 We've had nearly a thousand people take the online pledge to end the stigma associated with children's mental health. We also engaged key advocates across our community, several of whom are joining us here today. We provided resources to assist people with initiating a community conversation. Together, we created a wave of support. Through the events you attended, interaction on Facebook, Twitter, at our website, one in five minds dot org, and public service announcements on TV. We did this because we all know that stigma creates silence, and silence creates barriers to care. In addition to building awareness, the one in five minds campaign hosted a conversation with Liza Long last year. Liza is the mother of a child with a mental illness. She wrote about her experiences of mom in response to the Newtown shootings. To hear Liza speak about her experiences in such an honest and open manner, reinforce the need to continue to bring this message forward. That brings us to our event today. This forum, an anniversary celebration, continues the conversation. As we're about to hear, it's a topic of critical importance because one in five children that's one in every five will suffer from a mental, emotional, or behavioral disorder. For decades, children have gone untreated, only to drop out of school, self-medicate with drugs and alcohol, or become incarcerated. All outcomes that don't have to happen if they just got treatment. One of the primary reasons they don't receive treatment is because they're uninsured or underinsured. Another is the lack of providers, especially for children and adolescents. We'll talk about that some more today. The panel is going to help us understand these issues and current state of mental health funding in Texas for children. We'll introduce them in a moment, along with our guest moderator, Evan Smith. But first, a word from our, no, first, I'd like to thank our sponsors and acknowledge some special guests that are here today. Please join me in thanking Valero Energy Corporation for hosting us once again. Yay, Valero. Valero and its foundation provides crucial support to thousands with a focus on children across our community. Please especially join me in thanking Sylvia Rodriguez, Vice President of the Valero Energy Foundation. Sylvia, thank you also to Methodist Healthcare Ministries for underwriting the NowCastSA livestream that enables anyone with access to a computer to join in today's event. One of the focus areas of Methodist Healthcare Ministries is in fact mental health. Please join me in thanking Rebecca Brune, Vice President for Strategic Planning and Growth. And finally, thank you to NowCastSA and its dedicated leader who's back there working away, Charlotte Ann Lucas, for streaming this event. NowCastSA is your local public television on the internet. Several community leaders have stepped forward to become advocates for children's mental illness. They have agreed to start the dialogue in the community by tweeting, posting on Facebook, emailing, and sharing the message of one in five minds with their friends, family, colleagues, and partners. We are pleased to recognize some of these advocates who have joined us here today. So please stand and remain standing as I call your name if you would. State Senator Letitia Vanderpute is represented by Alexis Fonseca. Alexis, Dr. Deborah Healy, Director of Guidance and Counseling Services for the Northside Independent School District. Did Dr. Steve Plisca show up yet? Boy, is he going to be in trouble. Jackie VanDeWally, Lifetime Assistant Vice President for the San Antonio Livestock Exposition, which is also known as the San Antonio Stock Show and Rodeo. And Justice Luzelaine Chapa, Fourth Quarter of Appeals, who we will hear from momentarily. Okay, thank you. And we have a few more special guests that we'd like to mention. First of all is Jennifer Deegan, Senior Health and Human Services Advisor, representing Speaker of the House, Jo Strauss. She waved back there. Megan Regis, Healthcare and Social Policy Issues on behalf of State Representative Mike Villarreal. There she is. San Antonio Police Department Deputy Chief Joseph McKay. We also have the Executive Director, that wasn't the ex-executive, it was the Executive Director of NAMI, Texas, and that's Chris Scroggen. And we have also from the Fourth Quarter of Appeals Judge Sandy Marion. So thank you and thank you all for being here today. Everyone here plays a vital role in providing care for the children of our community. Because of your interest in children's mental health, we have set up a station to tell your story. It's located over there to my left, your right. If you would like to have your thoughts, audio taped, or your written message added to our newly redesigned one-in-fiveminds.org website, just visit that area after the panel discussion. And now, it is my privilege to introduce one of our newest advocates with a heart for children's mental health. Justice Lou Salana Chapa was elected to serve on the Fourth Quarter of Appeals, effective January 1st, 2013, and is currently the youngest sitting justice in the state of Texas. Justice Chapa attended St. Mary's University, where she received both her Bachelor of Arts in English and her law degree. Between college and law school, she headed to Capitol Hill, where she interned for U.S. Congressman Lloyd Doggett and worked for the late U.S. Congressman Frank Tejeda. Justice Chapa is a Texas Bar Foundation fellow and a 2014 inductee to the San Antonio Women's Hall of Fame. Her civic activities include mentoring students at Healy Murphy Center, where she serves as vice president of the board, and serving on the boards of the St. Mary's Law Alumni Association and the Center for Family Relations. She is a proud member of Impact San Antonio and is an official advocate for one-in-five minds. Justice Chapa has been married to Miguel for 11 years and they have two daughters. Please join me in welcoming Justice Luz Elena Chapa to the podium. I will not trip on purpose. Good morning. Meet Michael. Michael grew up on the Texas border in a middle-class family with college-educated parents, a sister, a twin brother, and a large extended family. As a child, he was funny, loving, respectful, and intellectually surpassed children his age. He was accepted into the gifted intelligence program at the age of eight years old. His analytical and math skills were off the charts. Not only was he smart, he was athletic too. Making a home run was a piece of cake for Michael, winning first place at a swim meet, no sweat. And not only was Michael intelligent and athletic, he was tall and handsome with dirty blonde hair and hazel eyes. There was no doubt that Michael was growing to grow up to be a heartthrob who excelled in AP classes all while winning state championships. Academic and athletic college scholarships would be in close reach. He indeed had a bright future. But then something changed in his behavior and his demeanor and level of commitment to himself, his family, and his studies. Countless number of doctors told his mother that it was a phase. He was simply a rebellious teenager trying to test boundaries. Stand firm, they told her. Teachers said it was common for boys growing up on the border to go across and partake in early age drinking and perhaps even smoke marijuana on occasion. No big deal. It's just a phase. Michael, he'll grow out of it. You see, there was nothing for Michael to grow out of. You can't choose to grow out of schizophrenia. It was a part of him during his teen years and will be a part of him for the rest of his life. Michael's now 30 years old and he is still the same loving, funny, respectful, and intellectually brilliant young man. He has a deep and strong faith in God, but he is tired of being sick. He is so tired of being sick. He is tired of not finding the right medication that will completely silence the voices that torment him. He is tired of not being able to finish his college education, although he has completed 60 hours. Not because he doesn't have the intellectual capability of doing so, but because he does not have the mental stability he so desperately desires. He is tired of not having a job and he's tired of being dependent on his 66-year-old mother for everything. He is tired of being someone a prisoner in his own home because there are no programs. There are no programs that benefit someone like him, none. There is no place for him to go without feeling the stigma that is associated with mental illness, especially someone who has schizophrenia. The one mental illness that I feel is on the bottom of the priority list. Ladies and gentlemen, I am so proud and honored to say that Michael is my 30-year-old brother. I love him dearly. I love him dearly, but there is not a day that goes by that I pray for him and that I wish for someone or something to cure his schizophrenia. Not because I'm ashamed, not because I'm embarrassed, but because I want him to have a life he can actually be happy about living. I carry an insurmountable amount of guilt. Why? Because I never asked him why he was drinking alcohol or smoking marijuana at the age of 14. To the contrary, I used to get mad at him and I judged him. I never asked why. Perhaps if I had asked, we would all have known that he was self-medicating because he didn't know how to handle or cope with what was going on in his head. He didn't know how to communicate it, but more importantly, us as a family. We didn't know anything else but to say that alcohol and drug abuse were not accepted in our home. We all stood firm. I have no medical background nor am I an expert. But ladies and gentlemen, what I do know is that my brother would be in a much different place today. Had he had an early diagnosis, had he been treated early, and had he been accepted early on, I often wonder what would have happened if he had had this early diagnosis. This is why funding for children's mental health needs is so crucial and so vital to our community and not to mention across the state of Texas. I often wonder if he had indeed benefited at an early age rather than at the age of 18 or 19. Would his schizophrenia have manifested and spiraled out of control? Would an early diagnosis have kept him from self-medicating? Would it have kept him out of the court system? I wholeheartedly believe that, yes, it would have made a huge difference because half of all chronic mental illness begins at age 14, 3 quarter of illnesses by age 24. There are long delays before the first appearance of symptoms and beginning of treatment. Specifically here in Bear County, every year 1,300 children are admitted to a local ER for psychiatric reasons. Depression, suicidal thoughts, and bipolar disorder are far too common. 50% of children with a serious emotional disturbance drop out of high school, and children who go untreated are twice as likely to abuse drugs and alcohol. Thankfully, Michael hasn't used alcohol or marijuana in years because he knows how to cope now and we know how to communicate with him much better. Here are some all-too-real statistics provided by Clarity. In 2009, 171 Texas counties did not have a single psychiatrist. 102 counties did not have a psychologist. And 48 counties in our great state of Texas did not have a single licensed professional counselor. While studies show that approximately 14 child and adolescent psychiatrists per 100,000 youth are needed, Texas has less than half that number with approximately six child adolescent psychiatrists per 100,000 youth. Most of them are concentrated in urban areas. In San Antonio, the rate is 7.53. Yes, still much less than the needed number of psychiatrists. And generally, it takes three to six months to see one. In 2010, only six child psychiatrists served a population of 814, 578,000 in the border region. These numbers, they sound disturbing. They're disturbing to me. I hope they're disturbing to you. And much more can be done to improve the mental health care available to our community's children. Undoubtedly, the conversation has begun and we are making progress. But I am cautiously optimistic because the progress is a slow one. More often than not, the issues of children mental health needs gets politicized. And those who truly need the help, they're no longer the focus. For those of you who have not visited Clarity's campus, I encourage you to do so. It is such a remarkable place. The reputable and caring physicians and staff create a sense of being at home. There is a sense of peace in knowing that the children who walk in and out of its doors are given the best quality care and attention that these children deserve. These children do deserve the best care. Clarity is one that gives children and their families hope of achieving a stable, normal, and happy life. Because I think we all do want to achieve stability in these situations. Clarity is one that I wish was on every street corner in the state of Texas. Imagine if we had a Clarity campus in every big town that was close to people who could just drive and go to Clarity. There wasn't a three to six month waiting list. And young children wouldn't start to self-medicate. Imagine the difference that could be. But early diagnosis and early treatment alone are not enough. Acceptance of the diagnosis is a must. Acceptance. Acceptance, embrace it. That's the biggest step ever. Because if you are affected by a family member who has a mental illness, you need to come forward. And you need to partake in this conversation. It's just too important to ignore. More often than not, parents are in denial. And they do not want to accept that their child might have a mental illness. Shame and embarrassment associated with mental illness is all too vivid and real. Society's lack of acceptance of children with mental illness keeps parents from coming forward. I get it. I do. It hits home. But I will tell you this. The more we share, the more we learn. Sharing our stories only benefits those who are confronted with the issue of mental illness. And let me be perfectly clear. There is nothing shameful or embarrassing about having a brother with schizophrenia. He did not choose to have this illness. It chose him. In my eyes, he is a normal 30-year-old male who happens to have schizophrenia, just like someone happens to have cancer or happens to have diabetes or Down syndrome or autism. It's all one and the same for me. Naturally, my mother is Michael's number one advocate. And she has never been in denial. She has tirelessly advocated for him throughout his entire life and continues to do so every single day. At times, I'm exhausted by watching her do it. Yes, she's 66 years old, and Michael depends on her for everything. And I'm not sure what the future holds for Michael. He is fully insured, has been in and out of hospitals, and has been seen by leading medical professionals across the country. You would think by now he would have achieved mental stability. You would think by now he would have found the right medication. But there are no real answers, and no medication exists that has stabilized his mental health without having serious side effects. And yet, my mother, she remains hopeful. Today is the first time I speak publicly about how my family has been affected. I have been thanked and told I was courageous about speaking here today. But let me set the record straight. I am not the courageous one. Michael is the courageous one for giving me permission to do so. My mother is the brave and courageous one for giving me her blessing and for encouraging me to be here today. And this is all in an effort for other families to start coming forward, to start joining the conversation. We are all dealing with the same issues, regardless of where we come from, regardless of our stature, financial stability, economic situation at home. We are all doing this together. And we now need to join forces. I ask that each of you open your hearts and your minds to the discussion that will take place here this morning. My hope is that you will leave here with a new sense of a personal mission at a minimum, help lessen the stigma, one day at a time, one child at a time. Because we all know that it's going to take moving mountains to end the stigma altogether. But if we can do our part and lessen it a bit, I think we're headed in the right direction. How can you help lessen the stigma? It's quite simple. As Fred mentioned, go to the website, take the pledge. It's free. You have no commitment other than to take the pledge. And there's actually a little icon that you can share on your Facebook, if you're a member of Facebook. It will take you to your page and you will show your friends, your family, your coworkers, that you have taken the pledge and they hopefully will follow by your example. I encourage you to do it today. In fact, maybe we should have a little standout here and make everyone do it before they leave if you haven't done so already. I'm sure we can manage that. Valero has been so gracious in hosting, we can set up another table. But in any event... Um... Also, help me encourage others to stop using certain vocabulary. Certain words, they sting. Skitso is one of my words that makes my skin crawl. She's mental. He's psycho. Using the term bipolar in a derogatory way have no business in our everyday conversations. Help me set the example as I ask and I know others will follow you. I extend my most heartfelt gratitude to everyone at Clarity Child Guidance Center and those associated with the One Invites Mines program for inviting me here to share some personal thoughts. I especially commend them in their efforts to create more public awareness about our community's children's mental health needs, not only in Bear County, but across the state of Texas. And more importantly, I congratulate them for creating and continuing a conversation to end the stigma that we all know strongly exists in our society in everyday lives. Congratulations on your campaign's one-year anniversary. I am extremely honored to be an official advocate for the One Invites Mines program. And I am wholeheartedly committed to your mission. I also thank Valero for hosting us today and for, this wasn't on my notes, for Methodist, help me. Methodist Healthcare Ministries for your support as well. And for Nowcast SA for streamlining. To each and every one of you who are here today who hasn't actually been affected by someone with a mental illness, I applaud you for coming, for showing your support because it will take people like you who haven't been personally affected by it to help lessen the stigma. The more we talk about it, the more we become comfortable with the conversation. Thank you for listening to Michael's story. I hope it inspires you to take the pledge to help end the stigma associated with mental illness. Thank you. Thank you, Justice Chapa, for your heartfelt words and your dedication to the children in our community. It's not just us, it's people like her that can stand up and say this and make a difference in the long term. Just as a minor, thank you. We have a pendant here that was designed by renowned jeweler Jeep Collins of our pinwheel and it is our symbol of hope and healing and the hope and healing that's made possible by children when they actually receive treatment. So just a minor thing, thank you so much. And now it's time to hear from our panel of professionals. This event is being streamed on the internet right now and will be available later for viewing through the support of Nowcast SA. If you are tweeting or posting about the event, join us with hashtag, and I gotta get this right, fund TXMH. As I introduced each panelist, please join us on stage. First is Ed Dickey, Vice President of the Texas Board of Directors, the National Alliance on Mental Illness. Ed, Melissa Rowan, Healthcare Policy Director for the Texas Council of Community Centers. Dr. John Thies, Chair-Elect, Mental Health America of Texas and Stacey Wilson, Associate General Counsel for the Texas Hospital Association. It is now my pleasure to introduce our moderator, Evan Smith, and I've already put my foot in my mouth with Evan this morning by telling him that the Texas Tribune is the second thing I read every morning. Being an old guy, I have read a newspaper every single morning as soon as I got out of bed and sitting down to eat my breakfast, and I do get that newspaper out of the front yard before I get to the computer, so I apologize about that. Evan is the Editor-in-Chief and CEO of the Texas Tribune, a nonprofit digital news organization based in Austin. The Tribune's deep coverage of Texas politics and public policy can be found on their website, TexasTribune.org, in the pages of the New York Times, and in the newspapers and on TV and radio stations across the state. In four years of operation, the Tribune has won four Edward R. Murrow Awards from the Radio, Television Digital News Association, two General Excellence Awards, and an award for innovation in journalism. Before co-founding the Tribune, Evan spent nearly 18 years at Texas Monthly, including eight years as Editor and a year as President and Editor-in-Chief. On his watch, Texas Monthly won the National Magazine Award for General Excellence twice. Please join me in welcoming Evan Smith. Thank you. Hello, panelists, hello. Good to see you. Glad you're here. We're gonna have a conversation about a couple of issues related to mental health policy, and at a certain point in our time together, we're gonna open the floor up for questions from the audience. We'll ask that you think up good questions during the time we're together, and when you get up to ask your questions, the only request we have is please no speeches. We'd like to use the time we have for as many questions as possible. Let me ask of our panelists a general question to begin. I know each of you has thought hard about this and works on this sort of thing every day. What is the most important issue in children's mental health right now? Different people coming from different perspectives are apt to have different answers. Stacey, you're here representing the Hospital Association. You understand from the provider side the sorts of things that you see coming through the pipeline every day. Tell us what you identify as the single most important issue in children's mental health. Well, first of all, thank you for having me here today. It's a pleasure to be here. One of the important things in addition to stigma that Justice Chavez pointed out is we are seeing a really big problem with readmissions for children with mental health and substance abuse. There was a report from in the Medicaid program for State Fiscal Year 2012 that showed that readmissions for children with mental health conditions was at least twice as high as readmissions for other types of conditions. Why do you think that is? Who owns that problem? Well, I think it's a combination. I think all problems are all of ours. So I think there's a problem with not being enough community mental health services to do a soft handoff to ensure that that patient, that child gets the treatment that they need. And I think there's a problem probably from the hospital perspective of not trying to make that connection. I think different hospitals obviously do it better than others, but I think one of the wonderful things that this waiver is allowing us to do, there's a Medicaid waiver that's allowing us to do things that people are nodding their heads in the audience. Right. You're talking to a hometown crowd as far as that goes. Yeah, that's a good thing. But I think one of the big things that it's letting us do is collaborate, trying to break down those silos of talking to one another. And I think that's a good place to start. Well, we're gonna ask about the waiver specifically a bit. Ms. Rowan, what do you think is the most important issue right now in children's health? Well, I think to pinpoint one issue is tough when I talk to some experts and they said, oh, fun. Give us one. But I think when you see the statistic that fewer than one third of Texas children and youth receive the mental health services that they need, I think that you have to say access to services is the primary issue. It's usually related to cost of care, stigma around receiving help, and also the availability professionals. So I think as we look to see what we can do to kind of address those problems, those are the things that we're gonna have to talk about. Right, Dr. Thies, give us your sense of what the most important issue is in children's health. From an advocacy point of view, stigma's at the heart of our poor reactions to mental disease. We're quick to support individuals and families who have physical health problems, but we have fears about people who act differently. And some people believe that it's a personal, a mental illness is a personal flaw. And so an education effort on behalf of this idea that we have to regard people who have issues with mental health in a certain way, perhaps differently from how we've regarded them in the past. Absolutely. We need to be taught how to think about mental illness maybe differently than the way we've been taught. Right, and I think the one point that I could make that I think is critically important in that education process is the whole idea of when we hear something that's not true, we need to speak up. We need to be in a crowd, in a small group with an individual, speak up, and speak to the issue, speak to your opinion, speak to your facts that support that opinion and be careful not to attack the person. And then you've put information on the table, then you've begun the process of changing how people think. Indeed. Ed, jump in here, what do you think? From the family perspective? Yeah, sure. Personally, but I will also say I'm in contact with one to two families per week, call my home. The first question they ask, where do I find help? Where do I go? Where do I go? How do I begin? I get a call and someone says, I got an appointment for my son, 11 year old son, three months away. What do I do in between that time? Parents are not educated about what to recognize. It comes back to education in a different way. And that goes back to stigma, but it goes back to the whole idea, where do we start? Where do we begin? We're confronted at a point of trauma. We're confronted as a family member at a point of crisis. When my family is to some degree still functional, working together, pleasantly interacting. I don't, as a father, recognize some difficulties or relate them to an illness possibility. And so, so much moving story from Justice Shapa about her family. This is a family story that you know the story. We're in the same family. It is a personal connection. We lived it. I lived it myself. My wife and I, I'm an accountant. My wife is a nurse. We are somewhat educated and felt like we should be able to recognize these things. But in reality, we did not. We did not understand the connections. And there was no one out in the community to help us understand those connections. And accepting as the fact that people come from different backgrounds or in different situations, there's probably a racial or ethnic aspect to this. There's probably a difference in socioeconomic groupings to folks that some people who are people of more means may have better access and better information, better education about places they can turn and it may not be the case. That is true to a degree, though, Evan. Even people who have a financial means, people who have good jobs. Maybe they don't know as much as they might know. We don't recognize the problem until we get a record from the police department that our son was delinquent until we hear from the school that our daughter is skipping classes until some type of crisis comes into play. When we are new parents, before we ever have a child, we're introduced by the community as to what's gonna happen when our child is born. As to what to expect when we are new parents then, we're given an education about these are the types of shots that your child should have. This is the kind of regular appointment that you should keep your child connected to your pediatrician with, but we don't hear about mental health. Right. It's not assumed that we should know that. Right, right. Ms. Rowan, so we hear the challenges, right? Everybody's offered what the challenges we face are. Tell us what's being done, what has been done to improve mental health for children in Texas. Give us a concrete thing that you're aware has happened that would be a step of the right direction, progress that we can point to. I think some progress particularly in this area, the legislature passed two bills, Senate Bill 460 and House Bill 3793, that both put an emphasis on the importance of knowledge for teachers and other school professionals around mental health. Right. And so I think the acknowledgement that that's where our kids are every day, that those doors are open, that those people really know our kids, and that they- We have to involve them in the solution. They have to know. They have to have basic mental health awareness training. They have to be able to know, they think something's going on, but they're not sure, and that kind of training that they're gonna get really helps them to say, there is something here. The red flag means something. And then also, what do I do with that? So that they can help actually say to a child. Right. Know what to say. Right. Because I've talked with some mental health first aid trainers, and one in particular is an adult with a lived experience of mental illness. And she says looking back as a child, she really struggled. And she knows that her teachers knew something was wrong. And no one ever said anything to her. Right. And she said, I know now, they didn't know what to say. They had no idea what would be an appropriate thing to say to a child struggling the way she felt. So that's a meaningful piece of legislation. That'll move the needle. Tell us, Dr. Thies, what's something you could point to that's a positive step that's been taken to improve? Well, while we're relatively poorly funded, we have potential for great progress in this area. We've got access to mental health first aid training. We have recognition and training resources for teachers and staff, as you mentioned. We have early childhood intervention services, all of which were initiated or expanded in this last legislative session. What we're missing is the social will to fund these services to engage these services. And sadly, you can't legislate that. Right? Absolutely. You can't legislate social will. Absolutely. Like Ms. Rowan, you believed that out of the last legislative session, a lot of good things actually happened. Oh, absolutely. I mean, we have inched forward since the 2003 session, and I think we made the greatest steps in the last session, but we're still way down on the list. This may be the nicest things that people have said about our legislature in a long time. Right. In one city, we work around the legislature a little bit. We know what the normal rap on that building is. What would you point to as a positive step in the last little while that you say we represent progress? Sure. In addition to the things that have been pointed out, House Bill 3793 also requires the Department of State Health Services to look at what is the need? What is the need? What are the current resources available? And then what's the gap? How do we fund that gap? Because until you can quantify what services we don't have, you can't go to the legislature and ask for the money. Doesn't mean they'll give it to you, but at least you have a quantifiable impact that you can say, we need X more services in this area or that area. The other thing that I will commend them for is House Bill 1023 requires a study of what the needed workforce is in mental health. You heard Justice Chapa talk about the horrible statistics in Texas. I think 241 counties are a health professional service shortage area in mental health in one way or another. And that's horrible. I mean, clearly you can't serve people if you don't have the workforce to do it. You don't have the workforce to do it. So at least House Bill 1023, again, it's a step. It's quantifying what we need, what we have and then what we need. Ed, what do you say? Give us a concrete step in the right direction. I think something that I saw through the legislation this past session that was really encouraging to me was the emphasis placed on early detection, early understanding, as Justice Chapa pointed out, when we catch a child's issues early, we know a large portion of illnesses begin at age 14. When we recognize catch it early, then we can have such a more positive outlook. That's exactly correct. And our own son, we saw his illness, emerge as a young child. His first hospitalization was here at Clarity at the age of eight. Several, he continued with several hospitalizations through his elementary, middle school, and high school experience. But today he is functioning extremely successfully. Made a big difference that you had access to that intervention. It's exactly right. And so all children need to have that access and need to have that opportunity. We're moving in the right direction. But our services are still provided in silos. Yeah, I get that. We need to put this together. We need handoff. When at one hospitalization, our son was in for an extended period of time during the school year. And when he went back to the school setting, it seemed that the information provided at one point in the school didn't connect anyone else. And this is extremely difficult. Now Stacy, I'm gonna go back to what you said earlier about the waiver. And I'm interested to hear that in all the discussion of positive things that have happened recently and all that happy talk about the legislature, nobody actually said, well the legislature actually gave us a bunch more money than we were expecting, right? Rare these days in times of austerity, even with money flowing into the state's bank account to see so much money come back out in the form of funding for programs. More than $300 million allocated. I think you all were expecting probably half that amount. So you've got all this new funding, you've got access to this waiver, you've got sort of possibility and hope on the horizon. What do you do with it? What's the highest and best use of all this additional available money? Well, I think one of the great things that's being done is we're trying to, number one, train more providers. We need more psychiatrists. There are additional residency programs that are being funded. Hospitals are doing about 73 behavioral health projects over the first couple of years in the waiver. I think one of the ways that we can start talking about mental health, because last time I checked, the brain and the mind are still part of the body, is to integrate the delivery of physical care and mental health. Because I think if you can do primary care and mental health together, number one, we're not treating it separately. We're treating it as part of your well child visit or we're treating it, you know, and that means you've got to have, either through telemedicine or some other way, you've got to have that behavioral health component inside a primary care setting. Or the primary care setting, I mean the primary care inside the behavioral health setting. And I think that's going to help reduce stigma. There's a lot of projects going on to integrate the delivery of primary care and behavioral health, and I think that's going to help as well. Melissa, money doesn't solve every problem, but it's certainly easier to solve problems when you have access to those resources. And there are probably some people who say, well, yes, it's wonderful to celebrate more than $300 million, come back into our mental health. We would have preferred to have more even. So theoretically some things are not going to get done, even though you've got more money than you thought. But what's the best way to spend the money that you've now got available to? I think particularly in children's services, what we're seeing is a build out of a continuum. So what we have now, if you're a parent, you have maybe some options for outpatient care, and then you have inpatient care. And we haven't always had a lot in between that. And so what we're seeing in the alum 15 and in some of the projects funded by the legislature is building out crisis services, building out residential treatment. So for example, one of the... This is a bridge, maybe, right? It's the bridge. So that for example, one of the 1115 projects is a therapeutic foster care treatment program. And so when a child's in crisis, instead of them having to go into an inpatient setting or a juvenile justice facility, they have an option to go into a trained foster care home where crisis is resolved, family stability is regained, treatment started, and then they go back home. And so maybe they're 30 or 45 days in a different setting, but they're not, they're still in a home-like setting and they're not in an institutional level of care. Ed, what would you say the money will mean and what can be done with it to make the biggest impact? I think the money is everything, because that's why it opens up interest, it's why it opens up services. When Texas starts paying for services, then businesses will come. Texas is a very... So you actually think that from an economic, that's the interesting, let me stop you for a second. You think from an economic development, we love to brag about our economic development in the state. We run around the state, run around the country, pardon me, pickpocketing businesses from other states saying, come to Texas, we have all these wonderful conditions that would make it favorable. But you think actually adequate mental health services, adequately funded mental health services would be another arrow in that quiver. Absolutely. I truly do. And the money that was appropriated by the legislatures and it was up to something like over $300 million. That's significant. That talks to businesses. That tells business, oh, maybe I can make a difference here then, maybe I can survive and still provide support. It is huge. There are, there is a residential treatment facility near Victoria, great facility. It's extremely expensive. Most of their patients are out of state because Texas doesn't pay for residential treatment until now. Now they will start paying for residential treatment. That is something that is sorely needed, especially for children. You can deal with a crisis on occasion in a short period of time, through a short hospitalization. But there are some cases when a child needs an extended care. Residential treatment is one resource for that. And the legislature appropriated funds for I think it was like 10 beds. And even on my mind, I heard the dollar value associated with that and I don't recall the dollar value and I thought, oh great, that's good money. And then I heard 10 beds. That's an opportunity for expansion. But it is the right direction. Well, you're never gonna get everything you want. Well, but if you figure out at least, how can we claim victory at least in terms of heading in the right direction? Dr. Thies, what would you say the biggest impact of the money could potentially be? More importantly, I think we need to put that money in perspective as to how we got it. We started 10 years ago with an initiative that said crisis funding will make a difference. Crisis funding made a difference. The police are on board. The emergency rooms are on board. The coalition grew. The education of the legislature grew. The number of people who were in lobbying for those funds grew. That's how we got that money. That's how we're gonna get more. And we need to show that this money paid off in terms of social stability and in terms of the economy. So you think actually we have to, however we spend this money, one of the most important things is to spend it in a way that has a visible impact or consequence because unless you do, then people come back next time and they say, well, you didn't really use what was given to you the last time, so why should we give you more? Absolutely, and it's important to notice that there isn't much in the way of funding to do this at the state level. This is a local issue. This is your new programs, your new initiatives have to be looked at by you, evaluated by you, and reported back to legislators by you. It's an interesting point because really these days in terms of funding of social services or just about anything that the state once had is it's purview exclusively. Everything is state local now. Everything is public-private. So we really are, we're in kind of partnership mode, whether it's partnership between the state and communities or a partnership between the public side and the private side of things, we're not gonna accomplish these things just one way. Right, and that partnership is how we got that money. A piece of that partnership that we need to continue to grow with. So that actually gets to the next question, which is effectiveness, metrics for success. What do you do to demonstrate that these changes you might make, Stacey, got this money you wanna go forward with any of the good ideas you've had? How do you demonstrate upstream that this money was spent wisely, that this money was used effectively because the theory, and we'll ask about this in a second, you've got another legislative session less than a year from now will gavel in in Austin and you obviously would like to roll that progress forward into the next thing. So now it's crucial that you demonstrate effectiveness. How do you do that? Well, I think given the fact that our legislature is relatively conservative, you talk about cost avoidance. You talk about- That wasn't a very big, I expected more of a giggle than that, and that is an undeniable fact. And it could become even more conservative depending on what happens in this election. So everyone go vote, that's my big story on that. Well, you're not advocating for certain outcomes, or you could all have to exercise immediately. Everybody go vote. However you wanna vote, go vote. Just be sure you vote. But just go exercise that right that you have. But I think that it's gonna be data. These, our legislators are very data-driven. And so to the extent that you can show that you reduce the number of state hospitalizations, you reduce the impact on an emergency department, you reduce the impact on law enforcement. How have you gotten people served in the least restrictive setting with the best outcomes? And we have to have data to show that. And if we don't, because their stories are delightful and they're wonderful and they show it, but until you put paper in front of those guys- Actual numbers on paper, they don't pay them. And ladies, they're not gonna listen. Dr. Thiesta, reality is this is not a very long amount of time that you have to demonstrate this progress before we get into another legislation. Can there actually be a meaningful impact to be demonstrated in this short timeframe? I believe so with good community engagement. We've had a number of efforts at the legislature to produce statistics, to give local areas information, and they've consistently failed. And we have a new piece of legislation. Actually, it's in two different bills, but the big one is Senate Bill 58. And it basically requires the Department of State Health Services to provide us with performance statistics locally based on the web and distributed where we can seize them and access them. So a dashboard. A dashboard, absolutely. Now the quality of that dashboard is gonna vary and it's gonna vary based on whether we look at it and whether we use it. And whether we take the information that we get from that into a voting booth, because that's what's gonna make the difference. Stigmas at the base, change that, change perception, change the way people see the economic value of treating mental illness and we will get where we need to go. Ms. Rowan, tell me what success looks like here. What are the metrics that would demonstrate effectiveness adequately too? I think fortunately the way the 1115 transformation waiver works with the federal government is providers get paid for performance on metrics. And so we are collecting data. There is accountability. There is accountability. And so we have data, both kind of process data and outcomes data required reporting to get paid for any of these programs. And so I think we're gonna have a data set that we haven't had before. We do wanna be able to point out that it's early in some of these projects, but what we can say is this is the data we have now and then here are our goals for where we're headed. And if you model based on what we've seen so far, then you can actually project out even more success. And in the end that may be enough, that may be suitable to the task here, right? And actually I'm an accountant by training. You understand little numbers and little boxes. I can't argue with any of this. As well as anybody. The numbers are important. And especially to our legislators. And rightfully so. They want to see results. And we as taxpayers expect that. They're gonna be held accountable so they need to hold you accountable. But I still value tremendously the changed lives. The change in family life, the change in direction that families living with mental illness are able to see. That is still necessary. So the anecdotes matter because they put a human face on the issue. It's not about statistics versus anecdotes. It's both and. Correct. Right, not either or. So we have a little bit of time left before we open it up to questions from the audience. Let me ask each of you. Let me start down here and we'll come all the way down to Stacy. You have the ear of the legislature, let's just say. 2015 session, gavels in, second week of January of next year. Without really knowing what the outcome of the fall elections are, stuff that didn't really change. Couple people on one side or the other. It's basically the legislature that you've got now is what you're gonna have next time. Some different nameplates. But more or less, the politics are gonna be the same politics. So going into the session, what's your wish? What's the one thing you want them to take in there with them that you'll be advocating for? I would like them to understand that mental illness is a normal illness, a normal ailment that afflicts the human nature. It's not the same as every other ailment, but we shouldn't make it so much the other. That is right. It's just a normal condition of being human. And we need to respond accordingly. So we're gonna normalize it basically. Absolutely. As you were talking about anything else. Not just the families who live it. We educate the entire community so that when my son, with the supports that he's receiving behind our front door, is able to walk through that door into our neighborhood and receive reciprocal, similar type of support from our neighbors. That was just as choppy as well. One of the points I thought was, we have to start thinking about mental illness like we think about cancer. That is right. Or as we think about diabetes. Basically think of it as just another reflection, serious. Let's not minimize the seriousness of it, but don't make it the other, right? Don't stigmatize it. That actually helps. Ms. Rowan, what would you say? Going into that building, pink building next January? What do you want them to think about? Well, I would say that I would hope we don't wait until January to go into the building. Because I- Some of us have to work on covering this stuff so we share your hope. Right. That they're there sooner, but let's just play this out. I really think from an Austin-based organization, we're not gonna be the ones that make the impact. It's gonna be people like you in your community meeting with your members now to make sure that they understand your story. And I do think the data's really important, but what we do find is that what has the most meaning for many members is to have a local constituent explain to them what their struggles have been and their families and what they need to be supported to be successful in their community. So you would say that people take up these folks on the opportunity, on the invitation, to go see them. Absolutely. You're essentially citizen lobbyists, right? You're gonna go see your members and you're gonna say this is why this is important. You will be the difference between whether they stay engaged or whether they think they've solved the problem. Or not. Dr. Thies, what would you say? Going into next January is a big thing that they should be thinking about. Well, one of the things that I have learned from the Mental Health America of Texas staff really is that citizens need to stay informed. We need to work together. We need to speak with one voice because that's how we get results. Crying out as individuals only confuses the issue. We need to know who each other are. Collective action. Exactly. If you go in and give three different people, give the same story from three different perspectives, you have lost that legislator. Right. So your advice then would be what? To band together, to work together, to support your community. So something more traditional organization. Well, NAMI and Mental Health America of Texas are key advocates in this state. We have branches and affiliates throughout the state. Work with them. Feed up through us. Let us feed back to you guys so that we're all using the same nomenclature so that we appear to know what we're talking about. Power in numbers. Right. I get that. Stacey, the last comment from you. You know the challenges that the state always has going into a led-slave session. A finite amount of money, public education, higher education, health care in general, costs of health care are spiraling upward, threatening to overtake the budget. Enormous challenges in a fast-growing state. How do you say to people when all that is going on? Whenever all these other things are on people's radar screens, stop, pay attention to this. How do you do that? And I think it's important. The point that you made that you need a story and you need the data. You need both of those things. We always said, when we went to go talk to a legislator, you need a hook. What's the story that we can tell that that legislator, every time that issue is going to come up, is going to remember Michael, or is going to remember, and they're going to go, oh, that's important to a constituent because. I think John is absolutely dead on that we need to have one message. Because if you come in with multiple messages, they've got 140 days, and they throw up their hands, and they go, you know what? At this point, public education is simpler. Much more important and simpler to fix. And when public education is simpler to fix. Exactly. Exactly. Watch out. What we've been saying is that what they did last session with the $332 million was an excellent first step. And they need to build on that. But it was only one step. It was only one step. If you have one piece of candy in a candy bowl and you get two pieces of candy, yes, you've increased that by 100%, but you only have two pieces of candy. And that's kind of the theory about they have so poorly underfunded mental health for so long that this is, it's great. And we're not going to say, please don't give us the money, but it's a step. Got to be a step. Stepping step. Good. A good conversation that sort of sets the table. I hope for good conversation that will come audience up to the stage. So we are going to ask that you join in here. Do we have any amplification for our questioners? Both sides. We have a microphone over there on the end. And we'll ask that you line up on either side, one, two. We're going to take as many questions as we have for the balance of the time we have here till about 5 of 11. I'm going to bust people who make speeches, I'm afraid, because we want to take as many questions as we can in the time available. And I'll go side to side, not discriminate on one side or another side if that's OK. Why don't we begin here? Yes, ma'am? Yes, I'm the grandmother of two children that need a lot of help. I'm raising one of them that's up to the mental disability. Yes. I have a 14-year-old grandson that was sexual abuse. He had two meltdowns last year. Ended up in Planetary at one time and at different aneurysms at the second time. The school, I was fighting with the school because I wanted them to help him because he has mental problems, so is his mother. And the school sent him to the alternative school instead of helping him. So I went to the board meeting to beg them to put him in a hospital. He needed to be in a hospital, not in the alternative school. We have an opportunity for people that I want to remind people. We have an opportunity to tell your stories, actually, and have them be up on the website. Can I just ask if you have a question? OK, yeah, that's my question. This is a bill here that they said it passed. The school refused to recognize that he has mental problems. Right. So they're just punishing him and they're punishing me because now I'm there and from going to the school I have to have an alternative because what I mean is they do not recognize the mental illness. It's a great question that really is a question that a lot of people in a comparable situation might have because you think I'm at the end of my rope, I don't know what to do, and the help I'm supposed to be getting, I'm not getting. So if you're in that situation, Ed, what do you do? I do appreciate that question very much. What I would like to encourage you to do is go to your local NAMI affiliate organization and ask for a free class called NAMI Basics. NAMI Basics is a very short, sick session course that will educate grandmothers and parents and family members, caregivers on what symptoms relate to mental illnesses. They provide you with a new vocabulary to communicate it more effectively with physicians and with teachers. But does it also give you the means to know if you're attempting to get help or asking for help and you're being rebuffed? If you're running into the wall, does it then tell you? NAMI Basics instructors are taught to help people find assistance in the school setting. NAMI Basics. NAMI Basics. Got it, sir. Good morning. My name is Clayton Travis with Texan's Care for Children. I just first want to thank our panelists for being here today and supporting this cause, and thank you to the Tech's Tribune for your ongoing coverage of mental health issues. Sure, thanks. What's your question? I just wanted to ask, first, many people and legislators don't realize that the Medicaid program is the largest payer for children's mental health services in the state, and I'm curious for the panelists, what impact would expanding the program to a million parents and single adults have on children's? So you're asking the question that is on the minds of a lot of people and has been from the beginning of this last session, why don't we take advantage of the opportunity to expand Medicaid? This is a complicated question. It's fraught with politics. As Stacey understated, this is a conservative state. Elections have consequences. We've elected conservative people to the legislature and state leadership. They've opted not to expand. And there's questions about even if we did expand whether Medicaid is working adequately or if the program is broken, if we'd be essentially buying into, in a bigger way, a program that doesn't necessarily work. So it's fraught with all kinds of controversies and politics. Jump in here, weigh in here quickly. What do you think, Melissa, on this question of what the impact of expansion of Medicaid might be? What would the trade-offs be? Well, I certainly think the cost of care for families is one of the barriers to access. And so I think we have to have a discussion about how do we make care affordable? Is that through a Medicaid expansion? Is that through more general revenue funding? Is that through a different Texas-based solution to our uninsured problem? But I think we have to have a real discussion about the impact of the cost of care for families. You have a personal view of what we should do as a state? I don't have a personal view on that. You may be the only person who doesn't have a personal view. Dr. Thies, you have a personal view on this that you want to share with us. Well, I think it's important to expand Medicaid or do something equally effective, because just treating the children in a poor family is, yes, it helps. But it doesn't get you there. It doesn't affect the economy. It doesn't help that family improve their situation. It doesn't help the workforce. We need to be supporting our citizens so that they can become productive, so that they can have an opportunity to participate, and by not doing something, expanding Medicaid or some other initiative. Is this Texas solution that we hear about? We are spending more for less results. We had at least one person who agreed with you. Just to say, THA actually has taken an official position to support coverage expansion in whatever form or shape that takes, because coverage equals access. Access is important. So just FYI. Ma'am. Hi. I don't have as much a question as a comment. There was an example of the one piece of candy in the candy dish, and now we have two. In my family, we had good insurance. We had great doctors. We had a lot. But I really have to mention that one example of that, only one piece of candy in the candy dish, are the families out there who feel their only way they can get care for their children is to relinquish their parental rights to the state. And that is an outrageous thing to happen in a state that is so much our faith is very important to us. And I really don't understand how we got to that point. But that is an example of only one piece of candy. This ad is certainly a challenge. If you're so desperate for some kind of help, but the solution is something that runs completely counter to what you're able to bear, you're put in a terrible position, right? Absolutely. And there was legislation that addressed that this past session. This legislation is not requiring people to relinquish. The little list that the state used to keep on people who did relinquish is now inappropriate and illegal. And funding was provided to help families like that. And it goes back to one of the comments I made earlier about the residential treatment. There is funding for that. Is it adequate? I think our statistics will show it is not. But it is a start. It opens the door and it allows us to create something that we can build on and then increase the budget in the next session. Good. Hello, ma'am. Hi. Thanks for having me ask a question to you. I was thinking of collective impact. And I was thinking of community health workers if they're trained on mental health, but also the faith-based organization, churches. I mean, what could we do? Because I'm professional, but I'm also an aunt, a sister, a friend, an individual with mental health, and I'm a church. So how can I help? How can I help? How can our church's help? Right, Dr. Thies. This is actually kind of a version of what we talked about earlier, that everything used to be taken care of at the government level. But now it's community organizations, it's faith-based organizations are having to step in and sort of essentially replace what was once coming from government. Those services sometimes have to come from non-government organizations, right? I think that historically, they've always played a significant role, and they've always been a big part. One sense is maybe that they're having to play more of a significant role now as the funding challenges and the competition for funding gets created. I think that's what's happening is that the market within which we work and the communities within which we work are becoming larger and more complicated, and the silo funding, and the fact that this church is in this neighborhood and this church is in that neighborhood. And we all are trying to do too much with too little. So coordination and cooperation is at the heart of this. And what we need to do is have these organizations plug in to each other and to existing service organizations. It gets back to coordination. Coordination. Right. Mental Health First Aid is just a huge step forward in being able to help people to recognize problems. This training is going to be available all over the state. Within the next six months, you're going to see it blossom. Mental Health First Aid will help your organization to be able to put this together. Dr. Thise Stacey makes a really interesting point. This is a very fast-growing state. We've gone from 20 million people in 2000 to 26 and a half, almost 27 million today. We're adding 1,000 people to the state a day. But they're not bringing water, transportation, public education, or mental health services with them when they come. So these resources, physical and social infrastructure resources, of which one is mental health services, are being strained, right? That growth is making it harder and maybe making it more necessary that outside groups get involved. And because we have continually underfunded mental health since 2003, I mean, before then, we've always been low per capita. This just makes those scarce resources go, yeah, exactly. Ma'am. My name is Eileen Jones, and I'm coming to you as a child. I'm asking you a question who's in school. And I know that there is a stigma. So I have to go to the nurse's office. I have to get my medication, whatever. I know that medically there's a medical record. And I don't want to take my medicine anymore because if in the future, when I want to become a police officer or a public servant or whatever, I will have my medical records looked at. So I'm telling my mother, I'm not going to take this medicine. How do we help those children? Right. How does the stigma not roll forward? And how do you tell people it's important to get treatment without it being this black mark on you in the future? Melissa, what do you do about that? I think that's part of having a discussion about the reality of mental illness in our families. We need to be at a place that used to be where you couldn't talk about having cancer. No one talked about if they had cancer. It was a black mark on you. Or no one talked about having HIV. And those discussions are now very open. And so how is it that mental health continues to remain one of those things that you have to be embarrassed about and not talk about? And I think the fact that we have now, in a many way, said this is an illness, just like cancer, just like HIV, just like diabetes, when people really believe that, then things will really change. But the fact that children are still embarrassed to take medication at school, the fact that people in your family still don't want to tell anyone. And they don't really want to take their medication because they think they'll be OK. I think that says we haven't had enough conversation to make people comfortable. Ma'am. Good morning. I'm a graduate student pursuing my master's in mental health counseling. And the question that I have is, with the great need for the outpatient services and the lack of providers, are there any plans for funding to train, especially at the grass root levels, I'm thinking in particular for peer support? What do you all know about that available funding source? There is availability for funding for peer support, both training and then also the Medicaid program now pays for peers to provide services under the Medicaid rehabilitation office. So there is actually funding available, that's good news. And so we are seeing an increase in the number of peers trained. I think we may have time just for one more or possibly two more. So let me go ahead and take one here and then try to come back over here. And again, if you're not able to get your question asked, I apologize, we're out of time. Ma'am. Mine may require a very short answer. OK. It's a very practical question. I work in an after-school care program. Yes. Last week, a parent came to me and said, my son's been out of Laurel Ridge Hospital for about a month. He's been on medication and I'm out of the medication. I did have enough wherewithal to say, what is he being medicated for? And she said ADHD and schizophrenia. Now, I wished I had abilities, information that I could have given her to direct her to help get that medication. Right. So that's my first question. And the second is that I'm wondering, what's going to happen in our program? How is this child going to behave? And I thank you for NAMI basics. I think I'll try to participate in that. But if there are other community services that I could have referred to, it would have been great. Where do you send a parent in that situation? I would call the Local Mental Health Authority, which in Bear County is the Center for Healthcare Services. They can give guidance on that. And they can give guidance on that. I think you asked a great question about what happens when that kid comes back. What do you do? How do you integrate? It's a challenge. Let's make this one the last one. Ma'am. Diane Kosnowski and I'm a personal advocate for our special needs families. Many families have sought out resources, bar meeting roadblocks by agencies, not returning something as simple as a phone call. And having the fear of reaching out because of their fear of rejection, they don't want to come forward once again. What is the plan to rebuild trust in order to establish an open dialogue on mental health with children and regain these parents back into a system that has completely failed their children and they're trying to regain that trust so that they can come forward once again? How do you persuade people that it's OK to try again? You relate. You relate to them. Again, I encourage everyone to contact your local NAMI organization. NAMI is where families live with the issues. We've walked the shoes you're in. We understand where you're coming from. We can help connect you to specific individuals in the community who helped me. And those are connections made, but in a broader sense across the state, our legislators also appropriated within this $305 million funding for public announcements, for public education to try to change the nature, to try to discuss and impact the stigma. And so we need to make sure that these public announcements are effective. We pay attention to it. And it talks to the needs of children. In some ways, we end the program here where we began with better education as the most important thing that we can do to educate the community about the realities of what's going on here and to make the stigma go away and to give people the means and the wherewithal to talk about the stuff more out in the open. That's a really hopeful sign, I think. And it's a good place to end. I think we had a wonderful discussion. I was honored to have the opportunity to lead it. Please join me in thanking, again, our panelists, Stacy, Dr. Thies, Ms. Rowan, and Ed. Thank you very much. We'll turn back over to Fred. Good.