Partnerships with providers across the region indicate a bright future to come.
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Right now, across the state of Texas, children struggling with mental health issues are waiting to see a psychiatrist. They've been waiting for months, and they'll be waiting for many more.
And the real tragedy of the situation is when they wait that long for a solution and it's not the solution they need.
“It breaks our psychiatrists' hearts when we have kiddos who have been waiting several months, or in some places up to a year, to come in and see a psychiatrist – especially when they don't need medication management, but instead their parents need parenting classes to help manage behaviors or there's a workbook the family could have gone through, self-paced, at home,” says Nancy Trevino, director of the Texas Tech Mental Health Initiative (TTMHI). “They could have already been on their way to recovery, doing much better, but they've been waiting a long time to see the psychiatrist, which was not the appropriate level of care for them. That also creates a bottleneck for those kids who do need to see the psychiatrist.”
The situation is no better for adults, Trevino notes. But as a Texas Tech University alumna who earned her bachelor's, master's and doctoral degrees in human development and family studies and a board member for the Lubbock Area United Way, she is both deeply connected to the community and well positioned to benefit it.
So, with Trevino at the helm, the TTMHI is doing just that.
Five years ago this fall, leaders from Texas Tech and the Texas Tech University Health Sciences Center (TTUHSC) began assessing the mental health-related activities at each institution. Texas Tech had experts in psychology, the study of the human mind and its functions, and couple, marriage and family therapy. TTUHSC had experts in psychiatry, the study and treatment of mental illness, emotional disturbance and abnormal behavior, as well as mental health counseling and mental health nursing. Both universities offered counseling services to their faculty, staff and students.
But these leaders quickly decided taking care of their own people was not enough. As corporate citizens of Lubbock and West Texas, the institutions also had a responsibility to help the people in the areas they operated. The leaders envisioned a collaborative approach to mental health in which the universities of the Texas Tech University System contribute their expertise to solve problems in their communities and model solutions for the rest of the state and nation.
Of course, such a large, collaborative approach needs one entity to oversee it. So began the TTMHI, intended to coordinate mental health efforts to avoid duplication and encourage collaboration, serve as a repository of systemwide knowledge on mental health, look for ways to apply research findings in clinical practice and advocate for integrating best practices into public policy.
The leaders found a wealth of expertise across Texas Tech and TTUHSC, so they created university partnerships with more than a dozen areas dealing with mental health. From Texas Tech came the Burkhart Center for Autism Education & Research within the College of Education, the Center for Adolescent Resiliency and the Family Therapy Clinic within the College of Human Sciences, and the Department of Psychological Sciences and its Psychology Clinic within the College of Arts & Sciences.
From TTUHSC came the Campus Alliance for Telehealth Resources, the Center for Superheroes and the F. Marie Hall Institute for Rural and Community Health, as well as the Graduate School of Biomedical Sciences, the School of Health Professions, the School of Medicine and its Psychiatry Clinic, and the School of Nursing.
Then, the TTMHI began to expand.
By September 2018, the TTMHI had partnered with a group of stakeholders from across the community: representatives from the city of Lubbock, Lubbock County, University Medical Center, Covenant Health System and StarCare Specialty Health System, in addition to those from Texas Tech and TTUHSC. These seven entities were nicknamed the Big Six, stemming from a general tendency to unite Texas Tech and TTUHSC, even though they are separate universities.
One of the group's first goals was to study the existing mental health resources in the area, so it commissioned the Meadows Mental Health Policy Institute – Texas' most trusted source for analyses of effective and efficient mental health policy and programs – to conduct a mental health needs assessment, focusing on Cochran, Crosby, Hockley, Lubbock and Lynn counties.
After the report was finalized in December 2019, the Big Six intended to review it, then conduct a strategy session to better align the various programs already available. However, something happened that they couldn't have anticipated.
“During that review time, COVID-19 hit,” Trevino said. “Obviously, those were all major players for our COVID-19 response, so this got put on the back burner a little bit.”
It wasn't there as long as you might think, however. Trevino was hired in April 2020, and in July, the Big Six came together to review the report. At that meeting, they named the group the West Texas Mental Health Collaborative. With the realization that more partners would be needed to carry out the work that needed to be done, the Big Six were officially designated as the Founding Parties.
“We do want to grow the group, and in order for our system of health care to improve, we're going to need to,” Trevino said. “It's not going to just be the Big Six; we need the entire community to participate.”
It's well on its way. Since expanding, the TTMHI has added partners in the Texas Tech Department of Community, Family & Addiction Sciences, the College of Media & Communication, the Department of Sociology, Anthropology, and Social Work, Texas Tech Athletics and the School of Law, as well as on TTUHSC campuses in Amarillo, Abilene and the Permian Basin.
Crisis response, substance use
One of the collaborative's first priorities moving forward is to improve emergency access to mental health services for a person in crisis.
“When you see somebody in your neighborhood talking to themselves, or whatever it may be, and you call the police, what's going to happen at that point?” Trevino asked. “And how do we evaluate those individuals to determine what's the best place for them?”
Right now, many wind up in the Lubbock County Detention Center – a situation County Judge Curtis Parrish is not satisfied with. Part of Parrish's job is that, when people are having mental health crises that could make them a danger to themselves or others, he can commit them to a mental facility for a set period of time while they receive treatment.
“Our detention center is the largest mental health hospital in Lubbock County, so it's very important for us to be a part of the mental health solutions,” he said. “We want to make sure those who are in our detention center are the ones we really need to hold on to. And if you're only there because you're having a mental health issue, we need to get you out of there and we need to get you help in our community.”
To do that, the West Texas Mental Health Collaborative established its first work group to address the region's crisis response and procedures.
It brought together representatives of the Lubbock County District Attorney's Office, local courts, Police Chief Floyd Mitchell, Lubbock County Sheriff Kelly Rowe and other law enforcement and mental health providers. The group is facilitated by Brian Shannon, a Horn Distinguished Professor in the Texas Tech School of Law who quite literally wrote the book on mental health in the criminal justice system – he's authored or co-authored six editions of “Texas Criminal Procedure and the Offender with Mental Illness.” Shannon also serves on the Texas Judicial Commission on Mental Health, chairs a legislative subgroup and is a member of a Model Law Drafting Group attempting to develop new national standards for court-ordered mental health services.
“We're really fortunate to have the expertise to be able to facilitate these conversations that are community wide,” Trevino said.
“This is a passion for everybody: making sure that, in a crisis, we respond appropriately and the person gets connected to the appropriate level of care. It may be jail – we're not going to say we defer everybody from going to jail – but it may be hospital services. They may be experiencing psychosis, where they need to go to a special mental health facility, but it also may be some sort of mental health challenge that's exacerbated by substance use, or it could just be substance use. So, that's why we're looking at growing the continuum of care – to be able to provide care for all of these people.”
A second workgroup will focus on treatment and prevention for people dealing with substance use as well as education and training related to their needs. Lubbock currently has providers for adults and providers for adolescents, Trevino noted, but the goal is to grow those two groups and bridge the gaps in services.
“We have very sparse services and just a few service providers, so we're trying to grow that and seek additional resources,” Trevino said. “We're working with our faculty from Texas Tech, TTUHSC and several of our community agencies to see what we can do to really leverage the information and expertise we have to bring in more resources to be able to provide more services. But, not just provide services, provide quality services, and really build something that could be the model or the standard across the nation.”
The West Texas Mental Health Collaborative's progress really speaks to the recommendations it received in the Meadows report. The takeaway was Lubbock already had a lot of collaboration, but there was very little coordination. Because of that, there was some duplication of services and some gaps that were going unfilled.
Through its work, however, those gaps are becoming smaller.
One notable example is mental health care for children. In 2019, the Texas Legislature created the Texas Child Mental Health Care Consortium. Like the West Texas Mental Health Collaborative, its goal is to leverage the expertise and capacity of the health-related institutions of higher education to address urgent mental health challenges and improve the mental health care system, but its focus is specifically on children and adolescents.
Through their positions, Trevino and Dr. Sarah Mallard Wakefield, chair of the TTUHSC Department of Psychiatry, are members. In that capacity, they're helping to develop programs that provide telehealth consultations to primary care physicians and mental health care for students in collaboration with schools throughout the region using telemedicine.
“If a family practice doctor or pediatrician calls about a kiddo who's in their clinic who is having a mental health challenge, and they're not quite sure what to do, they can call an 800 number that's the same across the state of Texas, it'll roll over to our regional hub and we'll be able to have a consult within 30 minutes,” Trevino said. “The goal is to get young people a treatment plan they need from their primary care physician, who has talked with from a board-certified child or adolescent psychiatrist, before they leave the clinic.”
Similarly, if a student or parent notifies their school of a mental health challenge, rather than a physician, the school can arrange for a telehealth assessment and up to four sessions for that student with one of the program's licensed clinical social workers, licensed professional counselors, psychiatrists or psychologists. If they need additional services or supports, the team can connect them with local providers to continue care.
Texas is the 30th state to implement such a plan, Trevino says. While the national average wait time to see a psychiatrist is about a year, states with similar programs have reduced that wait time to about a month.
“One of my favorite things about West Texas and the Lubbock community, specifically, is that we are big enough to have really great clinicians and experts in many different fields, so we know the people who need to be at the table for the solutions, but also, we're small enough to actually all get to the table,” Wakefield said. “I think this is a really key thing about our community. Coming together, we have the ability to make some real change that, in larger communities or smaller communities, they're not able to effect that rate of change. So, I'm excited for us to all come together and be a model for other communities on the solution.”
Making an impact
Trevino notes that, because the Meadows report was conducted before COVID-19, some of the mental health needs in the community may now be even higher priorities than they were. Substance use has increased, for instance. The increase in virtual learning has corresponded with an increase in cyberbullying. Crisis response, in light of the Black Lives Matter movement in particular, also has moved into the spotlight.
But at the same time, COVID-19 reflected the strengths of West Texas.
“Because of the foresight of the 86th legislative session in providing funds to support mental health care, we were able to support kiddos using telemedicine, which we at Texas Tech are really good at,” Trevino said. “We were able to leverage that expertise and continue to provide mental health services. While other communities had to stop and pivot because they were doing everything in person, we already had some of the capacity built for telemedicine, so we were able to provide services for those kiddos and those families where other places weren't able to. They had to develop their infrastructure where we already had it.”
Another thing COVID-19 changed was people's willingness to accept and participate in virtual events. In addition to the socially distanced connection it provided over the past year – which was important for many people's mental health – this willingness will have an even greater impact on mental health going forward.
On July 16, the TTMHI, the West Texas Mental Health Collaborative and others across the region will host a mental health conference through Zoom for all the practitioners in its 86-county coverage area, featuring experts from Texas Tech and TTUHSC. A substance use treatment, intervention, prevention and awareness track will highlight the Center for Collegiate Recovery Communities and its work. Other tracks will focus on crisis response, child and adolescent mental health and other menal health topics.
There's a long road ahead, Trevino notes, but the vision is one worth striving for.
“When the work to improve the mental health care system in West Texas is completed, we will have a coordinated continuum of care that includes all levels of care from prevention, early interventions, intensive outpatient care and inpatient care,” she said. “We will have a network of providers at every level, from those who can provide psychotherapy, what people know as ‘talk' therapy, to our medical physicians in psychiatry who work together as a team for the care of patients and their families.
“We will have had success with the education and training opportunities that support primary care physicians and help them develop the skills they need so they feel more confident in connecting their patients with mental health care and providing medication management in the primary care setting for those who need that. Another milestone would be having fewer people present with mental health crises at our hospitals or through involvement with the justice system because they will have had the ability to seek services and enter treatment before that time.”
To get there will require a true community effort, she emphasizes, with West Texans helping West Texans. But the collaboration she's seen already is an encouraging sign of what's to come.
“I'm excited at all the positive impact the Texas Tech System can make for the community, but it's not Texas Tech fixing the community,” Trevino said. “It's Texas Tech truly partnering and collaborating with our community agencies and entities so the programs, initiatives and projects we put in place are sustainable and live beyond us. People transition and things occur, but the potential for change and systemwide improvement is really exciting to me.”
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