By Karen Brooks Harper
Originally appeared in the Texas Tribune
As public debate intensifies over how the state will divvy up billions in new money, community groups that treat children for mental illness fear they’re not a priority.
Jelynne LeBlanc Jamison makes the same impossible choice every month, when hundreds of children she can’t afford to treat show up at her publicly funded San Antonio mental health agency, desperate for help, in severe mental and behavioral distress.
Turning them away would leave her money for a more robust staff at The Center for Health Care Services, where she is director at one of 39 local mental health authorities in the state — and the only one in Bexar County.
It could reduce wait times for the children already in her agency’s care, most of whom are uninsured or don’t have access to a wide range of providers. It would broaden her treatment options and solutions for kids if the services weren’t stretched so thin.
But Jamison chooses to serve all the kids anyway — pulling them into her already overcrowded system of state-funded providers and thus risking employee burnout, long wait times and wait lists or desperate families on borrowed time bouncing between overloaded providers in order to access the help they need.
“Many times, we are the only source for [behavioral health] services,” she said. “Therefore, we are still serving the children.”
Another $730,000 per year would help the center — which averages about 1,800 children in its care but was funded for only about 1,600 during the last budget cycle — better absorb the cost of treating them.
But Jamison is still waiting for a sign from state health leaders that they’ll consider adding new dollars to her budget for the 2024-25 biennium, when she expects the trend to continue: more adults and children needing help than her clinics have the funding to treat.
Less than three months from now, Texas lawmakers will meet to write the new budget after sifting through more than 100 state agency budget requests that include nearly $20 billion in proposals for new money.
But so far, state health leaders have declined to talk specifics, beyond promising to prioritize child mental health. So for health providers like Jamison, there’s no word yet on how much more funding might be available in the next two years to treat the anticipated rise in patients.
“We are frustrated because we haven’t seen any specific dollars mentioned,” Jamison said. “We’ve had no indication.”
Texas’ health and human services department, per a recent budget proposal, already anticipates a 5% decrease in federal funding for counseling and medical services for children who are seen at the state’s 39 mental health authorities. Department officials did not include any specific dollar amounts for additional money for child mental health services for the 2024-25 biennium.
In the past year, the agency has spent about $3.6 billion on behavioral health services for children and adults. But Texas still ranks 51st among states and Washington, D.C., when it comes to per capita mental health spending.
Agency officials and lawmakers say they are still trying to determine what kind of funding might be needed to boost services for children, both with the local mental health authorities as well as in other programs in other agencies. The final budget bill is usually passed in May, near the end of the session, and takes effect in September.
What the omission does not signal, they say, is a lack of priority and attention on mental health services.
In the wake of the elementary school mass shooting in Uvalde in May, Republican House Speaker Dade Phelan proposed nearly $100 million in new funding aimed at improving children’s access to mental health services, including expansion of a new telemedicine program and an increase in pediatric psychiatry beds. Gov. Greg Abbott directed more than $10 million to mental health efforts immediately following the shooting, including $5.8 million to expand telemedicine for children and $4.7 million to increase the use of a treatment program for at-risk youth.
It’s a response that one Republican budget leader said should be continued during the next biennium.
“For me, and for other members of the Legislature, this is one of the top priorities,” said state Rep. Giovanni Capriglione, a Southlake Republican and chair of the House Appropriations Subcommittee on Health and Human Services. “There’s so much need for these services, and we’re hearing about it from a lot of our constituents as well.”
A spokesperson for the state’s health and human services department said the funding requests for mental health services are “a starting point” and will be updated, as they have been in previous sessions, with more specifics about their goals for children’s programs before debate begins on the budget bill.
“We needed more time to analyze the needs of the state in relation to adult and child mental health services,” said the spokesperson, José Andrés Araiza. “Improving mental health services for all Texans, including community mental health services, inpatient services, and other behavioral health services paid for by Medicaid are among [the agency’s] top priorities.”
Agencies are limited by rules affecting how much they are allowed to increase their requests each year and may also be hesitant to ask for too little too soon.
Leaving an amount out of initial funding requests does not always communicate a low priority. Abbott has not specified a dollar amount in his funding request to continue one of his cornerstone programs, the $4.4 billion Operation Lone Star, which is a clear priority.
But as public debate intensifies over how the state will divvy up a $27 billion surplus, the perceived silence by state agencies on behalf of additional child mental health funding has set the community who serves those kids on edge.
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