Understanding Senate Bill 10: Chapter 113: Texas Mental Health Care Consortium

On February 19, 2019, Texas laid the groundwork to comprehensively address its statewide mental health care shortage.  Senate Bill 10, passing with near unanimous consent, amended the Health and Safety Code to include “Chapter 113: Texas Mental Health Care Consortium”.  Said consortium, paneled by representatives from twelve health-related institutes of higher education, as well relevant non-profit organizations, has been tasked with strategizing solutions to the diminishing psychiatric workforce and broad challenges patients experience in accessing mental health care.

Improved Access to Care

In an effort to reduce mental health care shortage areas (M-HCSAs), Sec. 113.0152, Access to Care; Child Psychiatry Access Network and Telemedicine and Telehealth Programs directs the committee to create a statewide network of child psychiatry access centers (CPACs) within the twelve participating medical institutes.  These centers are to work alongside community care providers to offer psychiatric consultations to adolescents with behavioral and/or mental health disorders.  Per Sec. 113.0152, Mental Health Research Plan, the consortium is to compile and inventory available research on mental health and substance abuse disorders and delegate funding to further study in these areas.

An Expanded Physician Workforce

Sec. 113.0154, titled Psychiatry Expansion Workforce Project, aims to improve and increase psychiatric residency training via collaboration between medical colleges and community care providers.  Committee members have been permitted to fund one full-time psychiatric medical director and two rotating resident positions per provider.  Within the course of their duties, medical directors are expected to develop training opportunities for medical students and their residents.

Telemedicine’s Role

From a technology perspective, SB10 emphasizes the role of telemedicine in restructuring the state’s mental health care crisis: Sec. 113.0152.b instructs the consortium to create or redefine telehealth programs at the participating medical institutes to better recognize behavioral health needs and to supply statewide care; likewise, Sec. 113.0154.b.2 necessitates the application, education, and promotion of telehealth tools by directors employed through this project.

In her testimony at SB10’s hearing, developmental-behavioral pediatrician Nhung Tran, M.D., espoused support for the bill, noting that the establishment of CPACs and their application of tele-consultation services would “support primary care pediatricians in meeting the mental health needs of children” and “free up the behavioral health workforce to address higher-acuity concerns.”  Dr. Tran concluded her statement by acknowledging that while “telehealth and telemedicine are not the sole solution”, the bill “takes a critical step in leveraging technology to fill the gap … to create long-term solutions and improve care.”

Looking Toward’s the Future

Texas continues to have one of the largest discrepancies in mental health care access versus population of any U.S. state; however, SB10 is an informed, relevant, and dedicated approach to tackling these issues at their roots.  As this project grows, physicians, institutes, and telehealth services are certain to embrace its potential, hopefully reshaping the future of care for Texas patients.

The Looming Shortage of Texas Psychiatrists

The demand for mental health services grows daily; it’s estimated that nearly one in five Americans suffer from a form of mental illness, of which only 41% receive the necessary treatment.  And while many factors contribute to this lack of care, perhaps the most significant culprit is the drought of qualified physicians. 

Texas’ Health Professional Shortage Areas

Hundreds of counties across the U.S. are absent psychiatric professionals, with Texas leading the pack.  A 2015 study by the North Texas Regional Extension Center found that 185 of Texas’ 254 counties did not house a general psychiatrist.  Texas, generally, is ripe with Health Professional Shortage Areas (HPSAs).  A 2018 review by the Henry J. Kaiser Family Foundation placed Texas right behind California in number of mental health care HPSAs: 430 areas with a combined population of over 12 million people whose needs go unmet, dependent upon an influx of almost 600 practitioners in order to satiate demand.

The Physicians’ Struggle

Medical professionals are concerned.  Joseph Parks, M.D., of the National Council for Behavioral Health, was quoted in 2017 as having said:

“Two-thirds of primary care physicians report that they have trouble getting psychiatric services for their patients. So, they go to the emergency room. There has been a 42% increase in the number of patients going to the emergency room for psychiatric services in the past three years, but most of them are not staffed with psychiatrists … people end up stuck in emergency rooms for hours and at times days … finally, they try to get into an inpatient psychiatric bed, but hospitals have been closing their psychiatric units because they can’t find psychiatrists to hire and staff to run them. It is truly becoming a crisis.”

Psychiatry Careers Are Dwindling

This division of care will continue to grow.  Merrit Hawkins’ 2017 Review of Physician and Advanced Practitioner Recruiting Incentives notes that of the approximately 30,000 active psychiatrists in the U.S., 60% are fifty-five years of age or older, and “set to retire soon”.  New American Economy’s The Silent Shortage: How Immigration Can Help Address the Large and Growing Psychiatrist Shortage in the United States (2017) emphasizes that “just 4 percent of medical students decide to practice psychiatry each year … the number of psychiatrists has only increased by 12 percent since 1995, not enough to keep up with the growing U.S. population.” 

Texas’ own Department of State Health Services announced in its Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 – 2030 (July, 2018) that each of Texas’ eight primary regions, already experiencing shortage, will not produce enough psychiatrists to meet the scaling population demand by 2030. 

Solutions

What can be done?  One recommendation, as outlined by the Association of American Medical Colleges in Physician Supply and Demand Through 2030: Key Findings (April, 2018), is a multi-faceted approach, of which “innovative delivery” and broadened applications of technology are pillars.  Perhaps now more than ever, clinicians, schools, and other medical service providers should look towards telemedicine for solutions.  As medical schools and state/federal governments work from within to better incentivize psychiatric residencies, providers at the ground level should use the tools currently available to them.  In doing so, those seeking care can receive care.