To support mental wellbeing across Texas, we need to build community mental health into the design of the public sector. Considering the historic challenges to funding the public mental health system in Texas (much less reforming it), this is a tall order indeed. However, the first step in tackling systemic transformation is to recognize the efficacy of large-scale changes implemented in other cities and states that have improved mental health at a population level. Below, I’ve listed five ambitious, evidence-based measures that will do just that.
1) Implementing community-led policy. In recent years, governmental agencies have turned to community in-reach methods, like town-hall meetings, community dialogues, civic ethnographies, and surveys as methods to assess the issues that greatly affect their constituents’ quality of life. These models can help us to develop highly responsive governance systems that address community needs in real-time.
Justification: Given the erosion of public services over the last four decades, government officials need to have real conversations with communities about their strengths and needs. They need to create responsive policies to the economic crisis facing the vast majority of Americans, which studies have shown contribute to poor mental health.
2) Creating mental health/substance use jail diversion programs, via mental health/substance use specialty courts and the adoption of tribal/rehabilitative models of care within the criminal justice system. Justification: Mass incarceration contributes to poor mental health outcomes and worsens the prognosis of people with mental health challenges and criminal justice histories.
3) Increasing the number of school counselors and teachers trained in restorative justice techniques and neurodiversity support, and ending student suspension in the public school system.
Justification: Young people with behavioral health needs can be taught to recognize their emotional patterns and find productive ways to channel their energy. This method to de-escalate intense situations can lower the potential for students’ future criminal justice involvement.
4) Integrating health care services across criminal justice, physical healthcare, and behavioral health care systems. Our system often fails to ensure that public hospitals are able to access the medical records of those treated in other public institutions, such as the public behavioral health system. The first step to tackle this issue is the creation of shared medical records across public institutions.By sharing medical records within public institutions that provide health care and by increasing the number of social workers to support people through transitions to and from public institutions, we can prevent the number of avoidable emergency room visits and other large public expenditures caused by systemic failures in disease management.
Justification: Continuity of care relies upon open and thorough communication across health care teams and across all public institutions that provide healthcare to their patients.
5) Training health care providers, social workers, and other direct service providers on structural competence and trauma-informed care via continuing education and reform to health professions education.
Justification: Health care providers often feel the effects of burnout and compassion fatigue in their work, yet lack a robust framework to understand their suffering and the struggles of their patients. Training modules on structural competence is the first step for practitioners to connect their struggles to political and economic conditions that affect patient outcomes. In turn, health care providers can push for systemic transformation in upper administration that will build resilience at all levels of their organization.
In a time in which Americans report high levels of anxiety and fear for their futures, we need a bold vision to address the systemic causes of this epidemic. We need to articulate the connections between the everyday issues that affect our mental wellbeing and invisible yet all-pervasive stressors that affect our lives. We must work toward this vision by increasing our civic engagement in Houston. To do so requires that we first listen to community strengths and needs, then tackle poor mental health by addressing its root causes.
Dr. Erica Hua Fletcher
Zorich Fellow in Mental Health Policy