in the Dallas Co. jail. I believe that I've surveyed the full spectrum of clinical care available and have observed the steady decline, overall, in quality and quantity of psychiatric care available to the general public. On August 19, 2001, the Dallas Morning News published an editorial I'd written in response to the horrendous case of Andrea Yates, a mentally ill registered nurse who drowned five of her children in June of that year. I pointed out all of the problems mentioned above and warned that we, all of us, will suffer the consequences of neglecting our most impaired citizens. Since then, the state of Texas, one of the richest states in the union, has slipped from 46th... to 50th, last place, in per capita funding for the mentally ill. Apparently, we lack the political will to make a better showing. I recently returned from visiting the community in Tucson, Arizona, where representative Gabriel Giffords was grievously wounded and six others killed, when a neglected mentally ill young man shot them under the influence of his paranoid delusions. The reminders of the tragedy there were quite obvious and their grief continues. Meanwhile, we in Texas, pride ourselves on the ease with which each citizen can carry a concealed handgun. I can only conclude that some Darwinian force is working at the social level here. Writing about it has certainly failed to change anything in ten years.