Texas and mental health care are under a microscope after Uvalde school shooting

An updated report currently puts Texas at No. 33 for adults with mental illness and access to health care, according to that now updated report. However, Texas ranks lower at No. 41 when it comes to youth with mental illness. When it comes to overall access to mental health care, Texas ranks dead last at No. 51 (the District of Columbia is included with the 50 states in the rankings). 

For the 2022 fiscal year, Texas’ reduced its general revenue fund contributions to adult, children, and crisis Community Mental Health Services provided through Health and Human Services by $237,163. However, Community Mental Health Grant programs saw increased funding of $2,910,409. For the same budget period, federal funding increased by $41,103,876.

The Texas House voted down a proposal last April that would have used billions in federal funding to expand Medicaid to some of Texas’ estimated 5 million uninsured residents and conceivably improved access to mental health care. 

Only 9.7% of adults with mental illness reported having access to Medicaid in 2018 and 2019, compared to 21.6% of adults nationwide, according to the Kaiser Family Foundation. Medicaid covers most mental health treatments. There were 3.3 million adults who reported having a mental illness in Texas, and 59.6%, or 1,960,000, of that figure did not receive treatment, according to a 2021 Mental Health America ranking.

From 2018 through 2019, 69.8% (1,268,000) of adults with mild mental illness in Texas did not receive care, according to the Kaiser Family Foundation. For adults with serious mental illness in the same time period, 44.7% (375,000) of those adults in Texas did not receive care.

Breaking down barriers

Uvalde residents have access to mental health services through Community Health Development Inc., which also serves Real, Edwards, and Zavala counties.

CEO Mayela Castañon says that CHDI receives Health Resources & Services Administration grants from the state, as well as funding from the city and Uvalde County for indigent health care. Real, Edwards, and Zavala counties do not contribute to the organization, she says, and there is only a single psychiatrist and one licensed clinical social worker for the four counties — a total population of 38,527 according to 2021 Census estimates.

The city of Uvalde has contributed $65,000 to CHDI annually for the past five fiscal years, according to its recent budget. Uvalde County budgeted $2.7 million to indigent health services in the 2021 fiscal year, but it was not immediately clear how much of that went to the organization. 

CHDI posted to Facebook on Wednesday to announce plans to provide grief counseling for families impacted by the shooting. Castañon says other mental health professionals are coming in from surrounding areas to lend their services. 

Over the next two months mental health services will be accessible to everyone in the community, with no immediate plans to charge for services for the grieving community, she says. 

“I just want to make sure that we break down all barriers and make it available to whoever needs it,” Castañon says. “Regardless of income, insurance, anything⁠ — all we want to do is provide the services to the community.”

CHDI offers mental health services, including counseling, clinical assessments, therapy, medication management, and on-site pharmacy services, as well as in-person and virtual visits. All of these services are offered with a “Sliding Fee Discount” available to families earning less than 200% of Federal Poverty Guidelines, which is based on family sizes ranging from 1-8 and with incomes ranging from $13,590-$46,630. 

In Uvalde, the 2020 median household income was $45,936, while median income for individuals was $21,036, according to the U.S. Census Bureau. July 2021 census data estimates Uvalde is 72.7% Hispanic or Latino.

Patients needing services must provide a driver’s license or official ID card and either: their last four payroll check stubs; their most current tax return if self-employed; proof of residence such as a utility bill; insurance card or proof of Medicare or Medicaid if available. The typical minimum fee is $20 for mental health services, according to Castañon.

For immigrants or residents without an ID, access to that discount or other mental health services could prove difficult. Castañon says for those without ID or proof of income, they have a self-certification process where those in need can claim their income and identity. Castañon says CHDI is unaware of whether or not any of their patients are living in the country without legal permission because the organization doesn’t specifically request that information.