Lawmakers grapple with mental health after Uvalde

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TEXAS — House lawmakers — already slated to discuss youth health and safety on Thursday — weighed in on the idea of ​​how Texas can effectively deploy mental health resources for college students.


What do you want to know

  • Texas House members were already scheduled to discuss youth safety and health on Thursday, just two days after a gunman claimed the lives of 19 children and two adults at Robb Elementary School in Uvalde, Texas.
  • After the shooting, lawmakers grappled with the issue of effective mental health resources for students
  • Some Republicans, fearing backlash from parents in conservative districts, are reluctant to embrace mental health care models that would make such care available in schools
  • Another issue has raised concerns about payment for mental health care; people usually pay for health services, but not for wellness services

The House Select Committee on Youth Health and Safety was not scheduled to discuss this week’s mass shooting in Uvalde. President Rep. JM Lozano, R-Kingsville, plans to schedule a future hearing. But the topic of strengthening mental health interventions was on the agenda, and questions from lawmakers like Rep. James Frank, R-Wichita Falls, and Rep. Lacey Hull, R-Houston, highlighted how lawmakers are trying to balance interventions and parental rights.

Republicans — especially those in more conservative districts — have been reluctant to embrace models that would place health care and mental health care directly on a school campus, with parents fearing they would be left out of the process.

“Do you all have safety measures in place to make sure parents are included? I think that’s one of my serious concerns about providing mental health care at school,” Frank asked Lindsey Garner of Tarrant County Communities in Schools. “I think we should pay for mental health care, but I’m much more comfortable having it in a traditional clinical setting because it ensures parental involvement.”

Two models of mental health care delivery were presented to the hearing: an all-inclusive health clinic funded by the St. David’s Foundation and Communities in Schools. Communities in Schools provides more than 105,000 Texas students with comprehensive services on their home campus, including a case manager who can match students with resources in the community.

Students can have an initial risk assessment of communities in schools, but no mental health services are arranged without parental permission, Garner said. Even this step can be alarming for some lawmakers. Hull asked if a parent refusing services from communities in schools could result in a report to child protective services.

Garner said CIS is doing everything possible to provide parents with options. The aim is to provide support to families, not to place children on the welfare system, she said.

“There are instances where the CPS may become involved if a child is in need of recommended services and the parent is not acting in the best interests of the child, especially if there is a risk of harm,” said said Garner in Hull.

Texas requires school personnel to report potential cases of child abuse. Failure to report suspected child abuse or neglect is a criminal offence.

Garner pointed out that Texas is far from well staffed for mental health issues. Before the pandemic, Tarrant County was estimated to need 47 mental health professionals for every 100,000 children. At the time, Tarrant County had no more than four, Garner said.

The mental health effects of the pandemic will persist for at least a decade, Garner said.

“I think we need to look at at least the next 10 years to see how we can increase the accessibility of mental health supports and make them easily accessible – no transportation is needed and at no cost to these students and their families. “, said Garner. . “The ideal place to house them is directly in schools, where they can be seen at the convenience of the child.”

The other issue raised by the committee was the current health care payment model. People pay for a health care service; they rarely pay for welfare. Lozano spoke about his own father, a doctor who still practices in rural Texas.

“He would tell me the problems he saw in health care – how little time he had to spend with each patient. He was always complaining to me that he knew a lot of doctors were just writing a script, thank you, goodbye,” Lozano said. “They need therapy. They need advice. They need someone to talk to, and in rural areas, who are you going to find for that? »

Frank agreed that rural areas rarely have resources like federally qualified health centers, which are funded to provide comprehensive health care in underserved areas.

“I think the payment system is part of the problem and part of the reason and part of the reason for your father’s frustration,” Frank said, speaking to Lozano. “We pay for the procedures. We don’t pay for a doctor to sit down and talk to you, which is really (a problem for) another (House) committee.

Amy Einhorn of the St David’s Foundation said the Taylor Community Clinic takes a broader approach to health care.

“The payment mechanism is currently per visit per person,” Einhorn said. “We as a community are changing this approach by paying for better health outcomes. I think there is the possibility of saving money and improving the health of people in general.

Rep. Ann Johnson, D-Houston, agreed with Frank’s assessment and credited the St. David’s Community Clinic to Taylor for taking a more inclusive approach.

“When we think of physicians, you’re talking about disease remediation and acute care, as opposed to what you’re talking about here, which is effective prevention leading to positive health outcomes,” Johnson said. “Thank you for what you do in this collaboration.”

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