Policy Updates

Policy Updates

Welcome to the Institute’s resource page for public policy professionals. Below are original MMHPI products, updates about our policy-related activity, and information from sources that help inform our work in state policy development.
 
MMHPI’s policy-related work throughout the COVID-19 crisis is focused on the short- and long-term effects of the pandemic, while facilitating access to appropriate care within this evolving landscape. View our white papers and supplemental materials below to learn more.

COVID-19

The Meadows Mental Health Policy Institute (MMHPI) continues to examine and project the impacts of COVID-19 on the mental health and substance use disorder (MHSUD) needs of Texans (and more broadly whenever possible), rapidly providing policymakers with the most relevant and accurate information available. Our intent is two-fold: to provide sound guidance and also to bring other experts and thought leaders into the discussion to refine the guidance and improve the estimates available to the field. MMHPI will be releasing a series of papers on the anticipated impact of the COVID-19 pandemic as the situation and our understanding evolves. We will also update current documents as new information becomes available, archiving past versions for the record.

Projected COVID-19 MHSUD Impacts, Volume 1: Effects of COVID-Induced Economic Recession (COVID Recession) – April 28, 2020, Full Version

This appendix to the report above updates our original report on the effects of a COVID-19 recession with state-level projections of increases in illicit substance use as well as additional lives lost to suicide and overdose.

Projected COVID-19 MHSUD Impacts, Volume 1: Effects of COVID-Induced Economic Recession (COVID Recession) – Appendix of State-Level Estimates, April 28, 2020

In Volume 1, Meadows Mental Health Policy Institute (MMHPI) sought to examine and project the impacts of COVID-19 on the mental health and substance use disorder (MHSUD) needs of Texans (and more broadly whenever possible), rapidly providing policymakers with the most relevant and accurate information available.

MMHPI continues to analyze the mental health impacts of the COVID-19 pandemic. This report, prepared in partnership with Cohen Veterans Network, focuses on how an economic recession increases rates of mental health and substance use disorders (MHSUD), including deaths from suicide and substance overdoses, among veterans nationally.

Projected COVID-19 MHSUD Impacts, Volume 2: Effects of COVID-Induced Economic Recession (COVID Recession) on Veterans

In late April 2020, the Meadows Mental Health Policy Institute (MMHPI) issued the first in a series of reports analyzing the mental health impacts of the COVID-19 pandemic. Our initial report projected the impact of a COVID-induced economic recession on increases in rates of suicide, illicit-drug-related deaths, and substance use disorders (SUD).

In this report, we model the extent to which universal access to evidence-based integrated primary care to treat major depression through the collaborative care model (CoCM) and to medication-assisted treatment (MAT) for persons with opioid use disorders in all healthcare settings could offset a portion of the predicted increases in suicide and drug overdose deaths from the COVID-19 pandemic. In developing these estimates, we coordinated with colleagues at the Steinberg Institute to highlight impacts in both California and Texas.

Projected COVID-19 MHSUD Impacts, Volume 3: Modeling the Effects of Collaborative Care and Medication-Assisted Treatment to Prevent COVIDRelated Suicide and Overdose Deaths

To date, Congress has passed four bills in response to the COVID-19 pandemic. Substantial funds will flow to health care providers, either directly or through state/local governments. This briefing provides health care related highlights from each bill and information on funding distributed as of May 13, 2020. Grantmakers should be mindful of these funds when making grants to providers, as well as mindful of the vagaries involved in the flow of federal funds, which generally take longer than expected to reach their intended recipients and often do not reach them at all.

COVID-19 Federal Appropriation Considerations for Grantmakers (May 2020)

A subset of the behavioral health workforce currently serving should be prioritized for use of personal protective equipment (PPE) as these workers must deliver certain critical in-person services in order to allow for these high-risk individuals with complex health needs to be served in the community, rather than already over-burdened hospitals, residential facilities, and justice facilities.

The briefing below focuses on the need for personal protective equipment for the behavioral health and intellectual/developmental disability (IDD) workforce and is based on input from providers across Texas.

Personal Protective Equipment and the Behavioral Health Workforce (March 2020)

In response to numerous requests from Texas counties for guidance on the operation of jails during a pandemic, the Justice Policy Team at the Meadows Mental Health Policy Institute (MMHPI) developed the March 24, 2020 briefing, Planning Guide for County Officials Seeking to Reduce Jail Demand During Pandemic – Diversion Prioritization and Admission Protocol Considerations. That briefing was widely circulated to justice leaders across Texas for review and feedback, and it was intended to inform the efforts of county officials to prioritize jail bed use and admissions protocols in order to promote public safety by reducing the demand for jail space during this continuing crisis.

On March 29, 2020, Governor Greg Abbott issued Executive Order No. GA-13 relating to the release of arrested and jailed individuals in county and municipal jails during the continuing COVID-19 disaster. Thus, we are issuing an updated version of the briefing which includes our technical assistance: Planning Guide for County Officials Seeking to Reduce Jail Demand During Pandemic – Ten Principles to Guide Planning and Decision Making. This version addresses and is fully aligned with Governor Abbott’s March 29, 2020, executive order.

With federal and state health care policies changing rapidly in response to COVID-19, MMHPI is issuing weekly newsletters to support providers as they navigate this new terrain. In these updates, we highlight recent changes to regulatory and reimbursement rules from state and federal entities in response to COVID-19.

Letter to Providers #1: Telehealth & Telephonic Care – March 26, 2020
Letter to Providers #2: State & Federal Updates – April 3, 2020
Letter to Providers #3: State & Federal Updates – April 9, 2020
Letter to Providers #4: State & Federal Updates – April 16, 2020
Letter to Providers #5: State & Federal Updates – April 24, 2020
Letter to Providers #6: State & Federal Updates – May 1, 2020
Letter to Providers #7: State & Federal Updates – May 8, 2020
Letter to Providers #8: State & Federal Updates – May 15, 2020
Letter to Providers #9: State & Federal Updates – May 21, 2020
Letter to Providers #10: State & Federal Updates – May 29, 2020
Letter to Providers #11: State & Federal Updates – June 5, 2020
Letter to Providers #12: State & Federal Updates – June 12, 2020
Letter to Providers #13: State & Federal Updates – June 19, 2020
Letter to Providers #14: State & Federal Updates – June 26, 2020
Letter to Providers #15: State & Federal Updates – July 2, 2020
Letter to Providers #16: State & Federal Updates – July 10, 2020
Letter to Providers #17: State & Federal Updates – July 17, 2020
Letter to Providers #18: State & Federal Updates – July 24, 2020
Letter to Providers #19: State & Federal Updates – July 31, 2020
Letter to Providers #20: State & Federal Updates – August 7, 2020
Letter to Providers #21: State & Federal Updates – August 14, 2020
Letter to Providers #22: State & Federal Updates – August 21, 2020
Letter to Providers #23: State & Federal Updates – August 28, 2020
Letter to Providers #24: State & Federal Updates – September 4, 2020
Letter to Providers #25: State & Federal Updates – September 11, 2020
Letter to Providers #26: State & Federal Updates – September 18, 2020
Letter to Providers #27: State & Federal Updates – September 24, 2020

Introductory and General Information

With Governor Abbott declaring mental health an emergency item for the 86th Texas Legislature, and Lt. Governor Patrick making it a top Senate priority, the stage was set for historic steps forward, particularly for Texas children; legislative leaders did not disappoint. From a mental health perspective, the 86th Legislative Session was one of the most significant in recent memory. Not only did legislators maintain and build upon previous advancements, the creation of the Texas Child Mental Health Care Consortium will have a generational impact on the treatment of children with mental health issues, and cultivate Texas’ need to grow as a research hub for mental health and substance abuse issues. These documents illustrate how far we have come, how exceptional the 86th was, and the direction these collective advances will take us.

86th Regular Legislative Wrap up

Behavioral Health Appropriations in the 86th Legislature

The 85th Legislative Session saw mental health issues assume a large focus, resulting in strong progress toward smarter, more effective mental health policy in Texas. The Institute has furthered this progress by providing Texas legislators, state officials, members of the judiciary, and local leaders with objective, trustworthy data and policy analysis. MMHPI summarized highlights and budget allocations from Texas’ most material advances in mental health policy during the 85th Legislature.

85th Regular Legislative Wrap up

Behavioral Health Appropriations in the 85th Legislature

In the wake of the Santa Fe school shooting, Lieutenant Governor Dan Patrick appointed a bi-partisan Select Committee, headed by Senate Education Committee Chairman Larry Taylor, to review comprehensive strategies to address school violence. In Summer 2018, the Select Committee met to hear invited and public testimony. MMHPI President and CEO Dr. Andy Keller provided testimony during the hearing on Interim Charge 3, which included examining the root cause of mass murder in schools including, but not limited to, risk factors such as mental health and substance use disorders. The final report was released in August 2018.

Senate Select Committee on Violence in Schools and School Security Interim Report

Texas’ first-ever Select Committee on Mental Health released its report just before the start of the 85th Legislature. The committee’s charge included studying and recommending improvements to every aspect of behavioral health in Texas. Speaker of the House Joe Straus appointed committee members during the legislative interim and designated Representative Four Price (R-Amarillo) as chairman. MMHPI personnel attended select committee hearings over eight separate days during 2016, and our in-house experts provided testimony and analysis to committee members and staff. The report is a blueprint for Texas, which will help lawmakers and local officials help improve the delivery of mental health care in Texas for years to come.

House Select Committee on Mental Health Interim Report – December 2016

In June 2016, with the help of former Texas Supreme Court Justice and Institute Board Member Harriet O’Neill, the Texas Judicial Council established the Mental Health Committee to examine the administration of civil and criminal justice for those suffering from or affected by mental illness. The committee, chaired by the Honorable Bill Boyce, was charged with providing formal recommendations to the full Judicial Council and the legislature in advance of the 85th Legislative Session. The Institute contributes to committee meetings and provided research and technical assistance to committee members.

The 2016 report, released in October 2016, contains the committee’s findings, recommendations, and priority issues for future study.

The 2018 report, released in June 2018, contains the committee’s findings, recommendations, and priority issues for future study.

MMHPI addresses, in brief form, the factors that shape mental health needs in Texas. It addresses key questions such as how many Texans need mental health services, the costs of untreated needs, state spending, and the public and private systems.

Texas Mental Health Landscape – February 2016

The mental health policy discussion in Texas can leave some listeners with the impression that the state hasn’t accomplished much. That isn’t true. Texas has accomplished quite a lot, especially around crisis care and targeted populations.

A Decade of Public Sector Progress – January 2016

Many important terms are used in the mental health policy discussion. MMHPI has distilled them down into a handy reference guide.

During the 84th Legislative Session, in an effort to improve coordination between state agencies and create a strategic approach to providing behavioral health services, lawmakers directed 18 state agencies that receive General Revenue behavioral health funding to work collectively to develop a collaborative five-year behavioral health strategic plan and coordinated expenditures proposal (2016-17 General Appropriations Act, H.B. 1, 84th Legislature, Regular Session, 2015 (Article IX, Section 10.04)).  Released in May 2016, the Statewide Behavioral Health Strategic Plan is the result of months of collaboration involving these agencies, which represent the diverse landscape of behavioral health services in Texas.

 

In February 2019, a second edition, the Strategic Plan Update and the Foundation for the IDD Strategic Plan, was released.

Children

Multisystemic Therapy (MST) is a proven family and community-based treatment for at-risk youth with intensive needs and their families. It has proven most effective for treating youth who have committed violent offenses, have serious mental health or substance abuse concerns, are at risk of out-of-home placement, or who have experienced abuse and neglect.

This white paper discusses the basics of MST and explores the need and implementation potential of MST for Texas Youth.

MST in Texas (February 2020)

MMHPI examined prevalence estimates, reviewed literature and national best practices, and talked with key informants in Texas to describe how the state’s major child serving agencies have operationalized trauma-informed care for children and youth involved with the child welfare system.

Trauma-Informed Care – July 2017

Hurricanes and other natural disasters can have long and harmful effects on the mental health of children, youth, and adults. Based on the latest epidemiological research on the effects of disasters on mental health, the Meadows Mental Health Policy Institute (MMHPI) has estimated that we should expect to see significantly higher rates of posttraumatic stress disorder (PTSD) and other mental illnesses for children and youth in the Harvey-affected regions, with dramatically higher rates in those that experienced the most destruction.

This white paper explores post-Harvey reactions among children and youth and anticipated rates in the months and years after the storm:

Hurricane / Tropical Storm Harvey Impact on Child and Youth Mental Health (November 2017)

Today, children in foster care receive some services that are fully funded by the state because Texas is not drawing down federal dollars for services eligible for federal match. Maximizing Federal Funds for Child Welfare in Texas, finalized in February 2017, identifies strategies to maximize federal funding for services provided to children in foster care and better serve children with mental health needs.

The following white paper provides an overview of school-based mental health services, approaches for addressing mental health in schools, and an overview of school-based professionals and organizations that may have a role in providing mental health services or connecting students to school-based mental health services.

School-Based Mental Health – December 2016

Drawing on the work of Dr. Charles Holzer, a leading psychiatric epidemiologist, MMHPI is able to apply the best national epidemiological studies to Texas’ population data and estimate the number of children and adolescents who have severe emotional disturbances in a given year.

Estimates of Prevalence of Mental Health Conditions among Children and Adolescents in Texas – March 2016

This MMHPI white paper looks at the pattern of risk Texas youth face moving from a school setting and into the justice system. Students are more likely to be arrested now than they were 10 years ago. With leadership from the top, school discipline can shift from a system of punishment to a system of student development.

Closing the School to Prison Pipeline in Texas – February 2016

The Appropriations Committee met to consider the following interim charge:

  • Examine the availability of federal funding and Governor’s Criminal Justice grants that may directly or indirectly improve school safety. Evaluate the potential costs of proposals identified by the Governor and House Committees related to improving access to mental health services for children, improved school safety, and enhanced firearm safety.

Committee handout

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees. The following testimonies provide insights into challenges facing children’s mental health care.

Dr. Anu Partap, MD, MPH
Assistant Professor of Pediatrics, UT Southwestern Medical Center
Children and Mental Health – Clinical Setting
Dr. Partap’s testimony handout
Watch Dr. Partap’s presentation (begins at 0:04:40)

Lauren Lacefield-Lewis
Assistant Commissioner, Division for Mental Health and Substance Abuse, Department of State Health Services
Commissioner Lacefield-Lewis’s testimony handout
Watch Commissioner Lacefield-Lewis’s presentation (begins at 2:58:41)

Craig Shapiro, MEd
Interim Associate Superintendent of High Schools, Austin Independent School District
Children and Mental Health – Education Setting K-12: Examples of Collaboration and Innovation
Superintendent Shapiro’s testimony handout
Watch Superintendent Shapiro’s presentation (begins at 4:46:20)

Tracy Spinner, MEd
Assistant Director, Comprehensive Health Services, Austin Independent School District
Children and Mental Health – Education Setting K-12: Examples of Collaboration and Innovation
Tracy Spinner’s testimony handout
Watch Tracy Spinner’s presentation (begins at 4:55:56)

Elizabeth Minne, PhD
Licensed Psychologist, Executive Director, Vida Clinic
Children and Mental Health – Education Setting K-12: Examples of Collaboration and Innovation
Minne’s testimony handout
Watch Dr. Minne’s presentation (begins at 5:06:00)

Dr. Billy Philips
Executive Vice President and Director, F. Marie Hall Institute for Rural and Community Health
Professor, Family and Community Medicine and Public Health, Texas Tech University Health Sciences Center, Lubbock
Children and Mental Health – Education Setting K-12: Telemedicine, Wellness, Intervention, Triage, and Referral (TWITR) Project
Dr. Philips’s testimony handout
Watch Dr. Philips’s presentation (begins at 5:50:50)

Veterans

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees. The following testimonies provide insights into challenges facing veteran’s mental health care.

Sonja Gaines
Associate Commissioner, Mental Health Coordination, Health and Human Services Commission
Commissioner Gaines’s testimony handout
Watch Commissioner Gaines’s presentation (begins at 0:40:18)

Lauren Lacefield-Lewis
Assistant Commissioner, Division for Mental Health and Substance Abuse, Department of State Health Services
Commissioner Lacefield-Lewis’s testimony handout
Watch Commissioner Lacefield-Lewis’s presentation (begins at 0:04:13)

Suzanna Hupp
Associate Commissioner,Veteran Services, Health and Human Services Commission
Commissioner Hupp’s testimony handout
Watch Commissioner Hupp’s presentation (begins at 1:44:28)

Kenneth Wilson
President and CEO, Haven for Hope, San Antonio
Leon Evans
President and CEO, The Center for Health Care Services, San Antonio
Kenneth Wilson and Leon Evans’ testimony handout
Watch Kenneth Wilson and Leon Evans’ presentation (begins at 3:32:41)

Susan Garnett, MSW
CEO, MHMR of Tarrant County
Susan Garnett’s testimony handout
Watch Susan Garnett’s presentation (begins at 5:36:52)

Janie Metzinger
Public Policy Director, Mental Health America of Greater Dallas
Director Metzinger’s testimony handout
Watch Director Metzinger’s presentation (begins at 6:12:42)

Josette Saxton
Director of Mental Health Policy, Texans Care for Children
Director Saxton’s testimony handout
Watch Director Saxton’s presentation (begins at 6:29:24)

Kyle Mitchell
Senior Director of Veteran and Military Policy, Meadows Mental Health Policy Institute
Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 2:23:30)

Smart Justice

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees. The following testimonies provide insights into challenges facing veteran’s mental health care.

Kim Vickers
Executive Director, Texas Commission of Licensing Enforcement (TCOLE)
Kim Vickers’s testimony handout
Watch Kim Vickers’s presentation (begins at 5:14:00)

Chris Kirk
Sheriff, Brazos County
Representative Rural County Law Enforcement and Criminal Justice
Watch Chris Kirk’s presentation (begins at 5:36:50)

Barbara Dawson
Deputy Director, Comprehensive Psychiatric Emergency Services, The Harris Center for Mental Health and IDD
Representatives of Urban County and Municipal Law Enforcement and Collaboration with Local Mental Health Authority
Watch Barbara Dawson’s presentation (begins at 6:08:49)

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees.

Ron Stretcher
Criminal Justice Director, Dallas County
Board Chair, North Texas Behavioral Health Authority
Mental Health Hospitals and Criminal Justice
Mr. Stretcher’s testimony handout
Watch Mr. Stretcher’s presentation (begins at 2:23:25)

In response to 85(R) Senate Bill 1849, known as “The Sandra Bland Act”, Texas county jails are required to make changes to minimum jail standards as of September 1, 2017. The Texas Commission on Jail Standards (TCJS) asked MMHPI to help assess jail readiness. MMHPI took the lead in developing a questionnaire based on the requirements of the Sandra Bland Act and administered it, through collaboration with TCJS, to all jail administrators throughout Texas. This report provides a summary of survey responses received.

SB 1849 Survey: Summary of Major Findings – January 2018

Additionally, MMHPI assisted TCJS with revising the screening form for suicide and medical/mental/developmental impairments in response to the death of Sandra Bland.

New Jail Intake Screening Form

As a result of concerns expressed by Texas sheriffs regarding the provision of appropriate psychotropic medication in Texas jails, MMHPI investigated the status of selected jail behavioral health medication formularies, comparing them to one another and to the state formulary created by the Department of State Health Services (DSHS) for use in state hospitals (September 2016).

Jail Formulary Review – September 2016

In 2011, Seattle, Washington piloted the Law Enforcement Assisted Diversion (LEAD) program.  LEAD, now growing across the country, is an evidence-based, collaborative, pre-arrest diversion program.  The program focuses on providing harm reduction–oriented intensive case management, behavioral health, and substance abuse care rather than filing a criminal charge and seeking prosecution and incarceration.

Law Enforcement Assisted Diversion Overview

Higher Education

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees. The following testimonies provide insight into issues regarding mental health care on college campuses.

Rito Silva, PhD
Vice President for Student Affairs, Del Mar College
Mental Health Services on Campuses of Public Institutions of Higher Education, Community Colleges
Dr. Silva’s testimony handout
Watch Dr. Silva’s presentation (begins at 4:04:57)

Maggie Gartner, PhD
Executive Director for Student Counseling Services, Texas A&M University
Mental Health Services on Campuses of Public Institutions of Higher Education, Texas A&M University System
Dr. Gartner’s testimony handout
Watch Dr. Gartner’s presentation (begins at 4:22:15)

Dayna Schertler
Health Integration Specialist, West Texas A&M University
Mental Health Services on Campuses of Public Institutions of Higher Education, Texas A&M University System
Ms. Schertler’s testimony handout
Watch Ms. Schertler’s presentation (begins at 4:35:45)

Richard A. Lenox, PhD
Licensed Psychologist, Director, Texas Tech University Student Counseling Center
Mental Health Services on Campuses of Public Institutions of Higher Education, Texas Tech University System
Dr. Lenox’s testimony handout
Watch Dr. Lenox’s presentation (begins at 4:52:55)

Drew Miller, PhD
Assistant Vice President for Student Services, Sam Houston State University
Mental Health Services on Campuses of Public Institutions of Higher Education, Texas State University System
Dr. Miller’s testimony handout
Watch Dr. Miller’s presentation (begins at 5:24:42)

Norma Ngo, PsyD
Director of Counseling and Psychological Services, University of Houston
Mental Health Services on Campuses of Public Institutions of Higher Education, University of Houston System
Dr. Ngo’s testimony handout
Watch Dr. Ngo’s presentation (begins at 05:42:42)

Christopher Albert, PhD
Director of Counseling and Psychological Services, University of Texas Rio Grande Valley
Mental Health Services on Campuses of Public Institutions of Higher Education, University of Texas System
Watch Dr. Albert’s presentation (begins at 6:28:43)

Senate Bill 239 (SB 239), which passed in the 84th Texas Legislative Session, created a program offering up to five years of student loan repayment assistance to mental health providers working in Mental Health Professional Shortage Areas (MHPSAs), to be administered by the Texas Higher Education Coordinating Board (THECB). This brief provides an overview of the program as well as considerations for potential program improvement.

Loan Repayment Program for Mental Health Professionals – April 2017

In March 2018, MMHPI prepared the Texas Mental Health Research Framework upon the request of the chairs of academic departments of psychiatry in the state of Texas and behavioral health leaders in state government in an effort to promote synergistic collaborations in mental health research.

Beginning in 2013, the 83rd Texas Legislature appropriated $14 million to support several efforts to increase the number of first-year residency positions available in the state through the Graduate Medical Education (GME) Expansion.

In 2015, the 84th Texas Legislature streamlined these efforts and appropriated $53 million to increase the number of first-year residency positions and to establish new residency programs.

The 85th Texas Legislature increased funding to $97.1 million to continue support for the program in the 2018-2019 biennium. The Texas Higher Education Coordinating Board provided a break out of the awardees and program specialties funded through the 2018-2019 GME Expansion Grant Program.

Invited Testimony

Senate Select Committee on Mass Violence Prevention and Community Safety
December 3, 2019
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Watch Dr. Keller’s presentation (begins at 42:35)
Dr. Keller’s testimony handout

Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Texas House Committee on Public Health – May 1, 2019
Invited Testimony on SB 10

Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 11:36)

Texas Senate Committee on Health & Human Services – April 16, 2019
Invited Testimony on SB 2111
Watch Dr. Keller’s presentation (begins at 32:05)

Texas House Committee on County Affairs – March 7, 2019
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 4:18:40)

Texas Senate Committee on Health & Human Services – February 12, 2019
Invited Testimony on SB 10

Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 12:45)

Michele Guzmán, PhD
Vice President of Administration and Senior Director of Evaluation
Texas House Committee on Public Health – April 17, 2019
Invited Testimony on HB 3672
Dr. Guzman’s testimony handout
Watch Dr. Guzman’s presentation (begins at 4:33:56)

Nelson Jarrin, JD
Senior Director of Government Affairs
Texas Senate Committee on Criminal Justice – April 17, 2019
Invited Testimony on SB 562

Mr. Jarrin’s testimony handout
Watch Mr. Jarrin’s presentation (begins at 53:09)

Marcellina Melvin
Director of Program Implementation for Child and Family Policy
Texas Senate Committee on Education – March 19, 2019
Invited Testimony on SB 435

Watch Ms. Melvin’s presentation (begins at 4:40)

Kyle Mitchell, JD
Senior Director of Veteran and Military Policy
Texas House Committee on Defense & Veterans’ Affairs – May 6, 2019
Invited Testimony on SB 822

Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 23:45)

Texas Senate Committee on Veteran Affairs & Border Security – March 27, 2019
Invited Testimony on SB 822

Watch Mr. Michell’s presentation (begins at 23:28)

Texas House Defense & Veterans’ Affairs – February 19, 2019
Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 2:12:00)

John Petrila, JD
Vice President of Adult Policy
Texas Senate Committee on Finance – March 11, 2019
Testifying on SB 500

Mr. Petrila’s testimony handout
Watch Mr. Petrila’s presentation (begins at 47:00)

Monica Thyssen
Senior Director of Health Policy
Texas House Committee on Human Services – May 14, 2019
Invited Testimony on SB 1177

Watch Ms. Thyssen’s presentation (begins at 13:35)

Texas Senate Committee on Health & Human Services – April 9, 2019
Invited Testimony on SB 1177

Ms. Thyssen’s testimony handout
Watch Ms. Thyssen’s presentation (begins at 1:11:29)

Kate Volti
Director of Program Innovation for Child and Family Policy
Texas House Public Education Committee – April 30, 2019
Invited Testimony on SB 435
Watch Ms. Volti’s presentation (begins at 49:35)

Texas House Committees on Corrections and Criminal Jurisprudence
August 29, 2018
BJ Wagner
Senior Director of Smart Justice, Meadows Mental Health Policy Institute
Ms. Wagner’s testimony handout

Texas Joint Legislative Committee on Aging
August 28, 2018
Kyle Mitchell
Senior Director of Veteran and Military Policy, Meadows Mental Health Policy Institute
Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 59:00)

Texas House Committee on County Affairs
August 23, 2018
BJ Wagner
Senior Director of Smart Justice, Meadows Mental Health Policy Institute
Ms. Wagner’s testimony handout

Texas Senate Select Committee on Violence in Schools and School Security
July 18, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 1:40)

Texas House Committees on Public Health and Public Education
June 28, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 2:46:57)

Texas House Committees on Appropriations Subcommittee on Article II and General Investigating & Ethics
June 27, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 12:40:30)

Texas Senate Committee on Veterans Affairs and Border Security
May 22, 2018
Kyle Mitchell
Senior Director of Veteran and Military Policy, Meadows Mental Health Policy Institute
Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 2:23:30)

Texas House Select Committee on Opioids and Substance Abuse
March 27, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 5:23:54)

Texas Senate Health and Human Services Committee
March 22, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 4:14:36)

Texas Senate Finance Committee
March 20, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 4:14:15)

Texas House Committee on General Investigating & Ethics
January 18, 2018
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout

Texas House Select Committee on Economic Competitiveness
December 5, 2017
Andy Keller, PhD
President & CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 2:50:00)

Andy Keller, PhD
CEO, Meadows Mental Health Policy Institute
Invited Testimony on SB 674
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation

Invited Testimony on SB 74
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation

Texas Mental Health Workforce Needs
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation

Invited Testimony on HB 13s
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation

Invited Testimony on SB 292
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation

Michele R. Guzmán, PhD
Vice President of Administration, Senior Director of Evaluation,
Meadows Mental Health Policy Institute
Invited Testimony on HB 1600
Dr. Guzmán’s testimony handout
Watch Dr. Guzmán’s presentation

B.J. Wagner
Director of Smart Justice, Meadows Mental Health Policy Institute
Invited Testimony on HB 337, HB 1734
Ms. Wagner’s testimony handout
Watch Ms. Wagner’s presentation

Invited Testimony on SB 344
Watch Ms. Wagner’s presentation

Texas Senate Health and Human Services Committee
June 16, 2016
Andy Keller, PhD
CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 4:02:02)

Texas Senate Committee on Criminal Justice
May 17, 2016
BJ Wagner
Director of Smart Justice, Meadows Mental Health Policy Institute
Ms. Wagner’s testimony handout
Watch Ms. Wagner’s presentation (begins at 2:08:21)

Senate Committee on Veterans Affairs and Military Installations
March 10, 2016
Kyle Mitchell
Senior Director of Veteran and Military Policy, Meadows Mental Health Policy Institute
Mr. Mitchell’s testimony handout
Watch Mr. Mitchell’s presentation (begins at 1:00:12)

Texas House Select Committee on Mental Health
February 18, 2016
Andy Keller, PhD
CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 6:32:00)

Texas Senate Finance Committee
January 26, 2016
Andy Keller, PhD
CEO, Meadows Mental Health Policy Institute
Dr. Keller’s testimony handout
Watch Dr. Keller’s presentation (begins at 3:15:30)

Deeper Dives

Each year, about 3,000 Texas adolescents and young adults ages 14-35 experience a first episode of psychosis (FEP). Many have access to health insurance through their parents (up to age 26), Medicaid or CHIP, but they do not typically receive care and treatment until five years after first onset of psychosis.

Studies show that the longer treatment is delayed, the worse the outcome, both for the individual and for society. While most people who experience psychosis are not violent, they are much more likely to be violent or become entangled in our criminal justice system when their conditions go untreated.

This white paper explores the basics of coordinated specialty care – a team-based approach to provide assertive and intensive treatment as early after the initial psychosis as possible. It covers demographics, detection, screening and treatment in practice and provides and overview of the cost and impact of untreated psychosis in Texas.

Coordinated Specialty Care for Texans (February 2020)

The delivery of coordinated specialty care (CSC) in early psychosis programs transforms lives by changing the trajectory of schizophrenia for youth and young adults.  Unfortunately, the future of early psychosis programs is at risk because current reimbursement models do not sustainably support the provision of CSC services. To eliminate this risk, it is vital that health plans and providers develop and implement coding and billing practices specific to evidence-based practices that sustain the delivery of the CSC model in early psychosis programs.

This white paper highlights the need for coordinated specialty care and recommends the use of existing billing codes that offer a consistent national, multi-payer reimbursement method so people experiencing a first episode of psychosis, and who have Medicaid and/or commercial insurance, can access these services.

Payment Strategies for Coordinated Specialty Care (January 2020)

In our first white paper discussing the research on mental illness and mass murder, we explain that while there are common characteristics among many mass murderers, these characteristics are also present in people who do not commit murder. Enhancing timely and assertive community-based treatment for people with mental illnesses who are at risk for committing violent acts – either against others or themselves – holds promise for more broadly reducing the number of victims of violence in the United States each year.

Mental Illness and Mass Murder: What the Research Does and Does Not Tell Us (September 2016)

The research is clear that severe mental illness alone is not a good predictor of violence. A large-scale, multi-year epidemiological study found that people who only had a severe mental illness and did not have a co-occurring substance abuse condition or a history of violence had less than a 2% probability of engaging in any type of violence over a two to three year period, about the same as the general population.

Read the preliminary summary of current research on violence and mental illness (May 2018) or view Dr. Andy Keller’s testimony (begins at 1:40) to the Texas Senate Select Committee on Violence in Schools and School Security from July 2018. Dr. Keller’s testimony and accompanying presentation to the Committee can also be found in the Invited Testimony tab on this page under 85th Legislative Interim (2017-2018).

Additionally, a report in August 2018 provides a quantitative perspective on the prevalence of deaths that have resulted from mass public shootings, including school shootings, and from deaths associated with murder and suicide, which occur with much greater frequency.

Severe Violence Trends: Suicide, Murder, Mass Shootings, School Shootings

In November 2019, an update on current knowledge and best practices was presented during invited testimony to the Senate Select Committee on Mass Violence Prevention and Community Safety. Dr. Andy Keller’s testimony and accompanying presentation to the Committee can be found in the Invited Testimony tab on this page under 86th Legislative Interim (2019-2020). The most current version of this white paper is available below.

Mental Illness and Violence: Current Knowledge and Best Practices (February 2020)

Laws designed to put mental health coverage on similar footing with physical health coverage are complex and contain gaps that make true parity difficult to accomplish. This MMHPI paper walks through some of the issues in response to the June 2, 2016 hearing of the Texas House Select Committee on Mental Health.

In the 85th Legislative Session, Representative Price (R-Amarillo) and Senator Zaffirini (D-Laredo) teamed up to pass HB 10, which expanded the state’s parity enforcement authority to ensure that mental health coverage is treated the same as physical health coverage. Effective September 1, 2017, HB 10 also required the Texas Department of Insurance (TDI) to conduct a one-time data collection and report assessing mental health parity, specifically related to non-quantitative treatment limitations. The report – Study of Mental Health Parity to Better Understand Consumer Experiences with Accessing Care – was released in August 2018 and summarizes TDI’s findings.

Also effective September 1, 2017, HB 10 required the Health and Human Services Commission (HHSC) to conduct a study and prepare a report comparing benefits provided by Medicaid managed care organizations (MCOs) for medical and surgical expenses to those for mental health and substance use disorder (SUD).  Released in September 2018, Report to Assess Medical or Surgical Benefits, and Benefits for Mental Health and Substance Use Disorders, summarizes HHSC’s findings.

Substance Use Disorder Landscape
MMHPI summarizes key facts regarding substance use disorder (SUD) needs and current services in Texas. It addresses key questions such as how many Texans need SUD services, facts related to the opioid crisis, state spending, and the public and private systems. This document is updated frequently so check back often.
Substance Use Disorder Landscape
SUD Landscape Supplement: Methamphetamine Use in Texas – February 2018

Substance Use Disorder Glossary of Terms
MMHPI summarizes key terms related to substance use disorder needs and current services.
Substance Use Disorder Glossary of Terms

In the summer of 2016, a survey was conducted by the Texas Business Group on Health in partnership with the Meadows Mental Health Policy Institute and with promotional assistance from the Dallas-Fort Worth Business Group on Health, Houston Business Coalition on Health, Mental Health America of Greater Houston, and Texas Association of Business.

Depression in the Workplace serves as a report of the survey findings related to current policies, practices, and strategies of Texas employers to address untreated and inadequately treated depression in the workplace. The report includes a descriptive analysis summarizing the characteristics and perceptions of participating Texas employers.

The Legislative Budget Board (LBB) provides an overview of the state hospital system in Texas.

LBB State Hospital Primer – April 2016

The Health and Human Services Commission (HHSC) issued a comprehensive plan for state-funded inpatient mental health services (August 2017) in accordance with 2018-19 General Appropriations Act, S.B. 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 179).  The plan provides a three-phased approach to improve the state hospital system.

Comprehensive Plan for State-Funded Inpatient Mental Health Services – August 2017

The Texas House Select Committee on Mental Health was created by Speaker Joe Straus to take a comprehensive look at mental health services across state agencies as well as legislative committees. The following testimonies provide insight into issues regarding mental health care access within the state hospital system and the role of academic institutions.

Texas Select Committee on Mental Health
September 22, 2016
David Lakey, MD
Chief Medical Officer, Associate Vice Chancellor for Population Health, The University of Texas System
Dr. Lakey’s testimony handout
Watch Dr. Lakey’s presentation (begins at 1:16:55)

John Warner, MD
Vice President and CEO, University Hospitals, University of Texas Southwestern Medical Center
Dr. Warner’s testimony handout
Watch Dr. Warner’s presentation (begins at 02:09:24)

In response to the 2018-19 General Appropriations Act, S.B. 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 45), the Meadows Mental Health Policy Institute (MMHPI) performed a review of performance measures for individuals with serious mental illness (SMI) in Texas and other states’ Medicaid managed care programs and provided recommendations for improving Medicaid managed care for members with SMI.

Medicaid Managed Care Performance Measures Recommendations – March 2018

In November 2017, MMHPI conducted a brief literature review of epidemiological studies that estimated the prevalence of tobacco use among adults with serious mental illnesses (SMI).

Smoking Prevalence and SMI

Our list of Background Reading Resources provides more information on key policy topics in mental health including:

  • The Overall System
  • Local Systems Assessments
  • Best Practice Briefings
  • Medicaid and 1115 Waiver (DSRIP)
  • Needs of the Texas Workforce
  • Texas Veterans
  • Justice System
  • Super Utilizer Use Reduction
  • First Episode Psychosis, and
  • Deeper Background on Mental Health Needs in Texas.
2019 Annual Report
Testing 123