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Case Studies

Texas Health and Human Services Commission, Behavioral Health Division

Texas currently invests $8 billion biennially at the state level through general revenue, Medicaid, and local and federal dollars to increase access to behavioral health serves provided by multiple agencies across the entire state. Providing Mental Health First Aid to state employees – particularly those in public school districts – is an integral part of these efforts. Since Fiscal Year 2014, Texas has trained nearly 24,000 school district employees, 3,000 Health and Human Services employees and more than 17,000 community members in Mental Health First Aid.

A Coordinated Multi-Agency Effort to Reform Mental Health In Texas

In 2013, Texas legislators took stock of the state’s mental health services and discovered they were not meeting the needs of the population, as illustrated by the state’s high prevalence of individuals with untreated mental health and substance use disorders. The increased incidence of mental health issues among youth and incidents taking place in schools nationwide were particularly important in generating the necessary political will to address this problem. To improve coordination between state agencies and to create a strategic approach to providing behavioral health services, lawmakers called for the creation of a statewide mental health coordinator position through the 2014–15 General Appropriations Act.

Sonja Gaines, who filled the newly created position of associate commissioner for mental health coordination, soon realized there was a gap in knowledge around mental health among state agencies encountering individuals living with mental illness. Gaines said, “There are several agencies like school districts, criminal justice agencies and child protective services serving children in foster care that all touch people who might have a mental health condition. Some of their employees lacked the basic understanding of how to respond to mental health issues, which impacted individuals’ success.” Gaines continued that she thought this gap could be filled through the Mental Health First Aid training, saying, “We needed an intervention to educate [state employees], and the Mental Health First Aid program could do just that.”

Because of Gaines and her department’s efforts, Mental Health First Aid training soon became available for all school district educators, and eventually expanded to include all staff working in Texas schools. Gaines recalls some of the main reasons for focusing on bringing Mental Health First Aid to school settings across Texas: “[Some children were] ending up in psych hospitals and detention centers as a result of untreated mental illness. Our legislators also wanted to make sure school staff felt equipped to identify and prevent situations such as shootings.”

Besides providing the training to school district employees, other Texas state agencies are working together to provide the training to employees most likely to interact with vulnerable populations, such as military veterans, adults and youth involved in the criminal justice system, individuals with disabilities and elderly persons.

Results of Mental Health First Aid

The Mental Health First Aid legislative initiative passed during the 83rd Legislature authorized the state’s Department of State Health Services to provide grants to local mental health authorities to train school district educators, staff and the general public in Mental Health First Aid. Since 2014, more than 23,000 school district employees and 16,000 community members have been trained as Mental Health First Aiders, and 875 instructors have been trained in Mental Health First Aid through this legislative initiative.

In 2015, Texas authorized additional funding to train employees within the state’s Health and Human Services Division in Mental Health First Aid as part of the Mental Health First Aid Employee Initiative. Since 2015, over 3,000 HHS employees have been trained as Mental Health First Aiders as part of the employee initiative. The various state agencies administering the Mental Health First Aid program are responsible for periodically collecting data to assess the program’s growth and impact.

Surveys show that state employees from multiple agencies have found Mental Health First Aid training to be extremely useful, particularly as it pertains to increasing employees’ confidence and their ability to be more effective when interacting with individuals struggling with mental health issues. Seventy percent of the 166 Texas state employees who responded to a survey considered the Mental Health First Aid training to be extremely helpful or very helpful in enhancing their basic mental health knowledge. Seventy percent of respondents also declared having used the Mental Health First Aid training in the previous six months.

Gaines shared that Mental Health First Aid training has also improved retention in state-funded programs, saying, “People with mental health issues are likely to follow through with treatment and services and we can help them better, since our staff are now able to identify potential struggles.”

Gaines also emphasized how critical responding to mental health issues can be, given that untreated issues can prevent citizens from being able to access services: “Mental illness trumps everything! How can we teach a blind person how to live independently if they’re suffering from severe depression – we must identify and address that problem first.”

Future Direction of Mental Health First Aid

There has been significant progress in scaling Mental Health First Aid across the state of Texas, and Gaines has even bigger plans for Mental Health First Aid’s presence in the state, noting, “The program has been catching on like wildfire, but there’s still a lot more to be done. We must use this momentum and keep building.”

Gaines is working on engaging other stakeholders throughout the state, such as community and church leaders, to join the movement towards increasing access to mental health supports (including Mental Health First Aid) in Texas.