Mental Health
Addressing the issues
The President asked the Commission to recommend improvements in the mental health system by reviewing public and private policies that could help federal, state, and local governments maximize existing resources and improve service coordination at the community level. In its interim report, the Commission cites the mental health care needs of older adults as one of the top five priorities in the mental health system today, a step that serves to shape future policy at the state level. Other barriers cited by the Commission include fragmentation and gaps in care for children, fragmentation and gaps in care for adults with serious mental impairment, and high rates of unemployment and disability. The Commission also notes the importance of suicide prevention.
In response to the 1999 Supreme Court Olmstead decision, Governor George Bush issued Executive Order GWB 99-2 related to community-based alternatives for people with disabilities, including those with mental illness and mental retardation. The Texas Health and Human Services Commission (HHSC), with assistance from the Promoting Independence Advisory Board, developed the Texas Promoting Independence Plan. SB 367 (77th Session) directed HHSC and appropriate health and human service agencies to implement a working plan that provides services and supports to help people with disabilities live in the most integrated setting. Three populations of people with mental illness are the initial focus of the Promoting Independence initiatives:
- People who live in the community but are in imminent risk of requiring placement in an institution (including people who have been admitted to a facility for inpatient mental health services three or more times during a 180-day period)
- People who have lived in a state hospital for more than one year
- People who have a mental illness and receive services in a nursing facility, but desire to live in another setting
In April 2002, Governor Rick Perry issued Executive Order RP-13 to further the state's efforts regarding its Promoting Independence Initiative and community-based alternatives for people with disabilities. HHSC has included an exceptional item in its Legislative Appropriations Request to fund activities related to the Promoting Independence Initiative.
In Texas , the Promoting Independence initiative has made progress towards identifying, evaluating, coordinating treatment, and eventually relocating people with mental illness and retardation out of nursing homes and psychiatric facilities and into community-based services.
Promoting Independence initiatives in Texas have renewed interest in the Pre-Admission Screening and Annual Resident Review (PASARR) screening requirements for people with mental illness and mental retardation who are applying for admission to nursing facilities. This process is very helpful in identifying mental health needs and relocating people who could best be treated by community services or other mental health institutions.
In May of 2001, TDMHMR was awarded a three-year grant by Advocates for Human Potential, Inc. to fund activities related to developing a mental health focus in the Promoting Independence Project. An advisory committee was developed that advises the agency on use of grant funds. Current plans include funding research and regional training related to the mental health population and the Promoting Independence initiative. (Note: On Sept. 1, 2004, TDMHMR ceased to be an agency. Its mental health programs went to the Department of State Health Services [DSHS] and its mental retardation programs went to the Department of Aging and Disability Services [DADS].)
DSHS also works closely with DADS to identify resources for people with mental illness who receive care in nursing facilities. DADS will establish pilot programs with relocation specialists who will work with identified nursing facility residents to relocate eligible people in the community.
Updated: November 2, 2007
