County ready to consider options for designated behavioral health authority

After bouncing the idea around for several months, Travis County is ready to start exploring options to dedicate a local behavioral health authority as an overlay to its existing local mental health authority under Integral Care.

The local behavioral health authority, or LBHA, would be only the third in the state, joining the North Texas Behavioral Health Authority serving six counties in the greater Dallas region and LifePath Systems in Collin County.

The idea was encouraged by the Central Health Psychiatric Services Stakeholder Committee earlier this year, and a 30-day public comment period closing March 5 also showed overwhelming support for an LBHA. The county received over 50 comments from stakeholders and concerned members of the community.

“Every single response said we need greater coordination and a deeper level of investment,” County Judge Sarah Eckhardt said at the Tuesday morning Commissioners Court meeting.

Texas currently distributes small grants to a wide variety of organizations that treat substance use disorder in different ways at the local level. Demonstrated by the fact that Texas has the third-lowest ratio of substance use disorder treatment providers to number of adults living with an SUD of any state in the nation, this approach has failed to coordinate treatment efforts within communities and optimize resources.

In compliance with Texas Health and Safety Code, the county may consolidate substance abuse funding and resources by designating a single entity to act as both a mental and behavioral health authority.

Eckhardt said doing so “could have the potential to better coordinate our substance use disorder investments with our mental health investments.”

That entity would most likely be Integral Care, an organization that has served as the county’s local mental health authority for 50 years. While Integral Care primarily provides mental health services, it has launched a number of substance use treatment programs in recent years, partially funded through its Substance Abuse Managed Services Organization contract with the county.

Still, several community members expressed reservations about Integral Care during the 30-day public comment period. The most common criticisms were that the entity lacks financial transparency, does not collaborate well with other organizations and does not have the experience needed to adequately treat substance use disorder.

Ellen Richards, chief strategy officer at Integral Care, said the comments have been a helpful learning metric and that the agency is open to whichever outcome is ultimately chosen.

“It’s been a beneficial process for our agency to hear some of the feedback and we’re already working to incorporate some of the feedback that we’re hearing through this so that we can be more transparent and better partners to the folks we work with.”

A few comments also challenged the notion that a LBHA would better serve the community.

Rodolfo Pérez Jr., director of the county’s Drug Diversion Court, noted that 44 percent of direct felony clients and 56 percent of misdemeanor clients in Travis County were under supervision for a DWI or controlled substance offense in fiscal year 2018. A better solution, he said, is to refine the process of determining the unmet needs contributing to criminal offenses and connect clients to appropriate treatment options.

Eckhardt wants to convene a stakeholder discussion in April that could consider three or so “stalking horse options” that cover the diverse range of possible solutions. The meeting would include an outline of the state code provision that makes the LBHA possible and open up into public discussion.

Eckhardt put together a list of 71 potential stakeholders, some of whom either commented or were mentioned on the public comment portal. In the meantime, she asked the commissioners and members of the public to send her names and contact information of any organizations or individuals that may be able to get involved or contribute to the discussion.

“This will be a public meeting so even if somebody isn’t specifically reached out to, they would be welcome at the meeting,” she said.

Commissioner Jeff Travillion said it would be helpful first to identify an asset map of available services and their locations to use as a starting point for filling in the service gaps in communities.

“The really important thing for me over the long haul is how we build capacity in communities so that ultimately we’re not relying on organizations from 8 to 5, but we are building capacity in communities, whether that is in churches or other institutions, so that they can deal with some of the issues of folks that don’t talk to us about issues all of the time,” Travillion said.

The LBHA overlay could be an adjustment for some treatment providers that rely on funding through state contracts. For-profit providers, in particular, would not be able to access the federal block grant dollars dedicated to an LBHA; they would be able to continue doing work through other funds or develop a nonprofit treatment service to access the block grant dollars.

Eckhardt said the county is mindful of its providers who do medically assisted treatment, cognitive therapy, harm reduction and sobriety treatment.

“We’re going slowly and carefully because we do have a very deep network of substance abuse providers in our community.”

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