There is much work underway to improve the connective network among providers and patients, and to leverage the strengths and resources of local and regional organizations. There is also progress on in-depth evaluations and assessments of effective models for delivering care.

Transforming Local Behavioral Health Systems

Our mission is to support the implementation of policies and programs that help Texans obtain effective, efficient mental health care when and where they need it. Every community across the state is an important partner in our efforts to transform the mental health systems of Texas in pursuit of that goal. MMHPI works with cities, counties, and regions to build strong local partnerships in which key community partners merge their strengths and resources, creating effective, efficient, and accountable delivery systems to meet the needs of their local populations.

Explore our local systems change work done with partnering communities across Texas, as well as descriptions and products of other partnerships below.


The Meadows Mental Health Policy Institute (MMHPI), with the generous support of The Rees-Jones Foundation, conducted an assessment of Dallas County’s mental health service delivery systems for children, youth, and families. The goals of this assessment were to inventory and analyze Dallas County’s mental health systems, assess its current and potential capacity to deliver care along a continuum that provides highly responsive and clinically effective services, and offer specific recommendations to support the continued development of the system as a whole. This report provides guidance on strategies to improve access to the most effective mental health services in the right place and at the right time for Dallas County children, youth, and their families.

Downloadable materials

As part of The Hackett Center for Mental Health’s mission to transform systems and influence policy through unprecedented collaboration, MMHPI published the “Region 6a Community-Based Care Comprehensive Assessment and Environmental Scan (Environmental Scan).” The goal of the Environmental Scan is to serve as a resource for the Houston Community as it plans in the near term to improve the local foster care system and in the longer term to successfully transition to a community-based foster care model. The Hackett Center for Mental Health at the Meadows Mental Health Policy Institute was selected to conduct this Environmental Scan and provide a baseline understanding of the region’s capacity to serve its children and youth in foster care, identify areas for systems change, and initiate considerations for reimagining the local foster care system. The goal is for this information to be used to lay the foundation for Community-Based Care (CBC) in Houston. The findings in the report were shaped through the valuable input of many in the community and reflect their values and vision.

Downloadable materials

Child sex trafficking is a complex social problem that has horrific and enduring consequences for victims. Unfortunately, recent technological advancements have made it easier to perpetrate this crime. Texas leaders and communities across the state recognized the need to confront this issue on many different fronts and are taking active measures to stop this terrible crime. Many of these efforts are supported and guided by the leadership of Governor Greg Abbott and his office’s Child Sex Trafficking Team (CSTT). In partnership with the CSTT, the Meadows Mental Health Policy Institute created the Roadmap for Texas Communities to Address Child Sex Trafficking (Roadmap), using a framework that offers strategies to prevent future trafficking, identify and support victims, and reduce demand by prosecuting buyers and traffickers. The Roadmap provides communities with information, research, emerging practices, models, lessons learned, and resources to end child sex trafficking.

Downloadable materials

Academic goals are more difficult to achieve when the mental and behavioral health needs of students and staff are not addressed. This resource was developed to provide Texas schools and districts information on research-driven, evidence-based practices, as well as practical guidance to more effectively assess and address student mental and behavioral health needs. We divided this document into two sections - a Roadmap and a Toolkit - to best meet the needs of schools and school districts. The Roadmap provides an overview of definitions, research, evidence-based practices, and other information needed to implement school-linked mental and behavioral health supports. The Toolkit contains detailed and practical information to better prepare schools to support the mental health needs of their students.

Downloadable materials

The Houston Endowment and MMPHI released a comprehensive assessment of the scope and quality of mental health services available for Harris County children, youth and their families. The report identifies gaps in the system and offers strategic recommendations — opportunities to grow provider capacity and expand and reform the current continuum of care — to increase availability of the right types of services when and where they are most needed.
MMHPI developed a framework for recommending child outcome metrics following two core principles: that a framework is relevant to both child/youth functioning and developmental trajectory, and that it maintains operational feasibility. The metrics recommended within are intended to support efforts by Texas policy makers, mental health authorities, and providers to enhance the system and its services, and to support families, advocates, and other stakeholders as they seek to encourage better outcomes for themselves and those they care about.

Downloadable materials

Each year, 175,000 Texas children and youth suffer from severe mental health needs. Fifty percent of these youth will drop out of high school; they also face double the risk for substance use as compared to children without such needs. Despite the availability of Medicaid-funded, community-based services, too many Texas children first receive mental health services through foster care, juvenile justice, or special education. This briefing examines the challenges involved with serving these children, and considers elements of an effective approach.


The Justice-Involved Veterans Conference, sponsored by the Texas Veterans Commission and the Department of State Health Services, reviewed the needs and barriers to mental health care faced by Texas’ 5.3 million veterans, active duty members, and their families. This briefing provides an overview of the considerations and issues identified at the Conference in a range of topic areas including: law enforcement contact, intervention and jail diversion services before justice system involvement, development of veterans courts, mental health care and substance abuse treatment in jails and prisons, reentry services, and community corrections strategies.
MMHPI’s vision is that Texas veterans and their families will receive the mental health care and support they have earned. Texas will fill gaps in care through efficient and effective use of state and local resources, and communities will organize to help veterans and their families access care. Together, Texans will stamp out any stigma that keeps veterans and their families from seeking mental health care. MMHPI utilized the sources included in this briefing to inform our strategies for realizing this vision.
MMHPI serves as the grant administrator for Texas Veterans + Family Alliance, a new grant program matching $20 million in state dollars with $20 million in local, private, and in-kind funds to expand mental health care and support to Texas veterans and their families. We work closely with the Texas Health and Human Services Commission to develop the request for applications for the program, assist with grantee selection, develop performance data to determine effectiveness of grant-funded services provided, support grant program evaluation, and work with communities to identify matching funds.

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Smart Justice

The primary goal of this project—made possible by the Caruth Smart Justice Planning Grant—is to improve overall public safety by reducing the number of people with mental illness who receive treatment through involvement with law enforcement and the jail. This project is also expected to lead to improved health outcomes for individuals, better alignment of treatment needs with existing and future system capabilities, and decreased pressure on area emergency rooms.
MMHPI completed an in-depth data analysis in several Texas counties to assess screening, assessment, and diversion practices in county jails. The Challenge of Identifying, Diverting and Treating Justice-Involved People with Mental Illnesses provides a historical perspective on the legislative policies that have been instituted to address this issue and to improve mental health treatment options for people with mental illness who are involved with the criminal justice system. It also reviews Texas’s legal mandates for screening, assessment, and pretrial release, and identifies gaps between what is legally mandated and the system’s capacity to meet those mandates. The report ends with a set of comprehensive recommendations to addressed the issues raised.
Technical assistance for the Waco criminal justice system done in partnership with the Rapoport Foundation.

Priority Issues

The Meadows Mental Health Policy Institute has drawn on a number of sources to produce the following report, which offers guidance for effective integrated behavioral health programs. Commissioned by the St. David’s Foundation, the report offers a guide for providers, funders, advocates, and policy makers interested in promoting integrated behavioral health (IBH) in both primary care and specialty behavioral health settings.

Downloadable materials

In partnership with the Meadows Mental Health Policy Institute, the University of Texas School of Public Health is examining the overall utilization and cost of services for individuals with a serious mental illness receiving health care services through Texas Medicaid.
This report, prepared for the St. David's Foundation, examined best practices in mental health crisis services and proposed metrics to determine whether outcomes are being successfully achieved.

Downloadable materials

Senate Bill 239, passed in the 84th Texas Legislative Session in 2015, created an important program offering up to five years of student loan repayment assistance to mental health providers working in Mental Health Professional Shortage Areas. The first round of the application process took place in Spring 2016. MMHPI evaluated the process, results and potential impact of the program, and explored considerations for program improvement.
In December 2011, the Texas Health and Human Services Commission (HHSC) received approval for an 1115(a) Medicaid Demonstration Waiver to improve the quality and delivery of mental health care in Texas. In July 2013, the Texas Institute for Excellence in Mental Health at The University of Texas at Austin School of Social Work completed a review and analysis of the behavioral health project proposals (available below). In 2014, MMHPI partnered with HHSC and the Centers for Medicare and Medicaid Services to support a study of primary and behavioral health care integration programs implemented in a selection of community mental health centers. The evaluation report brief linked below summarizes the major findings of the final report and suggests key considerations for successful implementation of primary care/behavioral health integration in other organizations. The final report can be found here, and the executive summary prepared by UTSPH can be found here.

Local Systems Change

The Valley Baptist Legacy Foundation (“Legacy Foundation”) engaged the Institute to study the capacity and performance of behavioral health systems in the Cameron, Hidalgo, Starr, and Willacy counties of the Rio Grande Valley. The goal of the assessment was to provide an independent analysis of county mental health and substance abuse systems and identify specific improvement strategies for the Legacy Foundation to support the development of a responsive, clinically effective, and efficient regional behavioral health system for the Rio Grande Valley. A summary of the report will be posted soon.
In 2016, the Paso del Norte Health Foundation requested that MMHPI conduct an assessment of the current functioning of the El Paso Behavioral Health Consortium in order to identify opportunities for strengthening its role in promoting system enhancements. MMHPI also examined accomplishments and changes brought about in the behavioral health system since 2014, updated basic prevalence and needs data, and developed informed recommendations.

Downloadable materials

This local systems assessment of Bexar County was conducted in partnership with Methodist Health Ministries.
In partnership with the United Way of Denton County, MMHPI provided an analysis of the county's local mental health system performance and identified best practice opportunties.
In partnership with the Paso del Norte Health Foundation, MMHPI conducted an evaluation of the current El Paso Behavioral Health Consortium (BHC) and offered recommendations for enhanced BHC functioning, the development of metrics to track their ongoing assessment of mental health systems performance, and the identification of state -level and organizational-level policy priorities. The Institute is also developing a brief to support the efforts to start a psychiatric nurse practitioner program in the El Paso area.
This local systems assessment of the mental health services delivery system, with a primary focus on The Harris Center for Mental Health and IDD, was conducted in partnership with the Houston Endowment, Inc.
This local systems assessment of Midland County was conducted in partnership with Midland Memorial Foundation.
Key community leaders and foundations came together to form the Panhandle Behavioral Health Initiative. This collaborative is organizing a formal behavioral health leadership team to address the behavioral health needs of the 26 counties that compose the Panhandle. MMHPI provided this group with facilitation and guidance, and conducted a “System Assessment” in 2016. The assessment established a baseline data set and recommendations upon which to build a strategic plan, which they expect to initiate in early 2017.
In partnership with Texoma Health Foundation, MMHPI is convening local leaders and creating community awareness through the Okay to Say campaign.
With MMHPI support and facilitation, this community launched the Smith County Behavioral Health Leadership Team in June, 2015. The group has become more formalized, with approximately 30 members representing major community constituencies. The Behavioral Health Leadership Team received formal acknowledgment from both the County Commissioners and the Tyler City Council and is currently working on major priorities involving crisis system development and prevention/early intervention. Episcopal Health Foundation has provided funding to the Behavioral Health Leadership Team to hire facilitative support.


While only one in three Texans with a diagnosable mental illness receives treatment, an overwhelming majority of Texas counties are designated as communities without a sufficient number of mental health care workers. There is an opportunity for us to improve the way we care for those with mental illness. The The Texas Behavioral Health Landscape report highlights high needs areas in our efforts to ensure that all Texans can get mental health help when and where they need it.

Downloadable materials

The shift in health care towards continuous quality improvement for better outcomes and lower costs impacts mental health care as well. This report shares best practices involving evidence-based treatments for a variety of populations.

Downloadable materials

In partnership with the Texas Conference of Urban Counties, we documented the burden of unmet mental health needs on Texas counties, estimating the that costs to local governments exceed $2 billion annually. The Institute also estimated that while most adults with severe needs (63%) and even more children and youth with severe needs (77%) receive some level of care, 300,000 Texans with severe needs still go without care each year.

Downloadable materials

2019 Annual Report
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