Texas injects billions to close mental health care gaps in rural areas

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AMARILLO — Three times a week, Potter County Judge Nancy Tanner holds hearings for people to determine whether they should be placed in a mental health hospital.

Since she was elected in 2014, she has seen many of the same people cycle in and out of her courtroom — a long-running marathon of familiar faces who either don’t want help or get it, and still end up back in Tanner’s presence.

When she doesn’t see them again, she quietly hopes they find help on their own. Unfortunately, Tanner is acutely aware of what can happen if they don’t.

“I go home thinking about these people some nights,” said Tanner, who is the county’s top elected official with broad constitutional powers in all three branches of government. Like other county judges in rural parts of the state, she maintains a limited judicial role. “I’m assuming they are OK, but I don’t know if they are. I can’t check on them.”

Organizations and nonprofits have fought for decades to increase mental health access in the Texas Panhandle, including Potter County and the county seat of Amarillo.

There is finally an oasis in sight.

This year, state lawmakers earmarked $2.26 billion to aid state hospitals and increase mental health care access. The funds approved include the construction of hospitals in Lubbock, the Permian Basin, and in Amarillo, worth $159 million. It’s an investment officials hope will boost the state’s offerings after consistently being rated one of the worst for mental health care by advocacy organizations such as Mental Health America.

“I think there have been so many people impacted by (mental health problems) that reached out to their representatives,” said Mellisa Talley, executive director for Texas Panhandle Centers Behavioral & Developmental Health. “Maybe not a lot of people spoke out in the past, but I think we all talk about it more now.”

Advocates say the Amarillo hospital likely will fill the gaps when it comes to serving the nearly 436,000 people living in the farthest northern areas of the state, a largely rural area that has long been starved for mental health care.

While there are some local outpatient resources people can voluntarily use, inpatient care is essentially nonexistent. In the Panhandle, anyone in a mental health crisis who needs hospitalization would not find that in Amarillo, a city of more than 200,000 people — the same size as the Dallas suburbs of McKinney and Grand Prairie. Instead, they would be sent more than four hours away from home to Wichita Falls or Big Spring.

If those hospitals are full, which is often the case, patients have to wait for an opening. During this time, Tanner said, they end up back in her courtroom.

“I can’t imagine how terrifying it is to be in a psychotic break and then to be somewhere far away from your family,” said Dr. Amanda Mathias, the Panhandle regional director for the Meadows Mental Health Policy Institute. “Any sort of health issue you’re going through, whether it’s physical or mental, you want to be as close to your support system as possible.”

The Amarillo hospital, along with one being built in Lubbock, is coming at a time when they are needed most for the rural communities surrounding the two cities. According to a 2022 report by the state behavioral health coordinating council, suicides in rural areas are rising faster than in metro areas and have increased by 55% from 2000-2020.

Data for the Panhandle paint a more concerning picture. During the last two decades, the 21 counties represented in the report show an 81% increase in suicides. In 2000, an estimated 11 people per 100,000 people died by suicide. In 2020, the suicide rate jumped to 20 per 100,000 people. In 2020, the Panhandle had the highest rates of suicide attempt hospitalizations in the state with 120 per 100,000 people. The rate does not appear to be slowing. At least five people in Potter County took their own lives this month, according to Tanner.

Mathias said just like the body, the brain benefits from early detection. In the Panhandle, that will most likely be picked up in religious circles, primary care visits, or pediatrician offices. Mathias said because of this, some local clinics have begun asking more questions about a patient’s mental state.

The Amarillo Area Foundation has invested $725,000 toward integrating this approach into clinics in the area. It has already been used to screen more than 100 people in one clinic over a month.

“That’s 100 people that weren’t being asked those questions before,” Mathias said. “Doctors should be asking the questions that provide early intervention so we don’t get to the point of a crisis where somebody is thinking of suicide.”

Libby Moore is the chief clinical officer for Texas Panhandle Centers, a community behavioral health clinic with six locations throughout the region. She has noticed a change in how people discuss mental health in general, and her organization has responded to what the community cried out for.

The clinic offers mental health first aid training to adults and youth, a team dedicated to guiding family and loved ones after losing someone to suicide, and a mobile crisis outreach team for telehealth needs.

What they can’t offer, Moore is hopeful the hospital could. This way, she says, patients can get any kind of care they need closer to home. She compares it to people who have heart attacks and how some might be able to get back to their routines, while others may need to stay at a hospital for more treatment.

“Being able to meet the person where they are, at the time they most need it, is just a better prognosis,” Moore said.

Tanner, the Potter County judge, sees the hospital as more proof that people are ready to talk about mental health. She grew up in a generation where those talks were hushed away before neighbors could find out. She wonders how many “accidental gunshot” deaths she heard about were actually people who were quietly struggling before they took their lives.

Amarillo needs to be at the forefront of that conversation, she said, and be the hub for mental health care in the Panhandle.

“All the other counties look to us because they don’t have big hospitals or treatment centers,” Tanner said. “They all come to us, so our role is important.”

Disclosure: The Meadows Foundation has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.