Today, the Meadows Mental Health Policy Institute (MMHPI) and Houston Endowment released a comprehensive assessment of the scope and quality of mental health services available for Harris County children, youth and their families. The report identifies gaps in the system and offers strategic recommendations — opportunities to grow provider capacity and expand and reform the current continuum of care — to increase availability of the right types of services when and where they are most needed.

It is estimated that, each year, nearly 310,000 children and youth in Harris County suffer from some form of mental health disorder. Systemic barriers to access result in too many children experiencing their first care in a juvenile justice facility or an emergency room.

“Houston Endowment recognizes that the mental health of our youngest residents is a critical issue with lasting impacts,” said Ann Stern, president of Houston Endowment. “We hope that this assessment will equip decision makers in the provider community with information they can use to enact changes necessary to best serve Harris County’s children.”

The assessment notes that “the best mental health care should be just like the best health care” and recommends, in particular, that on-site behavioral health integrated into primary care should be expanded, with an emphasis on school-linked integrated primary care. Such integrated pediatric settings could serve up to two-thirds of children and youth with mental health needs.

“Harris County children and their families deserve the right types of services in the right place and at the right time,” said Andy Keller, president and CEO of MMHPI. “This report provides essential guidance on how to best meet the mental health needs of this community and underscores the importance of integrated primary care.”

The report offers nine strategic recommendations that could move Harris County incrementally closer to the “Ideal System of Care:”

  1. Expand on-site primary care access, with an emphasis on school-linked clinics.1. Expand on-site primary care access, with an emphasis on school-linked clinics.
  2. Reframe the work of specialty behavioral health providers to either integrate with primary care or focus more on moderate to severe conditions.
  3. Work to strengthen the partnerships between schools and community providers and expand schools’ liaison capacity to facilitate connections to services.
  4. Leverage state grant funds to expand intensive Medicaid services for children in foster care.
  5. Develop a broader local initiative to build capacity for evidence-based services for the 4,000 children with the most severe needs, over 90 percent of whom currently lack access to such care outside the justice system.
  6. Incorporate First Episode Psychosis (FEP) into the youth-serving service array for the 200 people under age 18 who develop a psychosis for the first time each year.
  7. Better coordinate child welfare, juvenile justice and mental health crisis response resources in order to improve the responsiveness of the overall crisis system.
  8. Make more effective use of existing psychiatric inpatient bed capacity by considering ways to extend the reach of capacity in underutilized facilities.
  9. De-emphasize residential treatments—and when used, make them as brief, intensive and as close to home as possible.

The Institute began the assessment of the current system in fall 2016. The assessment included site visits and interviews with leading providers and advocates across Harris County in mental and primary healthcare systems, child welfare, juvenile justice and school systems across the county. Additionally, researchers carefully collected and reviewed data and statistics, including data from the Texas Health and Human Services Commission, the Department of Family and Protective Services and the Texas Juvenile Justice Department.