Harris County’s population continues to
increase and is projected to reach 4.5
million residents by 2020.
Mental Illness
In
Harris County
Prevalence
Issues of Concern
Recommendations
Simultaneously, poverty level is
estimated to increase from 12.5
percent up to 16 percent.
Texas has the highest rate of medically
uninsured citizens among the states.
Harris County has the second highest
rate of uninsured citizens among Texas
counties.
Texas is rated last in per capita mental
health funding compared to other
states.
A Report of the
Mental Health Needs Council, Inc.
2013
Mental Health Needs Council, Inc.
P.O. Box 270205
Houston, Texas 77277-0205
(281) 575-9001
mhneedcl@hal-pc.org
Harris County is ranked 30th out of 34
among local mental health authorities
in per capita mental health funding.
The shortfall in available mental health
services for Harris County residents
will only worsen as the population
grows.
PREVALENCE OF MENTAL ILLNESS
IN CHILDREN AND ADOLESCENTS
 Of the 750,000 children and
adolescents in Harris County
between 6 and 18 years old (2010
Census), nearly 150,000 have a
mental illness. Of those, 89,162 have
a serious emotional disturbance.
 Approximately 19,300 children and
adolescents with serious emotional
disturbance needed services from
the public mental health system in
2012, yet 74 percent (14,335)
received none.
 Almost 69 percent of the 9,100
children referred to the Harris County
Juvenile Probation Department have
a diagnosable mental illness.
 Of those, 70 percent report cooccurring behavioral health problems
of substance abuse and mental
illness.
 About 41 percent have a history of
trauma exposure, often having
witnessed or experienced family or
community violence.
PREVALENCE OF MENTAL ILLNESS
IN ADULTS
 Of the 2.9 million adults in Harris
County (2010 Census), 496,358 have
mental illness. Of those, 137,219
have severe and persistent mental
illness (Major Depressive Disorder,
Bipolar Disorder, or Schizophrenia).
 Of those with severe mental illness,
86,000 have no public (Medicaid or
Medicare) or private health insurance
and are totally dependent on the
public mental health service system
for treatment.
 In 2012, approximately 69,800 adults
with severe mental illness were
unable to access treatment from the
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public or private mental health
systems.
Of the Harris County citizens in jail,
24.1 percent have a current or past
mental illness diagnosis.
An estimated 15 percent of
individuals with severe mental illness
will be homeless at some point within
the year.
In the 2012 Point in Time Count of
homeless persons in Harris County,
66 percent reported prior psychiatric
hospitalization, needing mental
health treatment, or having to leave
their homes due to mental illness
issues.
In Harris County, 38,421 or 28
percent of adults with a severe
mental illness report co-occurring
substance abuse.
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ISSUES OF CONCERN
Consequences of untreated mental
illness may include school failure or
dropout, juvenile or criminal justice
involvement, victimization, acute
psychiatric crises, unemployment,
homelessness, or suicide.
The limitations in the Harris County
mental health service capability,
especially outpatient services, have
resulted in a dependence on crisis
services.
 The Mental Health and Mental
Retardation Authority (MHMRA)
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NeuroPsychiatric Center (NPC)
currently treats over 13,000 crisis
episodes per year.
Demand for crisis services at NPC
has frequently exceeded capacity,
forcing the facility to close its doors to
new admissions more than 75 times
in 2012.
Ben Taub General Hospital
Emergency Room treated over 4000
with mental illnesses each year in
2011 and 2012.
In 2012, around 250 were seen each
month for psychiatric consultations.
In 2012, almost 870 were admitted to
psychiatric inpatient services at Ben
Taub, up from about 850 in 2011.
The number of mental illness-related
calls received by the Houston Police
Department Crisis Intervention Team
increased from 10,800 in 2003, to
25,105 in 2010, to 24,771 in 2011,
and over 27,000 calls in 2012.
Of those individuals hospitalized in
The University of Texas Harris
County Psychiatric Center
(UTHCPC), 22.6 percent were
readmitted to inpatient services
within one year.
In 2012, about 70 children and 237
adults entered MHMRA services for
the first time each month.
An increasing number of children and
adults, previously unknown to the
public mental health system, request
services each year.
 MHMRA’s waiting list for outpatient
mental health services exceeds
1,600 adults each month.
 About 15 percent of those waiting for
services deteriorate into crisis and
require intervention at psychiatric
emergency centers, inpatient
hospitals, or in jail.
 At any given time, MHMRA provides
services to 2,400 children and
adolescents, 50 percent above its
contracted, state-funded capacity.
 On average, 168 children and 326
adults were readmitted to MHMRA
services each month in 2012.
The Mental Health Needs Council is
especially concerned with the
following issues:
Insufficient Funding for the
Medically Uninsured
 More children and adults with severe
mental illness reside in Harris County
than any other Texas county, yet per
capita funding is below the state
average for public outpatient
services.
 Reimbursement rates for public
health care programs are so low that
few private providers are willing to
participate.
 The private and public sectors must
collaborate in order to provide an
adequate array of services and
supports to address these needs.
Limited Service Capacity
 Each month nearly 270 more
individuals apply for public mental
health services than can be served.
As the population increases, there
will be more.
 Access to service is even more
limited to people without public or
private insurance.
Crisis Oriented System
 Due to significant funding limitations,
children and adults without insurance
receive few or no services, often
resulting in decompensation into
crises or incarceration.
 Emergency services can meet
immediate needs, but cannot support
long-term community stabilization.
 A larger, better funded, more
responsive, and more accessible
outpatient system would help to
break the crisis-to-crisis cycle.
 Increasing numbers of children and
adults with mental illness, whose
illnesses are not severe enough to
warrant inpatient or crisis care, are
forced to wait for services until they
are in crisis.
Michael E. DeBakey Veterans
Administration (VA) Medical
Center Mental Health Services
 About half of the eligible returning
Iraq and Afghanistan Veterans in
America and the aging veteran
population access mental health
services from the VA.
 Suicide rates among active military
and veterans have risen 80 percent
since the start of the Iraq War. Fully
20 percent of US suicides are
attributed to veterans.
 Support is lacking for spouses and
children of veterans or active military.
 Federal budgetary support has so far
funded the rising demand, although a
collaborative public/private system
may offer a better response in the
future.
Loss of Access to State Funded
Inpatient Care
 Harris County has fewer than 10
psychiatric hospital beds per 100,000
residents, less than the national
average of 17 per 100,000.
 Experts recommend adequate
capacity at more than seven times
current Harris County levels.
 Poor access to voluntary public
psychiatric hospitalization causes
increases in involuntary
commitments.
 UTHCPC continues to be
insufficiently funded to operate its
250 beds, thus curtailing capacity for
more people to receive timely
inpatient care.
 About 70 percent of Harris County’s
allocated state hospital capacity goes
to forensic cases. As a result, Harris
County is pressured to provide
inpatient services for voluntary and
civil commitment cases.
Less Access to Private Care
 At least 16 of Harris County’s private
inpatient facilities have closed within
the last 10 years, in part, due to
restricted access to care for insured
patients and failure to receive
appropriate, timely reimbursement for
insurance claims.
 Private psychiatric hospitals have
suffered from an increasing burden of
indigent care. Private hospitals often
care for the medically indigent and
should be commended for their
contributions to the community.
 Children and adults who have
psychiatric insurance benefits have
difficulty accessing needed services
due to shrinking provider rolls and
professional workforce shortages.
Lack of Access to Integrated Care
 Many children and adults with severe
mental illnesses may abuse
substances. Appropriate behavioral
health care requires coordinated
treatment for both problems, yet this
is rarely available.
 People with serious mental illnesses
have significantly shortened life
expectancies and higher rates of
metabolic disorders (e.g., diabetes,
hypertension, or high cholesterol).
 Although coordinated health, mental
health, and substance abuse
services produce better health
outcomes, these services are rarely
available due to economic barriers
for integrated care.
Lack of Access to Residential
Treatment and Housing Supports
 Many people with severe mental
illnesses lose their jobs, family ties,
and homes.
 At least 14,000 Harris County adults
with a mental illness lack appropriate
housing.
 Residential treatment services for
children and adults with mental
illness are in short supply. These are
vital components of the mental health
service continuum.
Mental Health Workforce
 Portions of Harris County are
designated as federal Mental Health
(Professionals) Shortage Areas.
 Due to reductions in the capacity of
training programs and continuing
population growth, there are fewer
psychiatrists, psychiatric nurses,
social workers, and marriage and
family therapists relative to the
county population. The supply ratio of
psychologists is only 60 percent of
the national average.
RECOMMENDATIONS
The Governor of Texas, members of
the Legislature, Harris County
Commissioners Court, and the
Health and Human Services
Commission should:
1. Enhance Funding
 Under the Affordable Care Act,
create coverage for the uninsured
with adequate service packages
and reimbursement rates.
 Expand the range of services and
the reimbursement rates for an
adequate array of supports to
address clinical needs.
 Maintain a ‘safety net’ for those
who need psychiatric services and
are not covered by other funding
sources.
 Establish mechanisms and
procedures that promote, expedite,
and maintain enrollment in CHIP
and Medicaid programs.
 Align resources with the prevalence
rates for mental disorders.
2. Expand Service Capacity
 Support a cost-effective public
mental health system by sufficiently
funding community-based
Resiliency and Disease
Management.
 Support the use of Medicaid 1115
Waiver projects to expand mental
health services.
 Oppose supplanting current
funding with Medicaid 1115 Waiver
revenues.
 Authorize legislation to allow Local
Mental Health Authorities to utilize
state funds in support of
uncompensated care and Medicaid
1115 Waiver projects, provided that
contract performance targets are
met.
 Expand public mental health
capacity to serve all those with
functional impairments due to a
mental illness.
 Insure prompt, adequate Medicaid
reimbursement.
3. Balance Resources Between
Crisis Services and Ongoing
Care
 Direct all additional mental health
General Revenue dollars for
outpatient services to minimize the
need for crisis and inpatient care.
 Fund restoration and expansion of
behavioral health services in public
schools.
 Sufficiently fund Harris County's
programs to divert people with
mental illness from the juvenile and
adult criminal justice systems.
4. Ensure Adequate Care for Iraq
and Afghanistan Veterans
 Enhance and supplement federal
(VA) initiatives to provide ongoing
mental health support to returning
veterans and their families.
 Explore public and private
collaboration possibilities.
5. Expand Current Psychiatric
Hospital Capacity
 Sufficiently fund public psychiatric
hospitals for care of voluntary and
civil commitments, as well as
forensic cases.
 Sufficiently fund UTHCPC to
operate at its full 250-bed capacity
to locally treat Harris County
citizens.
6. Support Indigent Care by Private
Providers
 Support continuation of the STAR
and STAR PLUS programs offering
integrated medical and behavioral
health to program participants.
7. Support Integrated Care for
Individuals with Behavioral
Disorders
 End discrimination for behavioral
health (mental health and
substance abuse) insurance
coverage.
 Sufficiently fund collaborative and
holistic rehabilitation services to
address social, vocational,
psychiatric, and health care needs.
 Fund electronic health records and
health information exchanges to
improve integrated health care,
promote coordination of care, and
reduce duplication of services.
 Support policies that promote
collaborative health care and
medical homes.
8. Prioritize Housing and
Residential Services
 Sufficiently fund appropriate living
options with supports tailored to
clinical needs.
9. Support Professional Workforce
Development
 Fund higher education programs
that will increase the number of
mental health professionals in the
Texas workforce.
 Sufficiently fund mental health
professional training programs,
including psychiatry, psychology,
social work, marriage and family
therapists, and psychiatric nursing.
 Expand Medicaid reimbursement
for mental health services provided
by advanced professional trainees.
 Offer tuition forgiveness in return
for public health service.
10. Support Local Control and
Accountability for Public Mental
Health Services
 Support accountability in service
delivery to reduce costs, improve
patient satisfaction, and produce
improved patient outcomes.