Update: Press Conference, January 3, 2013
By: Maria Arita, PIO

Dallas County Commissioner John Wiley Price led the team of stakeholders for a press conference, beseeching Texas legislators to heed the critical need for funding facing the county’s mental health and substance abuse treatment programs, on the heels of the Newtown, Connecticut shootings. Price was joined by newly elected Commissioner for Precinct I, Dr. Theresa Daniel and State Senator Royce West along with other county leaders. With extensive experience in public affairs and in program evaluation and accountability with DISD, Dr. Daniel will co-chair the Dallas County Behavioral Health Leadership team. Daniel embraces the new post, saying “I look forward to learning more and being a part of this critical committee in Dallas County”.

[Reflecting on the Newtown, Connecticut Tragedy; a Call to Action to Texas Legislators]

[Dallas, Tx] – [Dallas County Commissioner John Wiley Price as Chairman of the Dallas County Behavioral Health Leadership Team will hold a press conference focusing on the critical need for the Texas Legislature to increase funding for mental health and substance abuse treatment, including adequate housing for persons with serious mental illness.

WHEN: 10:00 AM, Thursday, January 3, 2013
WHERE: Allen Clemson Courtroom
Dallas County Administration Building, 411 Elm Street, Dallas, Tx

The recent tragedy in Newtown, Connecticut shocked the nation and has renewed the debate about gun control in America. The Newtown tragedy is sadly another of several recent incidents of such extreme violence. There is no doubt that some of these events could have been prevented. According to Dr. E. Fuller Torrey, president of Treatment Advocacy Center, 50% of these incidents have been carried out by persons with a severe and persistent mental illness. In the majority of these instances, we look back and see that there were numerous red flags and warnings that the person was losing control. In the incident at Virginia Tech, the individual even reached out for help and was unable to get the help he needed. Dr. Liza Gold, who is the clinical professor of psychiatry at Georgetown University Medical Center and Vice President of the American Academy of “Psychiatry & the Law,” agreed that some of these events could have been prevented on the Diane Rehm show which aired on 12/20/12.

What is needed to prevent such events is to have a place where persons who others fear may be losing control can be taken to be evaluated professionally and treatment can be initiated immediately if deemed necessary. It is crucial that people are able to be seen immediately and NOT be placed on a waiting list or told to come in for an appointment in a week or two when the person feels out of control or others around him fear that he’s lost touch with reality and could be dangerous to himself or others.
The Dallas County Behavioral Health Leadership Team joins other stakeholders in urging the Texas Legislature to focus not on gun control as a response to the Newtown and prior tragedies, but on the need for adequate mental health and substance abuse funding across the state and specifically in Dallas County and the rest of the NorthSTAR service area, which also includes Collin, Rockwall, Navarro, Kaufman, Hunt, and Ellis Counties. The Dallas County Behavioral Health Leadership Team (BHLT) was created by the Dallas County Commissioners Court on January 11, 2011 to be the single point of accountability, planning, oversight and funding coordination for all Dallas County mental health and substance abuse services and funding streams. The BHLT, led by Dallas County Commissioner John Wiley Price, evolved from a task force created in September 2009 and includes broad representation from consumers, service providers, advocates and other stakeholders.

In 2010, Texas spent $38.99 per person on mental health services, compared to the national average of $125 per person. Texas ranks 49th among the States in mental health funding, ahead of only Idaho. This low level of funding has hit Dallas County and the surrounding six NorthSTAR counties particularly hard. In 1999, there were 12,000 adults and children who received services in the NorthSTAR area. In 2011, that number had increased to 73,125. Funding has not kept up with the increase in need. In 1999, NorthSTAR was funded at $2,500 per year per person served; in 2011, the per year per person average had dropped to $1,534. Outside the NorthSTAR region, the average funding per person served in 2011 was $3,559. NorthSTAR now serves 24% of the state-wide population needing mental health and substance abuse services, but receives only 13% of the state-wide funding.

The NorthSTAR system is also facing barriers to full participation in the Medicaid 1115 Transformation Waiver currently being implemented in Texas. This “1115 Waiver” provides a new mechanism to increase federal funds matching for services and is expected to make significant additional funding available. Due to the unique managed care arrangement, the seven NorthSTAR Counties were not allowed to participate in the 1115 Waiver at the same level as the rest of the State.

Impact of Current Funding Levels on the Criminal Justice System
This lack of adequate funding for mental health and substance abuse services has a drastic impact not only on the consumers who need services, but also on local and state budgets. The impact is particularly significant to the criminal justice system. Research shows that it costs 11 times more to treat individuals with mental illness in the criminal justice system than in the community. Nearly 8 times more Texans with serious mental illness are in jails and prisons than in hospitals. Nationally, the ratio is 3 to 1. Texans in prison are 4 times more likely to have a serious mental illness than Texans in the general population. More than half of the Texans in prison with mental illness also have a co-occurring substance use disorder. One in three Texans with serious mental illness will be reincarcerated within 3 years. Locally, the number of persons committed to the Dallas County Jail who also have a history of receiving mental health or substance abuse services has increased from 7% of jail admissions in 2007 (6,501 admissions) to 20% in 2012 (17,012 admissions).

Stressed Mental Health System Leaves Children Vulnerable
Most recent data shows an estimated 192,500 children in Dallas County live in poverty, approaching one third of the population under 18. Children living in poverty in Dallas County would fill Cowboys Stadium; twice. In the City of Dallas, 37% of children live below the poverty line. Since the year 2000, there has been a 39% increase in the number of cases of child abuse or neglect in Dallas County. Many factors put a large number of our children at risk in North Texas. The difficulty with access and continuity of children’s mental health services is exacerbating the challenges that face our most vulnerable children and we must act now.

The NorthSTAR Service Delivery System
The NorthSTAR system was implemented in 1999 as a pilot program of integrated funding and managed care delivery of mental health and chemical dependency services to adults and children. NorthSTAR is comprised of Collin, Dallas, Rockwall, Navarro, Kaufman, Hunt, and Ellis Counties and combines local, state and federal funding into a single program budget. Medicaid and medically indigent individuals are eligible for mental health and chemical dependency services provided by a single behavioral health organization (BHO), Value Options, who manages a network of providers located throughout the NorthSTAR region. Value Options is “at risk” financially to serve all eligible consumers with clinically appropriate services. A key component of the NorthSTAR program is providing open access for consumers, with no waiting lists for services. The NorthSTAR program is governed by the North Texas Behavioral Health Authority (NTBHA), with members appointed by the Commissioners Courts of participating Counties.
In response to the decrease in funding per consumer served, the NorthSTAR system has made very difficult decisions that have maintained our “open access” and ensured that all eligible consumers will have access to some level of behavioral health services when needed. These funding decisions have strained the NorthSTAR service delivery system. One of two after-hours crisis clinics was closed, community-based support services have been reduced and caseloads have increased. These changes were painful to the system and resulted in a reduction of case managers and other providers and increased the time it takes to see a physician at some community clinics.

One of the strengths of the NorthSTAR system is the ability to quickly implement new programs and services. There has been much work done by all stakeholders to constantly look at better, more efficient ways to deliver services. Options either in the pilot stage or under development include: intensive case management for the highest utilizers of services, case management teams that target persons who discharge from higher levels of care (such as hospitals and emergency departments), and permanent supportive housing programs. However, all of these interventions require an initial investment in personnel and infrastructure in order to achieve longer term reductions in persons needing to access higher levels of care at costs significantly more than for community based services. In the current funding environment, it is very difficult to redirect already scarce dollars.

A Call to Action: Increased funding for Mental Health and Substance Abuse Services
The Dallas County Behavioral Health Leadership Team joins other stakeholders in calling for increased funding for mental health and substance abuse services state-wide, including funding for transitional and permanent supportive housing for persons with serious mental illness, and other programs that promote recovery and reduce repeat offenses. The Texas Legislature also needs to address the funding disparity in the NorthSTAR area and provide funding at least to the levels of per person served in the rest of the state. The Texas Legislature must consider all funding options, including:

  • Increased General Revenue Funding for mental health, substance abuse and housing
  • Medicaid Expansion through the Affordable Care Act
  • Implement the new Medicaid health home benefit created by the Affordable Care Act
  • Ensure that NorthSTAR can fully participate in the Medicaid 1115 Transformation Waiver

The State’s investment in mental health and substance abuse services will lead to direct economic benefit to the State, local governments, and consumers. Economist Ray Perryman says “the state’s investment in funding for treatment of mental health and substance abuse disorders more than pays for itself in reduced costs and increased revenues and produces excellent returns on the commitment of public resources.” His analysis shows that funding mental health services at the national average would stimulate Texas economic activity – for every $1 spent, Texas would see a return of $23.

Contact Information:
Commissioner John Wiley Price
(214) 653-6671