1.     We have a crisis in mental health staffing.
a. Frontline mental health staff working in community mental health centers are poorly paid. This results in frequent turnover, difficulty hiring and keeping skilled staff, and ultimately means that people with the most severe mental illnesses are treated by the least prepared staff statewide.

·      An example: in Denton County’s community mental health center, with a graduate degree and a license, staff are hired at a lower pay rate than employees at Buckees.

·      Occupational therapy graduates would love to be part of the solution to the staffing crisis in community mental health. Those who would like to work in community mental health generally cannot afford to stay in Texas because they carry the debt that goes with graduate school.

          ASK: Increase the wages of frontline community mental health staff

      2. Children and youth continue to be abused in tough love style, behavioral
          health residential placements. They are run by people with limited skills
          in mental health whose motives are entirely for profit. They hire staff                  without credentials and are allowed to injure our children. This must stop.            We cannot allow mental health or substance abuse programs to operate
          outside of established best practices, and these businesses cannot continue
          to injure Texas children.

           ASK: Require subtance abuse facilities to adhere to the 2020
           International Standard for the Treatment of Substance Use Disorders.
           Require residential treatment centers to adhere to Building Bridges and
           other established standards that protect the rights of patients/participants.
           Establish both criminal and civil consequences for violations of persons               civil rights in treatment facilities. 

      3. Occupational therapists have a long history in mental health practice, but
          people living with mental illness in Texas are about the only disability
          group who do not have access to occupational therapists.

·      OT’s focus is pragmatic. It is on what people need and want to do. In community this includes skills to maintain housing, build healthy lifestyles, sustain relationships, engage in volunteer and paid work, and participate in valued leisure occupations.

·      OT’s unique skill set, with a deep understanding of physical, psychosocial and cognitive person systems as well as a focus on creating environments that enable participation help us provide skilled task analysis. We often to see opportunities that might otherwise be missed.

·      Occupational therapists have practiced in mental health for over 100 years. Our training and accreditation requirements include mental health.  Texas looses occupational therapy graduates interested in mental health to other regions of the country.

ASK: Occupational therapy should be listed in state statute (as it is in federal statutes) as a Licensed Practitioner of the Healing Arts and should be included in the list of mental health providers that are considered qualified mental health providers. This would enable OTs to be listed in the state Medicaid rules as mental health practitioners and end the discrimination against persons with mental illness in access to OT.

4.     Expanding Medicaid is long overdue. It’s 90% match is a critical offset to the expenses we have incurred as a state, as Texas healthcare providers, and as families. In a state with the highest uninsured rates in the country, we were ill prepared to cope with pandemic. We do not know what the long term effects of Covid 19 will be and we need to be prepared to effectively and efficiently meet the needs of Texas citizens.

·      A bill such as HB602 that creates a single payor system will likely be the most efficient. Whichever alternative is decided upon, we would like there to be an occupational therapist with mental health practice experience as well as one with physical medicine and rehabilitation experience in the governance body as allied health providers are defined. It was our absence at those meetings that cause OT to be omitted from mental health provider lists in Texas.  

ASK: Include occupational therapists that represent OT’s range of practice experience on governance boards for Medicaid expansion or other initiatives such as the Health Texas Program.

5.     School mental health initiatives are a critical component for supporting children’s mental health. Occupational therapy frameworks are embedded in school mental health training in Texas, but school based occupational therapists are frequently not included in school mental health initiatives. There are additional models, such as Every Moment Counts, that we can also bring to the table as Specialized Instructional Support Personnel who are already in schools.

ASK – Include occupational therapy in legislation referencing school mental health.

6.     Texas has been forward thinking in adopting a number of best practices in mental health. However, these are not always implemented with fidelity to those models and so we are not achieving the outcomes that we should expect from our investment. We need to do an appraisal of our systems of care, wraparound, and recovery practices statewide and determine fidelity to the models we are intending to follow, who is getting the best outcomes, and what steps need to be taken to reset and increase our efficacy.

·      Wraparound is a practice within our community mental health centers. Are these programs part of a system of care and how are they adhering to the principles of wraparound?  We need to do some self-study.

·      Both the use of another disability group’s 1915c waiver as a model and the lack of connection to systems of care, have negatively impacted the outcomes of the YES Waiver. We need regional work sessions that include experts on wraparound and systems of care to take stock of our practices using the principles of wraparound as our measuring stick.

·      These self-studies need to include families and youth who have graduated from our wraparound programs, those still in them, and those who dropped out. They need to include regional and state family organization leaders as well as mental health professionals both inside and outside the community mental health centers. There need to be facilitators who are deeply grounded in the principles of wraparound and have experienced wrapround within a fully functioning system of care.

7.     We will be endorsing requests made by the mental health peer run organizations such as Recovery International, ACCEPT, Recovery People, and the Texas Coalition for Healthy Minds