The Senate Special Committee to Protect All Texans met on June 22 to hear invited and public testimony on Mental Health and Firearm Safety. An archive of the hearing can be found here.

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

Invited Testimony

Dr. David Lakey and Dr. Laurel Williams, Texas Child Mental Health Care Consortium

Dr. Lakey

  • Role of consortium is leverage expertise to work with the state to improve mental health services in the state and help children’s mental health
  • Providing an overview of who the consortium works with and how it works
  • SB 11 and the 5 components reviewed, TCHATT will be disused today
  • Provide support for primary care providers so they can care for a child that needs care the day of
  • During special session $113 million given to expand these programs

Dr. Williams

  • CPAN, 30 similar programs elsewhere in the country
  • Used to help primary care physicians and give them quick access to child psychiatric assistance
  • Also want to educate primary care physicians, want them to be comfortable dealing with mental health
  • Number of mental health providers and facilities increasing in the wake of COVID
  • Helped 9,000 families that have called today

Mr. Lakey

  • Goal of ARPA funds, we can bring kids in for in person mental health evaluations
  • ARPA dollars just going out right now, released by Governor’s office in spring so dollars in development right now
  • Challenge with maternal mental health in Texas, developing pilot projects to stand up at 4 sites in Texas
  • Want to see how we can make a program statewide that helps these women
  • Recurring theme through this presentation is workforce
  • There’s a challenge with the mental health workforce in Texas, we need to be able to hire people needed to provide services

Dr. Williams

  • TCHATT program is a telehealth program
  • Healthcare that’s embedded in schools, guided with parental advice and consent
  • Telehealth at a school can be a solution to providing children easy and close access to care
  • Program is trying to embed care into communities to prevent long drives to find it
  • Partner closely with school districts so that we know what they need
  • Can tailor what we provide to each district by what they need
  • 3,000 campuses where TCHATT services are provided, 2 million covered lives
  • Even when schools were closed, we were able to help
  • We work with TEA, education support centers, and local education entities to let people know about TCHATT
  • Very collaborative process where all parties are aware of what is happening
  • Our goal is to partner with any school that wants to partner with us
  • Committed to not just focusing on Urban areas, rural communities are just as important
  • Some schools don’t want to partner with us which is fine
  • Two most common reasons are that they either already have good system in place or they don’t have the resources to implement our program
  • Committed to helping those that don’t have the resources
  • We wanted to make sure we are helping the kids in an equitable way, take race and ethnicity into account to ensure all are treated equally
  • TCHATT is a health care visit so parental consent is needed
  • First the school has to inform parents then our team also has to talk to the parents and ensure care is permitted
  • Privacy is paramount, we do not discuss the child’s care with the schools unless the parents ask or consent to this
  • Our teams can see a patient within two to three days after a referral
  • Usually, can get them in within two weeks but that is due to parental consent and schedules
  • Parents are key in picking what type of care their child receives (psychologist or psychiatrist)
  • Another goal with T chat is to help kids receive specialty care
  • We do not stop seeing children after five sessions, will provide assistance until child has found care they are comfortable with long term
  • To date we’ve served over 18,000 students, more young women than men seeking help
  • Evenly dispersed across ages (1/3rd in lower school, 1/3rd in middle school, 1/3rd in High School)
  • Top 2 reasons for referrals are depression and anxiety followed by anger
  • 17% of kids are referred because of suicidal thoughts
  • Peaks of child mental health care are October, February and March
  • For families you need to see a physician and psychiatrist, we try to get these appointments done on same day
  • To date 45% of kids are coming for the five encounters
  • Most child mental health problems require psycho social or cognitive therapy
  • Half of the kids are being referred to further care
  • The outcomes we have to share are from parents and families, most are saying the service was enormously beneficial
  • If a family was not happy with their experience there is a system for them to voice their concerns

Mr. Lakey

  • ARPA funds should cover half a million additional lives we can cover, help us with goals to expand
  • Seeking to address trauma and anxiety in young kids
  • Starting up a pilot program providing screening for substance abuse
  • Also doing bilingual bereavement services
  • Now addressing some of the challenges we face with expansion
  • Challenge in rural areas due to broadband
  • We are working with local mental health authorities that are interested in bringing this program into their authority (currently talking to 13 that would like to)

Dr. Williams

  • In 2019 there were 27 first year child fellows, this year we’re going to have 46
  • Most individuals stay in the cities and states that they do their fellowships, we want to get them to Texas

Mr. Lakey 

  • A lot of individuals going in to this field are worried about cost of school
  • We should help alleviate this, provide paid internships and scholarship programs
  • Would be good if we had funding to provide free supervisory support to people seeking jobs
  • Training under supervisor is required, wait list’s are long now
  • We would benefit from streamlining this process
  • Programs that we are funded to implement will only be successful if the other aspects of mental health care in the state are up to par
  • Zaffirini – If we adopted or recommended these strategies what impact would have on protecting students, teachers, and Texans as a whole?
    • Lakey – It would help tremendously
    • Without these resources in place these kids will struggle to get on to the paths they should be on
    • Long term solution
  • Zaffirini – Do you have anything that would provide immediate help?
    • Lakey – Our goal is to make this service available to any school that wants it
    • Just hard because we need the workforce
  • Zaffirini – If you looked at the shooters in Texas what ethnic and race demographic would they fall in to?
    • Lakey – I can’t provide exact information to you
    • Mostly white males
  • Zaffirini – How do we overcome implementation challenges with T chat?
    • Lakey – We just have to keep at it
    • Keep doing the work we’re doing and stay collaborating with communities to let them know we are there to help
  • Zaffirini – How do we avoid a stigma
    • Williams – We want to help kids with their problems and to do that we need to know what they are
    • We hope that normalizing this care removes the stigma
    • It’s a public and universal conversation
    • Lakey – These programs help in a number of ways
    • Telehealth and immediate care help families incorporate this into their everyday life instead of going far out of their way and having to explain
  • Zaffirini – What are other ways to help rural communities?
    • Lakey – We need to build up our work forces
    • Programs where we train physicians in those areas help because many stay
  • Zaffirini – Uvalde isn’t involved in the consortium is it?
    • Lakey – No it is not
    • Not a part of the 40% that are enrolled (40% of Texas students are at schools with T chat)
  • Zaffirini – If students are identified with these characteristics should they be prioritized for this care ?
    • Lakey – If teachers find a certain student to be aggressive then we could emphasize getting them the help needed
  • Kolkhorst – You were forced to shut some programs down, was that because of work force problems?
    • Lakey – essentially
  • Kolkhorst – Define the different work force
    • Williams – there are work force services across the board
    • Employees in this field almost all have to go through extensive training
    • Lakey – The type of services provided by T chat only about 15% of participants actually go see a psychiatrist
  • Kolkhorst – How long does this record stay? Is it their permanent record?
    • Williams – It’s on a secured data system
    • It’s a part of their medical records
  • Kolkhorst – Do y’all pay the people at the HRI’s? What is the funding model?
    • Lakey – GR funds and ARPA funds
    • This is made available to anyone regardless of their status
    • It is net free, we don’t charge their health insurance
    • Doesn’t matter what provider they have or if they have health care
  • Kolkhorst – Does TCHATT help with special education?
    • Williams – Regardless of disability if they reach out to our team we’ll help
  • Kolkhorst – How much funding goes to research and how is that defined?
    • Lakey – About 10 million dollars
    • It’s not clinical or bench research
    • We look at depression and trauma that kids are facing
    • We work with ER’s and hospitals and use surveys to find what went wrong
    • See if there is something within the system that led to a child’s problems
  • Kolkhorst – What is conducted with parental consent?
    • Williams – First appointment almost always has parent present
    • If a session doesn’t have a parent present, parents are made aware of everything that happens in session
  • Kolkhorst – Was TCHATT in Uvalde?
    • Lakey – We were working on it but they had not received these services yet
    • Our HRI’s have been providing support to the local mental health authority that was low on work force, we’re providing counselors
  • Kolkhorst – Could T chat reach a kid if they were truant at school?
    • If a kid had these problems addressed earlier, like when in middle school, then we could help to treat as they grow up
    • We catch children that are having issues at an earlier age
  • Hinojosa – Why does your chart say you have had no cases of kids who want to harm others?
    • Lakey – We do reference anger
    • Williams – This is data from schools
  • Hinojosa – If the parents don’t provide consent what happens?
    • Williams – We don’t help
  • Hinojosa – But what if the parents are the problem, you walk away?
    • Lakey – We have to get parental consent
    • Our legislative direction is clear that we can only work after receiving parental consent
  • Hinojosa – We should revisit this because parents can be one of the main problems and it would be problematic if we were unable to help these kids
  • West – There is no profile of a school shooter, is there?
    • Williams – Correct
  • West – Are there some commonalities we should be looking at?
    • Williams – It’s a little out of my expertise
    • I think some later testifiers will be addressing that
  • West – Is compensation a big issue for the work force?
    • Lakey – It’s a huge issue for local mental health authorities
  • West – Is that tied to starting wages?
    • Lakey – Definitely
  • West – What are the unmet needs you are seeing among these work forces
    • Lakey – I can provide you information on the resources
    • Some facilities in the state have 30% vacancies among staff
  • West – Explain the compensation system for the people providing care through TCHATT?
    • Williams – Through the HRI’s
  • West – So we’ve put in over $300m into this correct?
    • Lakey – Over the course of the Biennium, yes
  • West – Who’s responsible for providing services to the region Uvalde is in?
    • Lakey – UT San Antonio
  • West – Had you discussed TCHATT with Uvalde prior to the shooting?
    • Lakey – We had done preliminary outreach, trying to set up meetings
  • West – Do you know what the shortage was with the Uvalde Mental Health Authority work force?
    • Lakey – Should definitely ask them but I think they were above 30%
  • Chair Nichols – How does a school that wants to be added reach out to y’all?
    • Williams – We do constant outreach and we have our contact information on our website for all to see
  • Chair Nichols – Is there a pattern on the age groups of kids who are showing suicidal thoughts?
    • Williams – Not exact figures but it’s more common in middle school and high school students
  • Chair Nichols – How common is it for parents to not provide consent?
    • Williams – It’s rare
  • Chair Nichols – Do you compare notes on best practices?
    • Lakey – We meet with the entire consortium once a month
    • We compare findings with each other
  • Campbell – You don’t have your own providers, you’re liaisons?
    • Williams – We do have our own providers, we hire the authorities
    • Lakey – We just don’t have them in the schools
  • Campbell – There’s a limit of five visits?
    • Lakey – We don’t drop them after five if they still need us
    • But we usually try to get them to long term care by their fifth visit
    • If we haven’t paired them with care we will continue to see them
  • Campbell – Do you provide medication?
    • Williams – If that is advised and parents consent then yes
  • Campbell – Is medication provided through telehealth?
    • Williams – Yes
  • Campbell – How does T chat interface with emergency rooms?
    • Williams – We don’t
    • We’re not available for E.R’s
  • Campbell – Do you consult with parents about outcomes?
    • Williams – Yes the parents are involved every step of the way
  • Campbell – Is it all online appointments?
    • Williams – Yes
  • Campbell – What do supervision clinical*
    • Lakey – There’s set hours that social workers have to meet before going in to practice, takes about two hours
  • Campbell – Could we get to a point in the future where too many kids are seeking mental health help?
  • Bettencourt – If someone is outside of the service area for T chart do you provide referrals?
    • Williams – We currently just can’t help them
  • Bettencourt – What is the total number of patients?
    • Lakey – We’ve provided care to 10,000 under CPAN and 48,000 through T chat
  • Bettencourt – How does this program help? Where can we expect problems to be identified?
    • Lakey – We want to be able to provide services to schools so they can make referrals to us when a young child with issues is identified
    • We’d be able to find them the care they need when they need it
    • Williams – Most children don’t need extended services but we do everything to ensure that no child gets left behind
  • Bettencourt – How do we get around not having parental involvement? How does this program address the messy realities of life?
    • Lakey – The work we do doesn’t replace the family or the role of parents
    • What’s being funded here will never replace what having a good family provides
    • Our focus is providing care to anyone that needs care at no cost to them
  • Hall – Will we ever get beyond the point where we can service the entire state?
    • Lakey – You see increases in mental health problems because of the way the world has been the past few years
    • We’re trying to help you leverage what you have the best you can
  • Hall – What are we doing to determine what should be the standard of care in regards to prevention?
    • Williams – It’s a multi factorial answer
    • A lot of the research underway is addressing this specific question
  • Hall – Would it be within the standard of care to suggest that they develop a closer relationship with God?
    • Williams – We’d have to understand where families are coming from
  • Menendez – Have you tried to make a parallel between someone’s mental health and their physical health to help alleviate the stigma?
    • Williams – It is definitely an aspect of your physical health
    • Your mind is just as important as any other part of your body
  • Menendez – Are there habits we could encourage that would help with mental health?
    • Williams – Yes
  • Menendez – As you learn and identify the best practices could you use this information to help schools implement programs that enforce these?
    • Lakey – We’re constantly in contact with TEA and we could advise them
  • Menendez – Would it be helpful having counselors in schools and training teachers on mental health?
    • Williams – Yes
    • We currently do provide education to schools
    • Lakey – It is hugely important that kids have in person help

 

  • Kolkhorst – We need to address that some kids are a true threat to society, they need to be disciplined more than they are now when a threat is made
  • Robinson – We do need a system that addresses this because it is a problem since these kids all end up in our public schools
  • Kolkhorst – We need to discuss this as a body, if someone makes a threat of violence do they deserve to go back to school
  • West – What do we define as a threat? Is I’m going to beat you up a threat?
    • Kolkhorst – We’re talking about when a kid threatens to kill someone
  • West – We need to be careful about this to ensure profiling doesn’t happen and its hard to verify whether someone is a real threat

 

Sonja Gaines and Chance Freeman, Texas Health and Human Services Commission

  • Gaines – Council made up of 23 state agencies
  • Group meets on a regular basis and have produced a number of quality outcomes
  • $8b spent across on behavioral health service across all of these agencies
  • We work with our 39 local behavioral health authorities
  • Each provides a standard array of services
  • Services included to children, adults, and those in crisis
  • Peer services are an integral part of this
  • Through local authorities we have hundreds of beds available in communities
  • Crisis service array provides 24/7 services through a call line
  • Required to have mobile crisis outreach teams with certified staff that can go and respond
  • Mental health first aid
  • Over 100,000 individuals have been trained
  • Variety of programs serving hundreds of thousands of people and their mental health needs
  • The work force is a challenge we’re facing
  • Our local authorities are servicing over 300,000 people
  • There are assessments in place that determine what level of care individuals need
  • Some getting in person care some only need online check ups
  • 50% vacancy rates in some areas are devastating
  • It is doubling or tripling caseloads which leads to people burning out and not being able to provide the best care
  • The availability of in-patient beds has also become a problem, especially since the pandemic
  • Another challenge is the forensic cases we have now
  • We have set up a hotline that has received 335 calls since the Uvalde shooting
  • The federally qualified health clinic in Uvalde has been fantastic, has served over 700 members of that community
  • Freeman – We take a notion of all hazards, regardless of what it is we respond
  • In Uvalde we established the immediate response unit to help with the communities recovery
  • We coordinate with local leaders and mental health authorities to help maximize the availability of resources
  • If it’s a federally classified crisis we can request federal funding
  • If it is a crime then we cooperate with the governor’s office to ensure the best response
  • Chair Nichols – How many people do you have in Uvalde?
    • It varies
    • We had over 70 first responders there
    • Reporting to local hospitals we had a team of 5
  • Kolkhorst – Did the LMHA there serve over 1,600 individuals?
    • Gaines – Yes, we provided them with mental health support
  • Kolkhorst – Why did the mental health first aid program have a dip in FY 22?
    • Gaines – A lot of that is because of COVID and we haven’t bounced back yet but we will soon
  • Kolkhorst – How do y’all measure outcomes?
    • Gaines – There’s many performance measures
    • One of them is our ability to keep people in the community
    • Another is to measure how engaged patients are with their treatment and medication
    • Less than 2% of the individuals involved in our programs end up in prison or homeless
    • We keep track of outcomes on every program
  • Kolkhorst – How can we see this?
    • Gaines – I can get it to you
    • On the grant programs we have report cards
  • Kolkhorst – Where in our system would the Uvalde shooter have gotten referred to service? How does someone who’s truant get help?
    • Gaines – It’s a challenge
    • The Uvalde school districts were heavily involved in mental health first aid
    • Mental health is everyone’s business
  • Kolkhorst – How are we doing on getting more beds to people in rural and urban communities alike?
    • Gaines – It’s going well, thank you so much for the funding because it has been a huge benefit
    • The value and benefit of these beds can not be stressed enough
    • We just need more beds
  • Perry – Are they building a new center in Midland/Odessa?
    • Gaines – I’m unsure
  • Perry – We don’t have bed space for minors do we? What is our capacity for minors?
    • Gaines – You’re right
    • The beds we had for children have diminished through hospitals
    • 80% of children we serve have some kind of benefits like Medicaid
  • Perry – How many beds would we need to meet the inpatient need for minors?
    • Gaines – I don’t have the information but it’s available
    • We have outpatient programs that are successful at keeping kids in the community
  • Perry – Do we have a place to put kids who have made threats outside of the education system before they come back
    • Gaines – The youth empowerment program works with kids, teachers and families and works with troubled children
  • Perry – Do we have an alternative holding cell for these checked out kids before being sent back?
    • Gaines – We don’t right now
  • West – Most of the kids that are shown to have problems are Hispanic and black?
    • Gaines – I’m not the expert on that
  • West – What can be done differently to reassure parents that the counsel is doing everything possible to provide a solution to mass shootings?
    • Gaines – This is a multi-faceted approach
    • We work on the mental health piece
    • A lot of our programs have been really effective
    • We work closely with schools and those programs have been especially effective
  • West – So we already have a structure in place in Texas?
    • Gaines – We have a basic structure of services
    • It isn’t uniform across counties, not all get school based services and those that do don’t have the same ones
  • West – So you recommend uniformity across the state relating to school based services?
    • Gaines – Those programs are having a huge impact
    • I definitely believe that would be a benefit
  • West – Do you have any other recommendations?
    • We have to strengthen the work force
    • More money to fund more services without the work force won’t happen
  • West – What is the case load for most of the individuals in these positions in Texas?
    • Gaines – There are several levels of care
  • West – Is there a national standard for case loads?
    • Gaines – It varies, if you have people that need more focus then you may need to take less cases
    • Each patient set is different and that leads to variations
    • In Texas, office based services can be a bout 250, community based programs are around 30 to 35
  • West – So work force shortage increases the number of people on a case load?
    • Gaines – Correct
  • West – So would you also recommend that we make a standard case load that a work force could maintain?
    • Gaines – Correct
  • West – Do you have any other recommendations?
    • Gaines – No sir
  • West – Have you compared Texas’s mental health structure with other states that have had a school shooting?
    • Gaines – I would not say with other states
    • We have collaborated with other communities like Sandy Hook
    • We see what they have done
    • We’re actually unique in Texas in regards to some of the infrastructure that we have
    • For example, the crisis service array
    • When I have talked to people in other states they haven’t had that infrastructure
    • We’ve done comparisons in regard to service arrays but haven’t talked to them about mass shootings specifically
  • West – Are there any other funds or revenue sources that we should use to make certain that mental health programs are adequately funded?
    • Gaines – We’ve received 250 million dollars in COVID relief funds
    • There are no other ones that have materialized yet
  • Campbell – Comal County is using ARPA funds to make a small mental health facility, could their process be replicated in small counties? Have you heard about that?
    • Gaines – We have heard a number of situations where the county and mental health authority work together to use COVID funding
    • I’ve heard of several cases where expansion of facilities is taking place because of local partnerships
    • Communities are also starting to see the benefits of putting their money into these facilities
  • Chair Nichols – You’ve been heading up that coordinating counsel since Jane Nelson first used the term right?
    • Gaines – I came into the job in 2014 as the first statewide behavioral health coordinator
    • After that Jane Nelson created the statewide counsel
    • Yes, I was on the front end of that development

 

Wayne Young, Texas Council of Community Centers and Harris Center

  • The Harris Center for Mental Health is the largest Mental Health Authority
  • The center serves Harris County
  • 88 care locations, last year served over 90,000 people who received over 1.5 million services across all areas
  • Served about 18,000 youth
  • Thank you for your investments into mental health
  • We partner with ACPC and fund about 170 beds locally
  • We also fund beds in local private psychiatric facilities
  • 2 research studies conducted by UT health this year identified that rehospitalization following specialty care and treatment was significantly reduced
  • Likelihood of arrests and convictions after specialty care was also significantly reduced
  • Multi systemic therapy teams (MST) are another evidence based program out there
  • We operate 2 of these teams, they’re intensive and costly
  • They target at risk youth and have criminal justice involvement
  • One team was funded through our juvenile probation department the other was funded through HHSC
  • Trying to prevent kids from staying in the criminal justice family
  • Of the 185 families those programs have served, 84% of the youth have finished the treatment process
  • 96% remained in their home (didn’t get placed elsewhere) and 88% had no new arrests while engaged in the program
  • The 998 launch is coming up soon
  • We’re one of the 4 community health centers in state that’ll answer those 998 calls
  • We currently answer calls on our crisis line and take calls from the national suicide hotline
  • We’re a certified community mental health center which allows us to coordinate with all of the authorities and entities that are important to work with
  • Our proposed solution to dealing with youth that make terroristic threats is to make a multi agency response team
  • Every school has a threat assessment team, our intention is to have a threat assessment management team that can work with these kids over a longer period of time
  • Our current process does a good job dealing with immediate danger but we need to be better at providing long term service
  • We don’t know how many teams we’ll need yet and we know they’ll be expensive
  • Other communities have used this model
  • We want these teams to tie into the existing threat assessment teams (like a level 1 and level 2)
  • Perry – Does your model envision that child still being at home or would he be an inpatient?
    • We still need to figure that out
    • We need those teams to determine that though, each case is different
  • Perry – I would love your input as you go through setting this up
  • Kolkhorst – What would you do with the kid after your team intervenes, where do they end up?
    • The focus is on how we do long term engagement to ensure we’re keeping tabs on these kids and help them
  • Kolkhorst – We need a place for these kids to go heal with help from expertise, what are those tools what does that look like to you?
    • Placing a child elsewhere is a different conversation
    • There are crisis units and different kinds of beds you can create
    • Residential beds, hospital beds, crisis respite beds
    • Most crisis respite beds are for adults but we want to create more for children
  • Perry – Can you make a statement on the deterrent effect? Could this be a deterrent to bad behavior?
    • I don’t think that any of these things would deter a school shooter
  • West – Would you agree that kids who make threats and have probable cause will go through the juvenile justice system?
    • There is a system in place
  • West – There are people in the juvenile justice system that do additional assessments to determine what the proper disposition of a case would be, correct?
    • Yes, in Harris county it’s actually our physicians that do this
  • West – So there’s a system already in place, wouldn’t another system just be repetitive of the system already in place?
    • To clarify, we’re trying to make a program that prevents kids from ever entering the juvenile justice system
  • Birdwell – Are the processes you’ve mentioned any different for kids that are in foster care and CPS?
    • Every community is a little different
    • We have a program designed for multi system youth
    • They would come to us in a different way and we would provide services in a more coordinated way
  • Birdwell – How do you address the fear of a parent being scared that their child seeking help could lead to them getting in trouble with CPS? What are the things in the psychiatric care arena that ensure we aren’t breaching the parents trust?
    • All of our care is administered in cooperation with families
    • The majority of parental concerns address fear of care being stopped
    • I’ve never seen a kid taken because they sought care
    • There are minimal scenarios where CPS would have to be alerted
  • Perry – Do you rely on schools or do you have your own process to determine when a terroristic threat is made?
    • Most people that come in contact with our team have been referred by the district to the DA’s office for consideration of charges, so it meets the legal criteria

 

Dr. Celeste Caballero, Texas Medical Association

  • Practiced general pediatrics for two years in Lubbock
  • Preventing gun violence is a complex issue
  • Wants to propose a two-pronged approach to curbing gun violence
  • One, we ask that you bolster and support medical mental health systems in our state
  • Two, we ask that you enhance family and child interventions as well as augment investments and social services to build resilient Texas families
  • CPAN is the child psychiatry access program
  • There’s a large shortage of psychiatrists in our state, one estimate is that we’re short about 1,000 psychiatrists
  • A lot of people are first seeking mental health help from primary care physicians like me
  • In my experience with a patient having a mental health crisis I reached out to CPAN and was in touch with them within 5 minutes, the patient saw a psychiatrist by the end of the day
  • It’s important that we talk about adverse childhood experiences (ACES)
  • When children face significant stress and trauma it can significantly affect their mental health
  • These ACES are common
  • Positive experiences with trusted adults in childhood can negate the toxic effect of ACES
  • Campbell – appreciate your focus on the mental health issues

 

Dr. Roshni Koli, Dell Children’s Medical Center/Ascension/Self

  • Addressing firearm injury and mental health
  • Is a licensed psychiatrist
  • Oversees clinical operations for a continuum of pediatric health care
  • Leads Ascensions firearm injury prevention task force
  • Ascensions CEO stated that they view gun violence as a public health issue that must be addressed
  • Ask our elected officials to view the issues on gun violence
  • As of 2019 firearm injury passed locomotive injury as the primary cause of death for children of the US
  • 26% increase from firearm injuries of kids from 0-16 from 2019 to 2022
  • Implementing counseling on firearm storage for families
  • Also educating the next generation of physicians
  • The risk of death by suicide from firearms in youth 4x higher
  • I see first hand the psychological effects that firearm incidents have on children
  • Mental illness in children doesn’t specifically predict violence
  • People suffering from mental health are more likely to be victims not perpetrators
  • Texas children need access to mental health services now more than ever
  • Partnership with UT Austin Dell medical school has increased access to pediatric mental health care in our community
  • UT Austin Dell Med hub has engaged 79% of all pediatric primary care physicians within our 13 county catchment area
  • Partnered with 21 school districts and 299 campuses
  • Provide education and guidance on mental health care of students to teachers and staff
  • Provide urgent assessments often same day
  • Gaps exist even with their policies in place due to a shortages of qualified providers
  • Lack of critical resources in communities bring more children to hospitals with mental health crises
  • Community resources with serious conditions are sparse
  • Partnered with meadows institute in order to identify best practices and solutions to help these children with this particularly vulnerable population
  • Encourage provision and easier access to mental health resources across the continuum
  • Additional resources to provide pediatric crisis stabilization and respit will be vital
  • Support investments in pediatric mental health infrastructure, increased mental health bed capacity and work force
  • Your work on making access to telehealth services permanent is much appreciated

 

Dr. Stephanie Chapman, Children’s Hospital Association of Texas/Texas Children’s Hospital

  • Psychologist and director of primary care at Texas Children’s Psychology Service
  • Wants to talk about a roadmap for children hospital system
  • Massive increase in children with mental health problems since the pandemic
  • Texas Children’s has had 350 mental health crisis patients per month since August 2021, over 400 per month since February 2022
  • First two quarters of FY 2022 referrals for outpatient mental health services has ranked number one at Texas Children’s, more than broken bone settings and other common medical practices
  • These problems are statewide, massive increases everywhere
  • The consortium is amazing but many of the kids we are seeing need higher levels of care
  • Massive problem with hospitals is the lack of inpatient beds
  • Huge gap between hospital care and the step below hospital care
  • A partial hospitalization program would allow hands on treatment while patients get to live their lives, strongly advise this is developed
  • Seeing a lack of residential treatment facility beds, state is working on funding this
  • We have a massive lack of work force
  • Highlights a lack of Spanish speaking caregivers
  • Texas Children’s investing heavily in ways to reconnect youth with their communities of care after being hospitalized
  • They need to be connected with care at home
  • We believe universal screening with parental consent for emotional distress and behavioral disturbances should be made regular at schools
  • Like we verify that kids are vaccinated we would verify their mental state
  • Also recommend that we implement universal mental health education in schools
  • Would include coping skills and recognizing symptoms of emotional distress
  • Both universal implementations would be very low cost
  • Also recommending an increase in behavioral health clinicians on site at schools
  • Would be able to deal with common problems earlier on
  • If schools are screening and engaging in early intervention it will help them identify kids that need more systematic and intensive care
  • Will better help schools address behavioral disruptions and issues
  • Recommending that we improve integration in pediatric primary care
  • It’s a great way to provide easy mental health services in a non-stigmatized way
  • Embedding behavioral health clinicians in the primary care environment would have multiple benefits
  • Adding mental health screenings on to average PCP check ups would help to identify problems earlier on
  • Having behavioral health providers in the environment would provide PCP’s with quick access to specialist care
  • The PCP can even bring the provider into the examination room
  • Kolkhorst – Why do you think the mental health crisis has increased so much since COVID?
    • Social isolation kids faced during the pandemic
    • Shutting down schools, financial stress on families, lack of healthcare providers, etc.
    • There are so many struggles these kids faced that have led to these massive increases
  • Kolkhorst – How do you define the residential treatment facility beds?
    • They are facilities where kids who can’t get better with inpatient or hospital care can receive the close monitoring and intensive care they need
    • Over a series of weeks to months with the goal of having them return to school and outpatient care
  • Kolkhorst – How many beds are in our communities?
    • I don’t have the data
    • I have anecdotal data from my experience of having to beg and wait long periods of time to get kids from hospitals into these beds
  • Kolkhorst – Underscoring that COVID policies have created a mental health crisis that we need to solve
    • Koli – I just want to point out that mental health cases and this crisis were rising before the pandemic
    • You’re right that it was exacerbated
    • However, suicide became the number two cause of death in children age 10 to 19 pre-pandemic
  • Kolkhorst – I agree but you can’t refute the evidence showing that COVID greatly increased this, we must accept that
  • Campbell – Can you comment on the effect of hateful music, video games, and violent movies? Why haven’t we addressed this?
    • There is some study that shows these things can negatively influence kids
    • But the bigger issue that we know is that children who socially isolate themselves because of electronics can face mental health problems
    • Koli – Social media does play a role in mental health
  • Hinojosa – What would you suggest we could do in terms of addressing gun safety, specifically relating to suicides and accidental shootings?
    • Koli – When I identify a patient that is potentially suicidal one of the first things I do is inform the family to make sure they make the home safe
    • We want to ensure that guns are stored properly and suicidal youth can’t easily access them
    • Young people are impulsive and so are these suicide attempts
    • Denying them access to a gun is a huge help in preventing an attempt
  • Hinojosa – What about accidents? I hear about this problem all the time and it seems so prevalent
  • Kolkhorst – Are teenage girls the most at risk youth in terms of suicide and suicidal thoughts?
    • Yes, I see that for self injurious behavior, suicidal ideation and eating disorders
    • With males we see more problems with substance abuse, aggressive behavior, and depression
    • Girls in general are more willing to get help so in many ways its boys that are underserved
    • Koli – I agree
    • I would add that we are seeing an increase in children coming in for suicide attempts who had no history of mental health
    • Also seeing children with preexisting mental health problems that have been exacerbated over the past year
  • Kolkhorst – What are the long term effects of recreational drugs on developing brains?
    • Koli – We’re seeing an increase in substance abuse across the board
    • This has a lot of effects on the developing brain
  • Kolkhorst – What substances are you seeing being used?
    • Koli – Marijuana, vaping nicotine, cocaine, alcohol, methamphetamines and LSD
    • Marijuana’s the most common
    • Worry with these substances and particularly marijuana is that their brains are still forming
    • They can dull their cognitive abilities such as memory
    • Can decrease their overall intellect
    • We are seeing individuals use substances to self-medicate their mental health woes

 

Dr. Andrew Keller, Meadows Mental Health Policy Institute

  • We are in a much better place today to implement additional mental health resources across the state because of your funding and organization
  • We do not rank 49th in mental health funding like certain media sources have said
  • That data is from 2015 and excludes a large amount of funding sources
  • Since the 2015 legislative session we have increased mental health investment by 34%
  • You can only increase as much as your work force makes possible
  • Mental illnesses are discreet and treatable health issues, not brain abnormalities
  • Mental illnesses on their own do not cause violence
  • There are certain illnesses that make violence more possible
  • Statistics on individuals with mental illness are not different from the population as a whole once you factor out substance use and other factors common among both populations
  • There are links between violence and specific mental illnesses
  • Severe mental illnesses drive slightly more risk for violence of any type (self harm included)
  • Mood disorders are primary drivers of harm against self
  • Untreated psychosis makes an individual 15 times more likely to commit murder
  • Wonderful thing about that statistic is that it shows that these illnesses are treatable
  • These are illnesses not evil
  • Two reports in 2021 focused on mass violence provided new information
  • One of the reports analyzed averted plots, shows that plots can be averted
  • A project last year that was based on 170 instances of mass shooting showed that the majority of these are a type of suicide
  • It is a case of individuals giving up hope who want to inflict punishment on those that they hold responsible before taking their own life
  • Very much a mental health component that we can treat if caught early enough
  • Regarding mass shooting in schools all perpetrators are males under 21 who have faced early childhood trauma
  • They’ve displayed behavior problems in school, in general are victims of bullying, have faced suicidal ideation
  • While that is the profile of mass shooters that is unfortunately also the profile of many kids that will never commit a mass shooting
  • They will have problems in life however such as becoming a criminal
  • Over 400 kids were lost to violence last year in Texas
  • First year where losses to homicide surpassed losses to suicide on a per capita basis
  • Black and Hispanic kids are disproportionately affected
  • We’re not just talking about interventions to help that shooter
  • Analogy I use is we have 10,000 kids who fit under this profile, once every few years you might have one that could be led to committing a mass shooting
  • However, the majority of these kids are in systems where they can be helped such as the juvenile detention system
  • The only proven treatment that works for kids of these ages involves caregivers
  • One thing that most predicts treatment failure is the lack of engagement of parents and caregivers
  • There are some real barriers as we try to scale up T chat in schools
  • Biggest barrier is the lack of work force
  • We recommended that the consortium be given the authority to expand the range of partnerships that can be involved so that local mental health authorities and community-based organizations can help surge the work force
  • Important to note that local mental health authorities aren’t losing their work force to other entities in the field, they are losing them to higher paying local jobs
  • Want to emphasize that the cost of the T chat component of the consortium is 25 Million dollars a year
  • For the 18,000 people served by the program last year, the cost is less than a trip to the emergency room
  • The best part of these programs like T chat and the multi systemic therapy (MST) program is that they address these children before they are at the juvenile system
  • MST works more than half the time, is better than residential care
  • We have seven teams currently but want to ramp that up
  • Another treatment that’s for a smaller group is for kids with psychosis
  • Only a small amount of school shooters and kids in general have psychosis, it usually develops at the end of adolescence and early adulthood
  • That subset that does have it need to be provided with the gold standard of care
  • For us that gold standard is called coordinated specialty care
  • We need to make sure this is available and we should work to get insurers to pay for it
  • We also need to respond to children in crisis
  • We have programs in place but for children and families the proven intervention is a person going to the family before the crisis and staying with them for 60 to 90 days
  • There to support them whilst they are in care
  • We think the I Watch Texas program needs to be leveraged to asses and act on school related threats
  • We don’t want mental health providers to be the threat assessors
  • Threat assessors should be individuals in the justice system that can take action
  • Psychiatric bed capacity is greatly needed
  • Our work force needs to be broadened
  • We need to ask our licensing boards to do more to have expedited licensing
  • This would help us to get more supervisors and prevent back logging
  • Perry – You believe that if the Uvalde shooter had received treatment earlier he could have been salvaged?
    • I would say that the systems stated in the media, which is all I have to go on and were present in the shooter in late 2020 are symptoms we treat every day
    • Treatment is successful in about half to two thirds of patients who receive it
    • What differentiates success is whether we are able to engage and support the family
  • Perry – What do you do with the third of patients who don’t succeed in treatment?
    • We’re going to maximize things if we do things like multi MST
    • MST builds up the caregiver cadre
    • If someone’s guardian isn’t providing sufficient care they try to place other adults in the patients life that have a positive influence
    • First week of treatment over 100 hours is spent with the family trying to identify adults that could help
    • End of the day we’re still going to have kids that have an overall lack of adults in their life
  • Perry – So at the end of the day there is a segment of kids that will be institutionalized?
    • Yes, there will be kids that will be institutionalized because of a lack of adults
    • We still have to look at that group though
    • Benefit of T chat is that if a youth fails in treatment he is in our system and we’ll be able to address him appropriately
    • We have seven MST teams in Texas right now, we need 140
  • Perry – Truancy is an indicator of problems right?
    • I see truancy and other problems like it as an indicator of need
    • If we react with expulsion or law enforcement we don’t address the need
  • Perry – What do we do with the kid that doesn’t respond to intervention who’s parents don’t care?
    • There are things we can do in school
    • We’re working with a couple of school districts that are looking at alternative discipline methods
    • They focus on educating the kids and providing some structure
    • Schools can’t replace parents but they can provide some structure that kids embrace
  • Perry – I argue that if a kid’s at a concerning level of stress we have to treat them before they return to class
    • I argue that they do it at the same time
    • I agree that right off the bat they should be in hospital or partial care then they should be transferred back in with the supports in place
  • Perry – That isn’t the system in place now though, we essentially can’t help them now?
    • I agree but that’s because we have a huge gap around intensive community based services like MST
    • MST would alleviate this problem
  • Perry – Do we have a mid-level fix available today before a kid goes back into a classroom?
    • It’s going to take 3-6 months with intensive services to make a change
    • We don’t want them out of school for that long, just the initial phase
  • Perry – Does a desire for notoriety play a part in school shooters psyches?
    • What you said is almost a direct quote from the secret service report, it’s definitely a factor
    • The American Psychological Association is about to publish a report that addresses that
  • Zaffirini – Did I hear you say that a coordinated specialty care plan is the gold standard for treatment?
    • I said that regarding kids with psychosis
  • Zaffirini – How do we educate people on the importance of this program?
    • We’re trying to partner with the private sector
    • Those groups have identified unmet mental health needs as one of their biggest concerns as employers
  • Zaffirini – Sometimes mental illness effects thinking, emotion, and behavior correct?
    • Correct
  • Zaffirini – How do we educate the public about the mental illness as it pertains to crime?
    • I think we have gotten better, the dialogue I engage in shows it
    • Don’t fund general health care we need to fund specific treatments for specific illnesses
    • A lot of it is mental health professionals have to be better about communicating
  • Zaffirini – But how do we do this?
    • If we don’t make distinctions between all of the different mental illnesses
    • We need to acknowledge that mental health is a broad term and that some illnesses untreated can lead to violence
  • Zaffirini – Would you explain the premise that most mental illnesses are associated with a comparable or lower risk of violence
    • The biggest mental health condition is anxiety, a peaceful mental illness mostly
    • If you take out drug use, which is higher among people with mental health, overall most mentally ill individuals are less likely to commit violent acts
  • Zaffirini – Is self harm more of an indicator of suicide than it is of mass homicide?
    • I would say it’s a sign of violence
  • Zaffirini – How do we avert more tragedies?
    • We have to find them before
    • T chat could have hugely helped
    • In west Texas they’re doing lessons on how to find signs of problems
    • We need to educate schools and show them that most teens can be helped
  • Zaffirini – You have indicated that around 10,000 students in Texas fit the profile of mental issues seen in school shooters?
    • Yes but only a very small number of them could grow into a shooter
    • Most of these kids are showing the systems of not having parental influence
  • Zaffirini – What’s the difference between the pediatric crisis stabilization response teams and the mobile crisis outreach teams?
    • The pediatric ones are just for children and families
    • They are a two-person team that includes a clinician and someone like a family member who’s been through the system before
  • Zaffirini – How do we address work force issues?
    • We’ve been doing things like loan repayment programs and internship programs
    • I think we need to steal workers from other states
    • We need to incentivize others to come to Texas
    • There’s a state interest in speeding up the process for clinicians to practice here
  • Zaffirini – Would it be helpful to have more fellowships and residencies in related fields?
    • Definitely
    • As a part of the consortium you’ve almost doubled the number of child psychiatry fellowships
    • One problem we’re having across the country is we’re not seeing a lot of those positions filled
    • You created a benefit in our Medicaid system for collaborative care last session that hugely helped
  • Zaffirini – What three recommendations do you have for this committee?
    • Statewide T chat expansion
    • State wide MST
    • Psychiatric stabilization teams
  • Bettencourt – Have we done an ABC costing on any of those recommendations?
    • Yes we have
  • Bettencourt – I didn’t see it in the presentation
    • I didn’t put it in but I can provide an example
    • If you were to fully ramp up T chat it would take about 62 million dollars a year
    • It would cost under 1,500 dollars per child served
  • Bettencourt – What can we reasonably expect as an outcome for any of these programs that will address school shooters?
    • If we do the model of the T chat program that they do in Lubbock we can do education in school
    • That will let us identify who needs coordinated specialty care and attention from the MST teams
    • From there we can build the infrastructure of care and adults around these kids that have been identified
    • For someone that fails treatment T chat will allow us to keep track of that student going forward
    • Instead of asking what’s wrong with kids we need to ask what happened to them
    • There’s no panacea but we can be a lot better
  • Bettencourt – What role do some of these fundamental diagnoses (like autism) play in this overall mental health process?
    • We’ll look into that
    • We try to focus on mental health issues that are most correlated
  • Kolkhorst – You said that since 2015 state funding for mental health has increased by 34% right?
    • Correct and we weren’t counting Medicaid
  • Kolkhorst – Is T chat the only of its kind in the United States?
    • I haven’t seen anything like it
    • The speed and organization of the system is unmatched
    • Having all 12 of our medical schools cooperating with each other is incredible
  • Kolkhorst – The data you’ve given us on homicide deaths of children under 18 since 2001 shows an all time low rate in 2012, why is that?
    • I will double check
    • It’s really hard to tell
  • Kolkhorst – Mass shooting fatalities is listed as less than .01 deaths per 100,000 children in Texas
    • Yes, that’s a rare event
  • Kolkhorst – Boy have more tendencies to commit violence correct?
    • I would say they have more risk factors to commit violence
    • Most will still not commit violence
  • Kolkhorst – We saw the chart indicating a dip in violent deaths in 2012 and then around 2014 it started going up again, we need to figure out why
    • Part of that was definitely social media
    • Not so much the content but the fact that some parents have been using it as a substitute parent in many ways
    • We’ve seen a lot more fragmentation of families and communities
    • We need to empower parents to combat this and take control in their home
  • West – Is TCHATT at all school levels?
    • It’s meant to be available to all children in the district
    • More focused on junior high and high school due to them being at more risk
    • Every campus should have access though
  • West – Have you done any analysis of the individuals involved in other mass shootings like sandy hook and parkland to see if there is anything they’ve done that we could use?
    • We looked at some of the things that were recommended in Connecticut and other places
    • My read of the data is that I don’t believe we have more instances of school shootings on a per capita basis since we have 1/10th of the students in America
    • There’s nothing going on in Texas that leads me to believe we have factors making school shootings more likely
  • West – Have there been any best practices identified?
    • The ones that we’ve assembled here are the ones we believe are helping
    • New Mexico and Louisiana are both successfully using MST teams
    • We also could benefit from these states having these programs because some of their personnel could come work in Texas

 

Nicole Golden, Texas Gun Sense

  • The only nonpartisan gun violence prevention organization
  • Represents thousands of Texans
  • Mission is to prevent gun violence through common sense policy, education, and partnerships with key stakeholders
  • Been doing this work for over ten years, never seen anything like this past month
  • CDC shows that the firearm deathrate among Texas children aged 0-17 has more than doubled since 2015
  • Solutions that only address mental illness and school security are not enough
  • Have tried to pass an extreme risk protection order
  • It is an evidence based legal tool to empower law enforcement and families to avert suicides and homicides
  • These tools work, in Florida law enforcement file 255 unique petitions in Broward county in which firearm owners had made violent threats
  • Advocating for a stronger vetting process for gun purchases, 80% of guns purchased for crime are bought through unlicensed sellers
  • Advocating for safe gun storage and reporting requirements for Texas’s rate of more than 1,200 lost and stolen gun
  • Pushing for protections of domestic violence victims
  • 150 Texans shot a year by a partner
  • New poll conducted by third way and GS strategy group found that 75% of Texas voters support red flag laws, 90% of voters supported requiring background checks on private purchases, over 80% support raising the age to purchase a semi-automatic firearm to 21
  • 4,000 Texans killed by guns every year
  • I want to ask what solutions we can get done right now
  • Zaffirini – What is your best estimate of the kind of legislation that the Texas legislature could pass with bipartisan support and have signed by the governor?
    • 19 states have passed an extreme risk protection order, also known as a red flag law
    • Those often have bipartisan support
  • Zaffirini – Are there specific bills that you can point to that have been passed with bipartisan support that we should consider?
    • Extreme risk protection order is urgent
    • Background checks behind private purchases
    • Domestic violence protections
    • All of these could be passed and have a positive impact
  • Zaffirini – How do you respond to people who say that we shouldn’t pass any new gun laws because of the rights under the second amendment?
    • None of the laws brought forward here take away second amendment rights from responsible citizens
  • Zaffirini – When we deal with red flag laws how do you answer criticisms regarding a lack of due process?
    • Reasonable question but there’s a clear due process that would allow for someone to receive their gun again if they are deemed to not be a threat anymore
  • Zaffirini – Do they need a lawyer involved?
    • Yes, it’s definitely a legal process
  • Zaffirini – When talking about raising the age to buy an assault rifle to 21 how do you answer critics who believe if you’re old enough to join the military you’re old enough to buy a gun?
    • I would say that there’s science that shows the prefrontal cortex isn’t formed until you are 25
  • Zaffirini – How could this committee make a difference?
    • There’s not one solution, need to throw all solutions on the table, all of the ones I have brought forward are examples
  • Zaffirini – Does your office support Governor Abbots policy recommendations?
    • We were a part of the roundtables that took place in 2019, we were in favor of some things he was interested in, but many gun safety reforms never got passed
  • Zaffirini – Could you describe the members of your organization?
    • People join from all parts of the state, we are not partisan
  • Zaffirini – How hopeful are you that this legislature will make a difference?
    • What’s happening at the federal level is giving me hope, also a believer in incremental change

 

Aurora Vasquez, Sandy Hook Promise

  • Points out the stark similarities between what happened at Robb Elementary and Sandy Hook
  • Our commitment is to increasing student safety in all aspects of life, school and home, common ideas but a unique approach to them
  • Our focuses are on violence prevention student education, raising the age, temporary transfer of firearms and closing the private sale loophole
  • Regarding violence prevention education we made the SSAVE* Students Act
  • Piece of model legislation that tries to institutionalize evidence-based violence prevention training
  • Addresses suicide prevention, promoting social inclusion, general violence prevention and anonymous reporting used as a helping tool
  • Advocating for raising the age to 21 for the purchase of certain types of semi-automatic weapons
  • Temporary transfer of firearms, essentially a red flag law, people on the brink of crisis should not be able to access firearms, crisis aversion, Sandy Hook model introduced in Kentucky which has a strong gun culture, thinks it would work in Texas as well
  • Closing the private sale loophole, how to define a stranger, one step to prevent people who should not have a firearm to not get a firearm
  • Zaffirini – You provide data that shows in states that raise the age to buy a gun to 21, suicides decreased, what states were you talking about?
    • Not sure on exact states, but we were talking about private gun sales and not sales occurring through an FFL
  • Zaffirini – In Texas, we are considering raising the age to buy an assault weapon, do you have similar studies?
    • Not for assault weapons in particular, but the emphasis we were trying to make is 21 is a much better age
  • Zaffirini – What are the major elements of your Kentucky legislation?
    • Very similar to an extreme risk protection order, not all aspects because it was tailored to strong gun culture, if immediate sense of urgency to separate a person from firearms, court order can be obtained, provisions to return
  • Zaffirini – You said this is not focused on the “good guy with the gun”, can you explain?
    • We see it as a helping tool for gunowners, if we intervene before a problematic person commits an act of violence, it will allow them to continue owning a weapon after the order is over
  • Zaffirini – What is the SAVE Students Act?
    • Seeks to bring evidence-based violence training to students, suicide prevention training, general violence training, social isolation training, anonymous reporting for students
  • Zaffirini – What actions should this Committee take to show we are serious?
    • SAVE Students Act, give them upstream violence prevention tools, if you couple with hardening of schools, students say they feel safer
    • Legislature taking these nonpartisan steps to address gun violence prevention
  • Bettencourt – The Sandy Hook shooter was 4 months away from being 21, and his moms bought him the guns he used, how could the age limit proposal make any difference?
    • I would hope his mother would not have purchased him a firearm that he was not allowed to own

 

Public Testimony:

 

Dr. Sandra McKay, Texas Pediatric Society

  • Agrees that mental health crisis in children needs to be addressed
  • Need to work on safe storage laws for children, if half of homes with unlocked firearms secured their firearms, we would see a 1/3 reduction in youth suicides
  • Need to fund research for firearm prevention in Texas
  • Kolkhorst – You mentioned geospatial analysis, what is that?
    • We are creating maps where firearm retailers are doing firearm storage, we are calling retailers and seeing if they provide training for safe storage or provide temporary storage services, for people in times of crises or just general need, can compare this data with levels of deaths and suicides, my team is doing this unfunded
  • Kolkhorst – 2.7 per 100,000 youth die of suicides, homicide is 3.1, do you know what weapons are most commonly used for youth suicides?
    • 50% of youth suicide use firearms

 

Andrea Brauer, Self

  • Mental health is a big issue, but we cannot solve every child with a mental health issue, end of the day is easy access to firearms
  • Lays out 8 different gun safety bills that have been passed in a bipartisan manner in different states, none would penalize law abiding gun owners:
    • Mandatory reporting of lost and stolen guns
    • State law prohibiting those that are mentally ill in institutions from owning weapons, passed House Homeland Security in 85th session
    • Straw purchases ban, Rep. Geren passed something similar last session
    • Suicide prevention bill, purely educational, NRA lobbied against it
    • Be more direct in gun violence language with state agencies
    • Provide educational materials to gun dealers
    • Raise age to 21 for automatic weapons, or at least require an LTC
    • Red flag law, can be crafted in a conservative way

 

Marco Pena, Police Chief of Elmendorf Police Department

  • In his career, has seen a drastic mental health crisis
  • Believes the 72-hour mental health holding of a dangerous individual should be longer, mental health institutions say this is a “revolving door”
  • Zaffirini – What legislation should this Committee recommend?
    • Both parties need to work together to get this under control, better evaluation for those that need to be seen
  • Zaffirini – How do you work with city and local law enforcement officials for school safety?
    • We have constant communication and collaboration with all agencies
  • Zaffirini – What would be your response if there was an active shooter in your city?
    • My response would be to get there as soon as possible and take out the threat
  • Nichols – We heard testimony about EOPs, Sherriff’s association suggested lead person for that school go over to local law enforcement to go over plan, do you do that?
    • That is imperative, we are in planning stages with schools currently

 

Allison Mohr-Boleware, Hogg Foundation for Mental Health

  • Overall school climate and student mental health, goal should be to prevent any student from getting to this place, do not want to incorrectly infer that violence is correlated with mental illness
  • Need to create schools providing safe and supportive learning environments, positive school climates with access to mental health for students and staff
  • Workforce shortage, many counties have no mental health professionals
  • You have created many programs for mental health, but we need programs to actually run those programs
  • Kolkhorst – What recommendations do you have?
    • Mental Health Consortium has proper funding, staff, numbers of mental health professionals
    • Mental Health Loan Repayment Program, need to increase funding specifically for underserved areas
    • Dedicated line item for mental health professionals for schools or contacted through schools

 

Judge Wayne Mack, Montgomery County-Behavioral Health Task Force

  • Brought together over 2,000 volunteers and 60 agencies to look at mental health and responses, can’t keep doing what we have always done
  • Texas is 50th in the nation for mental health, we need to do better, increase funding
  • Nichols – Do the Children’s Consortium interact with your group?
    • Not directly, but through the Texas Council on Suicide Prevention, trying to find workable solutions to fix the safety net
  • West – Are there any gun laws that we should at that would help reduce the probability of incidents like this?
    • Every suicide I have worked, there has been missed areas of warning signs, access and means is one of the ways you can reduce that, also in Texas you have to be 21 to smoke a cigarette, you should be 21 to buy an AR-15
  • West – What are your thoughts on red flag laws?
    • Have to be careful with that, but we must do something different, cannot allow people with mental illness access to weapons, not a Republican or Democrat issue

 

Lee Spiller, Citizens Commission on Human Rights

  • Agrees with Sen. Campbell about not “pumping kids full of psychotropic drugs”
  • Mental health screenings in SB 11 stated there would be nothing done without parental consent, but this is not happening in multiple districts across the state
  • Kolkhorst – Where is there not parental consent in SB 11?
    • In regard to TCHAT, districts are conducting screenings without consent, Austin ISD, Lewisville ISD, focus right now is opt-out consent, should be opt-in
  • Perry – When faced with giving up personal liberty or trying to forecast and protect the public, is there a way to do both?
    • If we are doing it based on a profile, we can’t take that chance, Houston Chronicle said we cannot predict criminal activity
  • Perry and witness engage in discussion about mental health condition of Uvalde shooter

 

Daniel Graeber, Self

  • Provides overview of gun recreation safety techniques in state of Texas

 

Greg Hansch, NAMI Texas

  • Important not to stigmatize mental health, should also address firearm safety and access and safe storage
  • Mental health workforce shortage needs to be addressed as well
  • Opportunity to expand access to coordinated specialty care, should require insurances to cover
  • Serious emotional disturbance should also be covered by insurances
  • Certified family partners should be covered under Medicaid

 

Krista Del Gallo, Texas Council on Family Violence

  • Most Texas victims of family violence live in a home with guns and domestic violence
  • Multiple Texas laws that are already codified but not enforced regarding preventing domestic violence abusers from owning a firearm

 

Victoria Woodruff, Self

  • Support evidence based, robust, gun violence prevention laws
  • A waiting period might have helped her son, who committed suicide, red flag laws could help other peoples
  • Kolkhorst – You mentioned a waiting period, was your son over 21 and did he purchase his own firearm?
    • Yes

 

Evan Roberson, Tri-County Behavioral Healthcare

  • Local mental health authority of Walker, Montgomery counties
  • Expanding child psychologist student program at his clinic, students will be able to practice with supervision, able to increase patient services
  • 5% job position vacancy at his clinic, bachelors and masters level staff, missing workforce is serious problem

 

Jason Sabo, Children at Risk/Texas Family Leadership Council

  • Gun violence is a serious issue, there are bipartisan ways this Committee can implement solutions
  • Last session, Legislature regulated 18–21-year old’s being able to open carry a firearm, there is precedent to regulate based on age

 

Margie Barilla, Elevante Healthcare

  • Outpatient mental health hospital in North Texas, serve ages 5-17
  • Advocating for assistance in pushing mental health screenings for children before the start of school, with the consent of the parent
  • Asking for additional support for how insurances handle denials, refusals to provide diagnosis

 

Sheila Hemphill, Texas Right to Know

  • Victim of “medical abuse”, only time she experienced homicidal idealizations was when she was on psychotropic medications
  • Insurance companies will keep you in a mental institution for maximum number of billable days, claims this happened to her
  • Perry – We don’t do a good job of a holistic look when discussing symptoms and issues, can you give us your conventions?
    • My formal degree is in computer science, I taught public school for about 4 months
  • Perry – Do you have a medical or biosciences background?
    • No

 

Closing Comments:

  • Chair Nichols enters written testimony into record
  • Nichols – Will instruct staff to look into these issues discussed today, asks Members to put together a list of issues they have heard today and share with his office to coordinate a master list and see what everyone supports
  • Chair Nichols recesses Committee at the call of the Chair