Hogg Foundation: Recommendations for Addressing the Texas Mental Health Workforce Shortage

The Hogg Foundation for Mental Health is an Austin-based foundation dedicated to promoting mental health in Texas through focusing on key strategic areas, including advocacy and public policy work to implement systemic changes that impact mental health services and conditions.

As the 84th Texas Legislative Session is underway at the Capitol, the Hogg Foundation has highlighted its 2014-2015 Mental Health Policy Priorities. The last (but certainly not least) of these priorities will be the focus of this post.

The 11 priority issues are:

  1. Recovery-Focused Treatment and Support
  2. Integration of Behavioral Health and Primary Care Services
  3. Mental Health Funding
  4. Peer Support Services
  5. Mental Health Services for Individuals with Intellectual and Other Developmental Disabilities (IDD)
  6. Creation of a Forensic Director Position at the Department of State Health Services
  7. Mental Health Services for People in and Recently Released from Jail
  8. Child Relinquishment
  9. Self-Directed Service Delivery Option for Mental Health Services
  10. “Normalcy” for Children and Youth in Foster Care
  11. Mental Health Workforce Issues (Hogg Foundation, 2014)

The Hogg Foundation’s policy recommendations as to how Texas can best address its mental health workforce shortage is grounded in its understanding that recovery for people experiencing mental illness “does not happen in isolation. It may require treatment and support from family, friends and mental health professionals such as psychiatrists, licensed professional counselors, social workers, psychologists, psychiatric nurses or advance practice registered nurses, certified peer-to-peer specialists and community health workers. (Hogg Foundation, 2014).”

Texas has a dire need for an educated, trained, and sufficiently sizable workforce of mental health professionals to serve its community. In 2011, the Hogg Foundation published the report, “Crisis Point: Mental Health Workforce Shortages in Texas.” The report revealed that the Texas Department of State Health Services (DSHS) estimates that less than one-third (44,787 or 28.9%) of Texas children who experience severe emotional disturbance received treatment through community health services. Similarly, 33.6% (or 156,880) adults who experience serious and persistent mental illness received services through the community health system. In other words, roughly two-thirds of the state’s population with mental illness are not receiving services.

State records also reveal that more than 200 Texas counties are without one practicing psychiatrist, resulting in 5.5 million people without adequate access to mental healthcare (Pierrotti, 2014).

Austin news station KVUE spent seven months investigating the state of mental health care in Texas. KVUE shared the story of Joann Kennedy, a women who lived with debilitating effects of schizophrenia and bipolar disorder for 26 years (Pierotti, 2014). Kennedy’s family regret the difficulties they encountered attempting to access resources, including the Austin State Mental Hospital, just one of 9 public mental hospitals in the state of Texas. Kennedy finally did receive care when she was arrested and held at the Travis County Jail. Over a 20-year period, Austin police arrested Kennedy over 38 times for minor offenses, resulting in over 1,3444 days spent in jail, costing an estimated $189,000 over a 20-year period to provide Kennedy with medication and counseling (Pierrotti, 2014).

Austin police arrested Kennedy 38 times, resulting in 1,344 days spent in jail over a period of several years.

Kennedy was not alone. Between 2007 and 2013, the number of inmates with chronic mental illnesses increased by 78% in Travis County. Additionally, Kennedy was one of hundreds of thousands of Texas residents with mental health issues without insurance (Pierrotti, 2014). The issue extends beyond the ability of hospitals and jails serving individuals suffering from mental health. On all levels, Texas has not created the capacity to serve the reality of the mental health needs of its residents.

 “You look at the psychiatric nurses or social workers, psychologists, licensed chemical dependency counselors. About 200 of our counties are considered health professional shortage areas.” – Texas DSHS Deputy Commissioner Mike Maples


In light of this need, the Hogg Foundation sees great social and economic value in providing appropriate mental health services to avoid the burden of staff and costs already placed on hospitals and the criminal and juvenile justice systems (Hogg Foundation, 2014).

The following are recommendations the Hogg Foundation has presented to the Statewide Health Coordination Council last February in order to advocate for investment in the Texas mental health workforce:

  • Increase education and training opportunities, particularly training based on the recovery model of care
  • Identify and implement changes needed to expand the use of certified peer specialists
  • Increase reimbursement rates for all disciplines
  • Analyze best-practices in tele-mental health and identify barriers that limit its expansion
  • Provide education, reimbursements, and provisions of flexible service in order to expand integrated health care
  • Additional workforce considerations:
  • Cultural and linguistic competency
  • Data collection
  • Geriatric mental health specialists
  • Mental health providers for individuals with intellectual and other developmental disabilities (Hogg Foundation, 2014)

Recent legislation has been submitted by Sen. Charles Schwertner of Georgetown seeking to address the workforce shortage. If approved, the SB 239 will offer tuition reimbursements to college graduates who obtain degrees in the mental health profession and agree to work in the underserved areas of Texas (Schwertner, 2014).



Hogg Foundation. (2011). Crisis point: Mental health worker shortages in Texas. Retrieved from: http://www.hogg.utexas.edu/uploads/documents/Mental_Health_Crisis_final_032111.pdf

Hogg Foundation. (2014). Mental health policy priorities. Retrieved from: http://www.hogg.utexas.edu/uploads/documents/2014-15%20mental%20health%20priorities-1.pdf  

Hogg Foundation. (2014). Policy analysis and information. Retrieved from: http://www.hogg.utexas.edu/initiatives/policy_analysis.html

Hogg Fundation (2014). Policy recommendations: Addressing the Texas mental health workforce shortage. Retrieved from: http://www.hogg.utexas.edu/uploads/documents/MH%20Workforce%20Recommendations_031213-1.pdf

Pierrotti, A. (2014). Legislation filed to fix mental health worker shortage. KVUE.com. Retrieved from: http://www.kvue.com/story/news/investigations/defenders/2014/12/18/legislation-filed-to-fix-mental-health-care-worker-shortage/20599683/

Pierrotti, A. (2014). The costs of troubled minds. KVUE.com. Retrieved from: http://www.kvue.com/story/news/investigations/defenders/2014/09/28/the-cost-of-troubled-minds/16115871/

Schwertner, C. (2014). Senate Bill 239. 84th Texas Legislation. Retrieved from: https://legiscan.com/TX/bill/SB239/2015


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