Texas wants to expand mental health services for students. Are there enough doctors?

As state leaders look for ways to shore up Texas’ youth mental health system following last year’s massacre at an elementary school in Uvalde, lawmakers are considering doubling funding for a mental health consortium that provides school-based telehealth care to students across the state.

But leaders of the consortium say a lack of mental health providers in Texas hamstrings their ability to get those services to every student who needs them.

Early drafts of state budget bills in both the House and Senate call for the state to double funding to the Texas Child Mental Health Care Consortium, giving it $140 million annually in the 2024 and 2025 fiscal years. Officials at the consortium and John Peter Smith Hospital, which handles the consortium’s telehealth services in the Fort Worth area, say they’re working to expand the Texas Child Health Access Through Telemedicine program to every school district in the state that wants to adopt it.

Consortium was founded after Santa Fe school shooting

State lawmakers established the consortium in 2019 following the previous year’s shooting at a high school in Santa Fe that left eight students and two teachers dead. Besides offering school-based telehealth services for mental health, the consortium also connects pediatricians across the state with mental health experts at 12 Texas medical schools. Those experts can offer pediatricians advice when patients show up in their offices with mental and behavioral health issues that they don’t feel prepared to address.

Although the program grew out of conversations around student mental health in the wake of the Santa Fe shooting, its founding was better timed than lawmakers could have anticipated: In the spring of 2020, just as the consortium was beginning to make its programs available to doctors and school districts statewide, the COVID-19 pandemic reached Texas, leading districts across the state to shut down their school buildings and switch to online learning.

Teachers, school counselors and mental health practitioners have worried about how students have been affected by the isolation of remote learning, as well as job losses, deaths and other family disruptions brought about by the pandemic. In December, Texas Children’s Hospital reported an 800% spike in the number of children showing up in its emergency rooms with severe mental illness.

Student mental health again became a key issue for Texas lawmakers after last year’s shooting at Robb Elementary School in Uvalde that left 22 people dead, including the gunman. In December, a special Senate committee released an 88-page report outlining recommended policy changes intended to prevent similar tragedies. Among other recommendations, the committee suggested that the legislature monitor and support the expansion of the telehealth program, with the goal of making it available to every district across the state. But the committee acknowledged that doing so would require significantly more mental health professionals than the state currently has.

In January, Gov. Greg Abbott listed expansion of mental health services as a part of the broader priority of improving school safety during his inaugural address. He pledged not to let the legislative session end without making schools safer.

“We must prioritize protecting students and staff,” Abbott said. “We must provide mental health services to students who need it. Parents must know that their children are safe when they drop them off every morning.”

Med schools struggle to find mental health care providers

The telemedicine program offers students four virtual visits with a mental health care provider. If the student needs ongoing care at the end of those four visits, the program works with their family to connect them with a provider in the community. School administrators refer students to the program, but parents must consent to treatment.

Dr. David Lakey, the presiding officer of the consortium, said the group is working to make the telehealth program available to any school district in the state that wants to participate in it. Lakey, who serves as vice chancellor for health affairs for the University of Texas System, said a small number of districts in the state aren’t interested in adopting the program because they already have something similar in place. As of Jan. 31, 528 of the state’s 1,021 school districts were participating in the program, according to the consortium.

Although the new money included in budget proposals would help the consortium expand telehealth services to more school districts, Lakey said he reminds lawmakers often that the state’s medical schools are struggling to hire enough people to provide those services. Texas has had a shortage of mental health providers for years. The Texas Tribune reported last month that those workforce issues are expected to worsen over the next few years, as more providers reach retirement age and the state’s medical schools struggle to produce enough graduates to replace them.

Another component of the consortium seeks to boost the number of mental health providers working in Texas. The program creates new child and adolescent psychiatry fellowship programs across the state, including at JPS. Although that program is already on track to boost the number of psychiatrists working in the state, it does nothing to address a lack of psychologists and licensed counselors, which Lakey said the state also needs to tackle if it hopes to have a robust mental health care system.

Lakey said the telehealth program can never replace school counselors or other mental health professionals Texans need. But it can help the state make the best use of the resources it has for helping students with mental health issues, he said. He hopes the program can be an asset for counselors in cases where their students need more intensive care than they’re able to provide..

JPS sees uptick in kids needing mental health care

Jessica Virnoche, a spokeswoman for JPS, said in an email that the medical system has seen an increasing number of children coming to its psychiatric emergency center requiring hospitalization. Although the growing number of students with mental and behavioral health issues is cause for concern, Virnoche said some of that uptick may also be due to an increasing willingness among students to seek help for those issues. The state telehealth program is one of several community efforts targeting school-aged children seeking to connect them with mental health services, she said. The program, and others like it, have reduced barriers to mental health treatment for students who need it, she said.

Expanded funding would allow JPS to offer those services to more schools in the Fort Worth area, Virnoche said. It could also help the consortium expand its contacts with primary care doctors, who often take over students’ behavioral health care after the four telehealth visits are exhausted, she said. Expanded funding would also mean more training opportunities for doctors and therapists who want to specialize in behavioral health, which could help address the state’s shortage of mental health care providers, she said.

Virnoche declined to comment on whether JPS leaders were confident they could recruit enough providers to expand telehealth services.

Telehealth offers lifeline for FWISD students as providers shift to private practice

The Fort Worth Independent School District was the first district in the area to sign on to the telehealth program. Ottis Goodwin, the district’s director of family and community resources, said adopting the program early on gave the district an advantage, because for the first year, Fort Worth ISD was the only district partnering with JPS. But as the program has expanded to other districts in the area, he’s noticed that the hospital’s providers are stretched thinner than they were. Still, he said the program has a good infrastructure in place, and its providers generally do a good job of communicating both with the district and with parents.

Goodwin said the program has been a lifeline for many students in the district who need help. Over the past few years, he’s noticed more licensed counselors in the Fort Worth area moving to private practice, leaving fewer options for children who are uninsured or covered by Medicaid. The large majority of students in the district fall into those two categories, he said. The telehealth program allows the district to get its highest-need students an appointment with a mental health care provider fairly quickly, without them having to be placed on a waiting list, he said.

It’s important that students suffering mental health issues get the help they need early, he said, before those issues start to affect other parts of their lives. When students are struggling with a mental health issue, there’s a good chance it will affect their ability to focus, he said, which will affect them academically. The sooner the district can get them care, the better their chances of heading off the worst of those effects, he said.

Northwest ISD adopts mental health telemedicine services

The Northwest Independent School District’s Board of Trustees voted to adopt the program at a Feb. 13 meeting. The district hasn’t yet begun offering telehealth services through the consortium.

Jamie Farber, director of guidance and counseling for Northwest ISD, said she had some initial concerns about how well the program would work in the district. The school district, which covers parts of north Fort Worth and its northern suburbs, stretches across parts of three counties: Tarrant, Denton and Wise. That complicated matters, Farber said, because under the consortium’s structure, students in Denton County would have been sent to service providers in Dallas, while the rest of the students in the district would have seen providers in Fort Worth. But JPS agreed to accept students from across the district, she said, meaning Northwest ISD students in all three counties will receive services through a single hub.

Farber said she was also initially concerned about finding private rooms in each school for students to talk to therapists. Northwest ISD is the fastest-growing district in Texas, and space is generally at a premium in its schools, she said. Most of the consortium’s providers only offer telehealth services between 8 a.m. and 5 p.m., meaning many families would have to pull their children out of school so they could participate in their appointments at home, she said. But JPS agreed to extend those hours until 7 p.m., allowing students to talk to therapists from home after school, she said.

Farber said her thinking about the program changed when JPS was willing to be flexible on some of the logistical challenges. One of the key benefits of the program, Farber said, is that telehealth providers don’t simply cut students off after four to six sessions. After those sessions, JPS works with students and their families to find providers in the community who will accept their insurance. Especially for students who need medication management, that extra level of support is crucial, she said.

Although the district hasn’t rolled the telehealth program out yet, she thinks Northwest ISD students stand to benefit from it. Accessing mental health services is difficult, she said, because there aren’t enough providers in the area to meet the community’s needs. School counselors do as much as they can, but they can’t provide much in the way of treatment at school, she said. That has often left parents struggling to find help for their children, she said.

“School counseling is like a school nurse. We’re notifying parents, we’re triaging, we’re asking for their assistance and we’re inviting them to come meet with us and to talk with their child,” she said. “But when it comes to students accessing mental health… it’s largely upon the parents to find those resources.”