Above: Texas ranks next to last in mental health spending per capita in the nation.
This year, the Texas Legislature had a chance to address suicide, an urgent public health problem that claimed the lives of 3,800 Texans in 2017. The crisis is especially pronounced in rural areas due to poverty, a dearth of health care options and other factors. The issue was in the public eye arguably more than ever in the lead-up to the session, given the recent high-profile deaths of celebrities Robin Williams, Anthony Bourdain and Kate Spade. Some lawmakers made a valiant effort to shore up mental health support and suicide prevention, but when the session ended last month, their victories were mostly contained within school-based initiatives — a byproduct of Governor Greg Abbott’s call to protect schools from gunmen.
First, the good news: Through Abbott’s mandate to make schools safer, lawmakers managed to elevate mental health education and suicide prevention in schools. They passed House Bill 18, by state Representative Four Price, R-Amarillo, to add mental health to public school curricula and to encourage school districts to partner with community health centers to prevent student suicides. Abbott signed HB 18 into law this week.
The omnibus bill “will in a meaningful way address the needs of students with mental health conditions and provide resources for educators,” Price said in a statement. The law not only instructs districts to add mental health education to their list of courses, but it also greenlights teaching students about substance abuse and requires districts to have suicide prevention plans in place. Children’s health advocates say the inclusion of suicide prevention measures is especially important — Texas teens are twice as likely as the national average to take their own lives. After all, Abbott himself said in his School and Firearm Safety Action Plan that “an individual is more likely to use a firearm to commit suicide than mass murder.”
But HB 18 is heavy on suggestion and light on mandate. It doesn’t require districts to partner with community health centers to bolster mental health support for students, though it does bless those partnerships. It also doesn’t mandate the Texas Education Agency to ensure teachers are being trained in suicide prevention. While suicide prevention training for teachers is already required under state law, the Observer previously pointed out that the agency doesn’t know whether districts are actually conducting the training because it doesn’t review districts’ compliance with the rule.
Still, the measures laid out in Price’s bill are “a step in the right direction,” said Lee Johnson, deputy director of the Texas Council of Community Centers, which represents the state’s 39 community health centers. Senate Bill 11, a successful measure by Friendswood Republican Larry Taylor, mirrors some of the language included in HB 18 but also establishes a network of psychiatric centers for children, some of whom can be treated via telemedicine. “It’s a very good thing,” said Greg Hansch, interim executive director of the Texas chapter of the National Alliance on Mental Illness (NAMI).
Now the bad news. Lawmakers’ progress on providing more robust mental health services and preventing suicides mostly stops at school campuses; bills that attempted to address mental health and suicide among adults mostly crashed and burned this session. The failure represents the continuation of a trend for Texas, which has been slow to address suicide, even as the state’s rate of self-inflicted deaths has ticked up from 10.2 deaths per 100,000 people in 2000 to 13.4 in 2017. The problem is even worse in some rural areas, where suicide rates skyrocket above state and national averages. In some rural parts of East and Central Texas, and in the Panhandle, rates border or surpass 20 deaths per 100,000 population.
Advocates say part of the problem is that Texas ranks next to last in mental health spending per capita in the nation. A rider attached to the House version of the state budget would have required HHSC to spend an additional $2 million on suicide prevention initiatives over two years, but the provision was stripped by the Senate.
Lisa Sullivan, of the Texas Suicide Prevention Council at NAMI Texas, called the failed attempt “highly unfortunate.”
“This rider would have also impacted broader suicide prevention efforts, including rural capacity building, deploying trainings and information, and expanding access to other vital resources,” she said.
A bill to create a mental health and suicide prevention task force was held up in the House Public Health Committee. A separate measure to require certain health care practitioners to be trained in suicide prevention was similarly bottled up in the committee.
House Bill 2693 would have addressed a lingering problem in the state’s response to suicides: failure to execute a statewide prevention plan blessed by the governor, the state health agency and the Legislature almost two decades ago. The Department of State Health Services has been sluggish to follow recommendations laid out in the plan, blowing past deadlines to develop prevention protocols and failing to hold statewide summits. If the bill, authored by Houston Democrat Representative Shawn Thierry, had passed, a grant-making program would have been established to ensure the plan is followed. Like the other bills, it was blocked in the public health committee.
But there is at least one successful measure that provides a shimmer of hope. House Bill 3980, by Corpus Christi Representative Todd Hunter, made it to Abbott’s desk this session. Unless vetoed, the bill will require state health agencies to prepare a summary report studying suicide trends by county and taking stock of the state’s suicide prevention initiatives since 2000. Depending on the report’s finding, it could set up further suicide prevention reports in the future, advocates say.