Pediatric Mental HealthFacts
State and local indicators. The Texas Department of State Health Services (TXDSHS) has indicated that Texas is currently experiencing a widespread shortage in the number of mental health service providers per 100,000 residents when compared to the national average. A study by the Hogg Foundation revealed that in 2014, 207 of Texas’ 254 counties (81%) were designated by the federal government as either whole or partial Health Professional Shortage Areas (HPSAs) for mental health service provision. Nueces County, where TAMUCC is located, and the 18 surrounding counties that comprise the Texas Coastal Bend region are all considered HPSAs. Further, TXDSHS reported that the statewide shortage is characterized by a dire set of disparities across the behavioral health continuum wherein 171 counties do not have a psychiatrist and approximately 1 in every 5 Texas counties does not have licensed professional counselor available for persons experiencing a mental health crisis or behavioral health disorder. This gap leaves Texas 49th in mental health expenditure per capita (National Association of State Mental Health Program Directors Research Institute, 2014).
The situation for mental health service provision for children, adolescents, and transitional-age youth is particularly ominous. The Hogg Foundation reported that among the approximately 22 million Texans aged 9-65, an estimated 650,000 are experiencing severe behavioral health disturbances. Within this population, an estimated 155,000 are youth ages 9-17 who are experiencing notable impairments in functioning that are predictive of psychosocial difficulties that may have deleterious effects across the lifespan if not mitigated. TXDSHS estimated that only 29% of those Texas children receive any form of intervention within the state funded mental health programs. Among the most common developmental risks for untreated mental illness among Texas youth include (a) academic dropout, (b) low vocational stability, (c) decreased lifetime earning potential, (d) development of co-occurring substance use disorders, (e) juvenile justice involvement, (f) poor health, and (g) increased risk for suicide. Furthermore, Colton and Manderscheid (2006) found that Texas residents who were diagnosed with a mental health issue that extended beyond adolescence tended to die at younger ages and lost more years of life than people with non-major mental illness diagnoses when undertreated by behavioral health specialists.
This trend is especially concerning when considering that the majority of behavioral health service providers in Texas and Nueces County do not specialize in treating children and many of the accredited counselor preparation programs in the state do not offer specialized training for prevention, diagnosis, and intervention with children. As a result, Texas is currently ranked 41st in the United States based on a ratio depicting high mental illness prevalence and low rates of access to care among youth. At a local level, our local state-funded mental health authority (Behavioral Health Center of Nueces County) almost always has several vacancies at their Youth Services division across provider positions (case managers, counselors, social workers, psychiatrists) despite offering very competitive compensations and benefits. This scenario is common among similar agencies and programs locally and results in the existing, overstrained behavioral health workforce for children and adolescents having very large caseloads and underutilization of services that would be available to consumers given sufficient numbers of providers locally. Although there are a number of factors contributing to underutilization of available resources for children and families, among the most glaring is the overall shortage of adequately prepared behavioral health providers.
The behavioral health service provider shortage in Texas, particularly in Nueces County where Corpus Christi is located, is a complex issue requiring an intentional solution. As depicted in the table below, the shortage is prevalent across the continuum of service providers. The evidence base for prevention and intervention is convincing and it is apparent that when youth and families have access to quality services, quality outcomes follow. As a result of quality mental health services, youth can alleviate psychiatric symptoms, develop adaptive coping skills, and pursue meaningful, productive lives in their communities.
Table 1. Number of Behavioral Health Providers in Texas 2000-2013
Year / Texas Population / Psychiatrists / Social Workers / Marriage and Family Counselors / Licensed Professional Counselors2000 / 20,945,963 / 1,422 / 14,549 / 3,417 / Not available
2009 / 24,782,302 / 1,634 / 16,574 / 2,789 / 15,686
2013 / 26,528,398 / 1,200 / 18,785 / 3,062 / 18,641
Source: Texas Department of State and Health Services, Professional Licensing and Certification Unit
Demographics of the population. Best practices for behavioral health intervention account for the influence of culture and diversity within treatment. The Hispanic population is one of the fastest growing groups in the United States with Mexican Americans making up the largest sub-group of the overall Hispanic population (U. S. Census, 2012). As an example, the city of Corpus Christi is approximately 60% Hispanic. However, within South Texas the population of children, adolescents, and transitional-age youth who are Hispanic has surpassed the prevalence of their Anglo and African American counterparts combined. Furthermore, among the behavioral health providers that are located in Texas, the Spanish-speaking and culturally diverse workforce is greatly underrepresented. Therefore, we need to address the disparity of cultural and diversity issues between providers and the child/adolescent treatment population in South Texas, especially for those children and adolescents from a Hispanic population background. TAMUCC has been designated as a Hispanic-Serving Institution (HSI) and, as one of the largest providers of masters and doctoral graduate degrees to Hispanic students in Texas, is poised to train a behavioral health workforce that is sensitive to Hispanic culture, diverse in nature, and qualified to provide evidence-supported interventions.
The ability of Texas to grow, prosper, and innovate depends on the wellbeing of Texas youth. With a population of approximately 7 million youth Texas accounts for 1 out of every 11 youth in United States. The Center for Public Policy Priorities (2015) reported that more than 1.7 million of those youth live in poverty. This is an increase from the 18% prevalence rate reported in 2011. As HRSA is well aware, children living in poverty tend to have worse mental health and academic outcomes than their counterparts which can put them at risk for developmental instability across the lifespan. A report by the Center for Juvenile Justice Reform went further to declare that children who are raised in poverty are at increased risk for juvenile justice involvement and development of behavioral health disorder symptoms. As evidence of this phenomenon, the Texas Department of Juvenile Justice (2012) reported 71,334 criminal arrests by Texas youth ages 10-17, many of whom received mental health screening and subsequent service referral. Among these youth, 49% were Hispanic, 25% were Anglo, and 25% were African American. When considering that only 29% of the estimated 155,000 Texas youth ages 9-17 who are experiencing behavioral health symptoms are receiving any intervention, it is apparent that there is a gap between the need for mental health service provision and the number of services being delivered.
Table 2. Ethnicity Demographics in Texas, Nueces County, and Corpus Christi
Anglo / Hispanic / African American / Other / TotalAll Texas Residents / 11,726,276 / 10,513,214 / 3,369,620 / 1,347,848 / 26,956,958
Nueces County / 110,072 / 222,281 / 15,674 / 8,194 / 356,221
Corpus Christi / 106,704 / 191,299 / 13,778 / 8,653 / 320,434
Youth
in Texas / 2,419,656 / 3,487,152 / 853,996 / 355,833 / 7,116,637
Youth
in Nueces County / 19,183 / 63,676 / 2,886 / 4,379 / 90,124
Youth
in Corpus Christi / 82,672
Sources: United States Census Bureau and Kids Count Data Center.
Needs of the behavioral health workforce in South Texas. Texas and specifically, South Texas need additional resources to address the disparity between the current behavioral health needs of Texas children and the number of culturally sensitive and qualified service providers. Reviews completed by the Hogg Foundation and Texas Center for Public Policy Priorities suggested that, at present, Texas and Nueces County in particular is at a critical mental health tipping point due to several key issues affecting access to behavioral health services for children including: (a) an aging mental health workforce that is beginning to retire, (b) recruitment and training challenges for mental health professionals, (c) lack of Texas mental health professional internship sites, (d) lack of cultural and linguistic diversity in the workforce, causing a significantshortage of mental health providers withthe knowledge, training and skills toserve people who speak languages other than English or are of racial or ethnicminority populations, and (e) increased demand for behavioral health services. These identified barriers were corroborated locally in a 2013 study completed by the TAMUCC Social Sciences Research Center that surveyed 669 patients of a large hospital system in Nueces County and surrounding counties, as well, as reviewed Coastal Bend Health Systems data of 214,651 patients.
Taken together, these groups identified the imminent need for funding to recruit and train the next generation of behavioral health service providers that specialize in the treatment of children and are culturally sensitive to the growing influence of Hispanic culture. Meeting this challenge is daunting in the Texas socio-political climate wherein funding for community mental health services is increasingly diminished and tuition costs at quality, accredited state and regional mental health service provider training programs is steadily increasing. Because this issue is multifaceted, the solution to stimulating a short-term, yet sustainable impact must be as well. Because of the behavioral health workforce shortage in Nueces County, TX, the existing system capacity cannot meet the needs of children and adolescents. The SPARC program will help reduce this deficit by strengthening organizational interventions to improve health outcomes along the behavioral health continuum. With appropriate support, TAMUCC can increase its ability to address that disparity.