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In 2016, the warnings about the future of Texas’ mental health care workforce were clear.
“More than 80% of Texas counties are designated mental health professional deficit areas, defined as 30,000 or more residents per clinician,” states the Texas-wide Behavioral Health Strategic Plan. said seven years ago. “Many of the most experienced and skilled practitioners are nearing retirement. …Texas higher education institutions have not been able to produce enough graduates to meet the projected demand.”
But no forecaster predicted a global pandemic that left Texas and the country, causing months of lockdowns and restrictions on public life, and trying to combat the resulting anxiety and depression. Both Republicans and Democrats have come to the same conclusion in a country where it seems rare. Mental health services are in direct need of transformation and expansion.
“With the ongoing mental health challenges posed by COVID-19, there has never been a more critical time to strengthen mental health resources in this country,” said Sen. John Cornyn, Texas Republican. Said in November 2020
‘Mental health affects us all’ President Joe Biden Said After announcing last fall that it would provide millions of dollars in new funding to state mental health services,
The calls spiked again last summer after a teenage school shooting in Uvalde, Texas, that killed 19 children and two adults.
“Mental health services must be provided to students who need them,” said Gov. Greg Abbott. inaugural speech last month.
Texas House Speaker Dade Phelan is calling for a $100+ million school safety and mental health package, with nearly half of that package going to children’s mental health services. is expected to pour into a variety of services for all Texans.
texas rank died at the end Mental Health America, a nonprofit advocacy group, ranks 33rd for adult care when it comes to access to mental health services for children. To increase the number of experts, we have a lot of work to do first.
Today, 98% of Texas’ 254 counties are designated by the federal government as “mental health professional shortage areas,” in whole or in part.
How did this happen
“We really couldn’t keep up with demand,” said Dr. Sarah Martin, a psychiatrist and medical director of the Texas Children’s Mental Health Care Consortium. “The pandemic has only floored the stigma around mental health, and it happened so quickly that lines and waiting lists for therapists have gotten so long.”
This should come as no surprise to Texans who have tried to make an appointment with a mental health care provider over the past three years. Some therapists have had to stop accepting new appointments altogether as demand for their services began to overwhelm their systems.
“The pandemic has exacerbated the existing shortage of behavioral problem clinicians at every level of the mental health continuum, including our state hospitals, private mental hospitals and local mental health authorities,” the House of Representatives said earlier this week. told the appropriations committee.
Workforce issues have reached the highest levels of the mental health system. Texas now says more than 700 of its 2,911 funded state psychiatric hospital beds are unusable due to labor shortages, officials with the Texas Department of Health and Human Services said. As of December 31, the state hospital had 5,987 full-time employees, down from 7,409 full-time employees in 2019.
Shortages of therapists, psychiatrists and psychologists are also affecting other government agencies.some counties prisonincluding those in Dallas and Houston report a long wait for people with mental illness who have been arrested and need treatment before trial. I was waiting for
And with many therapists, psychologists and psychiatrists heading into retirement, the labor shortage is expected to get worse. Fresh graduates and young professionals out of college aren’t enough to replace them, according to Texas government agency officials.
of Texas Behavioral Health Executive Council Oversees mental health licenses for marriage and family therapists, professional counselors, psychologists, and social workers. The council confirmed a slight increase in the total number of licensed professionals last year, with 80,546 licenses, of which 75,327 are considered “active,” compared to 74,890 two years ago. There were license holders, 69,729 of whom were considered active.
The council’s executive director, Darrell Spinks, said despite this growth, the industry has been completely overwhelmed by demand. , said he should spend a certain amount of time with his supervisor before being allowed to work on his own.
“There aren’t enough people to meet people coming out the door,” Spinks said.
The state is also coping with a dwindling supply of providers willing to train graduates seeking licenses. This hesitation stems partly from fear of responsibility.
“So the training program can’t pump out enough talent. If you get one, you won’t have enough internship or postdoc sites,” says Spinks. “This further limits the number of people who can be fully licensed to become mental health providers.”
This legislative session has several bills on the agenda aimed at addressing some of the concerns of overburdened mental health workers.
House Bill 1211 and House Bill 1551 Both are means of providing loan repayment assistance if mental health providers meet certain requirements. House Bill 2361 If a school district is unable to fill a vacancy for a non-physician mental health professional due to a shortage of qualified applicants, the school district may request a waiver and hire a licensed master social worker. .
These and other bills seek to solve the labor shortage, but also the burnout problem experienced by those already working in the mental health field.
“The work itself is tough. No one comes to your office with a good day,” Spinks said.
Employee stress and burnout
Victoria Alicia Torres, a first-generation college student from Houston, has always been fascinated by mental health, but during the pandemic she considered leaving the field.
“I was physically and mentally exhausted and at times felt overwhelmed and overwhelmed,” she said.
She said the increased face-to-face case load as a graduate student during the pandemic is sometimes too much.
“If I got really sick from interacting with other people, it really made me stop and think about whether this was the kind of job I wanted to do,” she said.
Torres has been able to find the motivation to continue, but that’s not always the case.
“Every healthcare provider should pursue their own health and meet their own needs. It’s a thing,” said Dr. Jeffrey Kahn, a psychiatrist and medical director at the Baylor Psychiatric Clinic in Houston.
The additional financial burden and current controversial political climate also contribute to professional burnout among mental health providers, it said.
“I think in Texas and some other states it’s kind of scary. It’s kind of a scary landscape. What can I say and what can’t I say during the session?” Mental Health, Communities In Schools of Central Texas Dorothy Garza, Senior Director of Services, said: “What is the client needing to deal with and what legalities might be at work?”
Payments are another major stressor for Texas providers.
Medicaid-qualified low-income individuals, the nation’s taxpayer-backed health care providers, have the lowest per-session reimbursement rates. The same applies to private insurance. This has led many mental health providers to switch to a cash-only model.
“If you can’t make money, you won’t be in the profession. Everyone in the industry has a servant heart, but you don’t want to be poor,” Spikes said.
Kristy Mitchell, a community-in-school project manager at Jane Langford Elementary School in southeast Austin, said she couldn’t blame anyone for the decision to quit her job.
“A lot of this field is built on goodwill and perhaps self-sacrifice, which can be difficult to do consistently,” Mitchell said.
Not only are more providers needed, but there is a growing demographic imbalance in the geographic distribution of mental health workers in Texas. In Texas, approximately 40% of the population is Hispanic, 39% white, 12% black, and 5 black. % are Asian.still state investigation A survey conducted this year revealed that most of the 2,873 respondents (about 85%) were white.
Only 20% of respondents in this survey said they provide mental health services in a language other than English. And more than half of mental health care providers are located in urban areas such as Harris, Dallas, Tarrant, Bexar and Travis counties.
Ultimately, there will be a need for greater recruiting efforts and a better overall state strategy, industry experts say.
“We need to recruit and actively seek out people who want to go home from underserved communities,” Khan said.
Mitchell agreed.
“We need them on the ground. We need more people of color. We need more service providers with the experience our clients have had to deal with,” she said.
