The Arc of Texas Provides Recommendations for Delivery of Mental Health Services
The Arc of Texas Senior Specialist, Mental Health and Criminal Justice Kirk Noaker submitted testimony to the Texas State Senate Finance Committee. Noaker submitted written testimony during the committee meeting on June 28, 2022. Read the testimony submitted below.
Thank you for this opportunity to testify today and for your leadership during the 87th Texas Legislature.
My name is Kirk Noaker, and I am a retired law enforcement officer where I served with various police, and sheriff’s departments. Additionally, I am a former DEA Task Force Agent, Federal Air Marshal, FBI Joint Terrorism Task Force Agent, Criminal Defense Investigator in death penalty cases only, and a former Texas Magistrate Judge. I am currently a member of the Collaborative Council which is part of the Texas Supreme Court’s Judicial Commission on Mental Health and I work for The Arc of Texas as Senior Specialist, Mental Health, and Criminal Justice.
As a statewide membership organization, The Arc of Texas promotes, protects, and advocates for the human rights and self-determination of more than a half-million Texans with intellectual and developmental disabilities (IDD). Approximately 35 percent of individuals with IDD have a co-occurring mental health condition. Additionally, individuals with IDD experience high rates of trauma including physical abuse, sexual abuse, emotional abuse, exploitation, isolation, bullying, institutionalization, and more. With their input in mind, The Arc of Texas respectfully submits the following recommendations regarding this interim charge:
Mental Health Delivery: Examine the state mental health service delivery system. Study the state’s Comprehensive Plan for State-Funded Inpatient Mental Health Services and the Statewide Behavioral Health Strategic Plan and evaluate the existing state investments in mental health services and state hospital capacity. Review current forensic and civil mental health service waitlists and recommend ways to improve coordination and outcomes to reduce waitlists. Explore and report on options for additional mental health service capacity, including building state hospitals in the Panhandle and Rio Grande Valley areas.
Recommendations for Mental Health Delivery
We propose the following five solutions to improve the state mental health service delivery system.
- Improve Equity Among LMHAs and LIDDAs
- Establish Mental Health Triage Centers
- Expand Availability of the Outpatient Biopsychosocial Program
- Affirm Commitment to Olmstead
- Establish and IDD Coordinating Council
Improve Equity Among LMHAs and LIDDAs
As I have traveled the State of Texas to teach new and “in-term” judges about many of the legislative updates and mental health emphasis over the past several years – I all too often hear: “All Local Mental Health Authorities (LMHAs) and Local IDD Authorities (LIDDAs) are not created equally”. The meaning of this suggests some local authorities provide services more effectively than others. The wealth and size of catchment areas should not determine the quality of services available to Texans seeking mental health care. The Arc of Texas supports legislative efforts to improve equity among LMHAs and LIDDAs. We must bridge the gap between the rural regions of Texas with little to no access to mental health crisis services and the more urban regions who often have more access to mental health crisis services.
Establish Mental Health Triage Centers
The creation of regional mental health triage center(s) operated by the LMHA charged with providing services to its respective counties and/or regions would be a useful tool for not only the law enforcement community, but also the public seeking services for a family member or friend requiring immediate mental health assistance. The State of Texas has 39 LMHA’s serving Texas’ 254 counties. All too often citizens residing in the rural counties suffer from a lack of mental health resources based on the scarcity of mental health service centers and/or a lack of funding and training for mental health facilitators such as law enforcement. Presumably, Texas’ rural counties would require more of these mental health triage centers and in relation, such mental health triage operations should be void of geographical restrictions and be available for the “over-flow” needs of nearby regions.
For example, let us say that a small, rural county with three on-duty law enforcement officers is responding to a person experiencing a mental health crisis. Can that jurisdiction still manage emergency services effectively if one-third of their law enforcement capabilities leaves their service area for 6 hours to transport a person experiencing a mental health crisis to a more urban area of Texas with adequate mental health services?
Currently, a person seeking mental health assistance calls the 9-1-1 because they have no other way to facilitate help for a person in crisis. Upon police arrival, law enforcement has little to no options and often arrest the person and hope that once they are booked into the jail, that person may be subject to mental health services. This happens in rural counties with more frequency than urban counties who have more mental health services to consider. Often jails are employed as mental health triage centers, yet they are woefully underequipped to provide and/or facilitate quality mental health services and require a criminal charge for entry. We know that when people with IDD come into contact with the criminal justice system, it can lead to devastating consequences – resulting in even greater harm to the individual.
A mental health triage facility could be the destination for law enforcement to invoke CCP 16.23 (Diversion of persons suffering mental health crisis or substance abuse issue). Additionally, a mental health triage facility could be a resource consideration for family and friends seeking immediate mental health services for a person in crisis thusly avoiding the criminal justice system all together.
Expand Availability of Outpatient Biopsychosocial Program
The 86th Legislature created the OBI (Outpatient Biopsychosocial) program through Exceptional Item 22 and this program has highly been successful in providing quality person-centered and trauma-informed care for people with co-occurring IDD and mental health conditions among 5 LIDDAs. The OBI program’s holistic case management approach focuses on increasing access and creating a team of medical, psychiatric, mental health, and paraprofessionals to address a person’s unique needs. Additional components of the program include mental wellness support, skills training for the person and their support system, and education and training on co-occurring IDD and mental health conditions to practitioners in associated fields.
The Arc of Texas recommends that the 88th Texas Legislature continues supporting the OBI program, including an expansion to fund additional LIDDAs across the state.
Affirm Commitment to Olmstead
The Arc of Texas asks the Texas Legislature to affirm Texas’ commitment to Olmstead in all deliberations surrounding mental health delivery. Texans with disabilities have the same basic legal, civil, and human rights as other Texans. All mental health delivery efforts should ensure people with disabilities and mental health conditions live and receive care in the most integrated setting possible. They may need accommodation, protection, and support to enable them to exercise these rights, but these rights should never be limited or restricted without due process.
Establish IDD Coordinating Council
The promise of the Statewide IDD Strategic Plan fell flat due to the failure to pass House Bill 4571 (87R) by Representative Toni Rose. As you all know, the wide array of services offered to Texans with IDD is complicated, disjointed, and sometimes duplicative. Texas would benefit from a purposeful review of the entire system used by Texans with IDD with a focus on providing coordinated care to ensure high-quality, cost-effective services.
Even when positive policies are implemented and funds are appropriated, Texas legislators and state agencies do not have a strategic plan to track and review system improvements and cost savings within individual agencies let alone across the entire IDD system. Due to the numerous state agencies with appropriated funds to support individuals with IDD, transparent, clear data that tracks available programs and services is hard to obtain. The solution is a coordinated council of state agency decision-makers and IDD stakeholders that provide input about how the entire IDD support system can provide quality, cost-effective services to Texans with IDD.
The Texas Statewide Behavioral Health Strategic Plan has played an integral role in advancing behavioral health policies and has helped Texas achieve considerable progress to develop a coordinated statewide approach to providing appropriate and cost-effective behavioral health services to Texans. HB 4571(87R) would have established an IDD Coordinating Council to implement, track, and continuously evolve a statewide IDD Strategic Plan in a similar model to the Behavioral Health Coordinating Council. We look forward to supporting a refile of HB 4571 and any Senate companions during the 88th session.
We appreciate your consideration of this information and recommendation as we approach the 88th Texas Legislative Session. Please do not hesitate to contact The Arc of Texas for additional information or if we can be of service.