1. Thomas F. Best Deputy Assistant Commissioner Division for Mental Health and Substance Abuse Department of State Health Services The 84 th Legislature and Substance Abuse Services: Funding, New Programs, and Behavioral Health Integration

2. Need Met for Substance Abuse Treatment Services 2 SUD Population Below 200% FPL Served in DSHS-Funded Substance Abuse Treatment Programs (including NorthSTAR) 4 38,977 5.87% Need Met Texas Adults 2013 Texas Population 18 and older 1 19,406,207 8.07% of Texas Adults with Alcohol or Illicit Drug Dependency or Abuse (SUD) 2 1,566,081 Sources: 1 US Census Bureau: Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2013: 2013 Population Estimates 2 2012-2013 NSDUH State Estimates of Substance Use and Mental Disorders 3 Based on column – ABODILAL: Illicit Drug or Alcohol Abuse or Dependency, National Survey on Drug Use, 2013 4 Texas Department of State Health Services, Mental Health and Substance Abuse, Office of Decision Support, 06/18/15 42.42% of Texas Population 18+ with SUD Below 200% Federal Poverty Level (FPL) 3 664,331

3. Need Met for Substance Abuse Treatment Services 3 Texas Youth 2013 SUD Population Below 200% FPL Served in DSHS-Funded Substance Abuse Treatment Programs (including NorthSTAR) 4 5,604 6.35% Need Met Texas Population Aged from 12 to 17 1 2,321,185 6.68% of Texas Population aged from 12 to 17 live with SUD 155,055 2 Sources: 1 US Census Bureau: Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States, States, and Puerto Rico Commonwealth: April 1, 2010 to July 1, 2013: 2013 Population Estimates 2 2012-2013 NSDUH State Estimates of Substance Use and Mental Disorders 3 From Column ABODILAL: Illicit Drug or Alcohol Abuse or Dependency, National Survey of Drug Use, 2013 4 Texas Department of State Health Services, Mental Health and Substance Abuse, Office of Decision Support, 06/18/15 56.92% of Texas Population 12-17 with SUD Below 200% Federal Poverty Level (FPL) 3 88,257

4. Sunset Legislation 4 SB 200: HHSC Consolidation Bill Mental health & substance abuse services consolidated into HHSC by September 1, 2016. State Hospitals consolidated into HHSC by September 1, 2017. DSHS will retain public health functions. SB 202: DSHS Sunset Bill Originally contained several elements related to behavioral health services. Final version was almost exclusively specific to DSHS Regulatory Licensing. Some behavioral health elements of the filed version of SB 202 were moved to SB 1507.

5. SB 1507 DSHS to hire a forensic director to address issues with delivery of forensic services in the state (population changes, service availability, waitlists, etc.) Convenes a forensic work group DSHS to re-allocate inpatient mental health beds DSHS, with input from the court of criminal appeals and the Forensic Director, will develop and maintain a training curriculum for judges and attorneys. Outreach, Screening, Assessment and Referral (OSAR) Services Requires DSHS to contract with local mental health authorities for OSAR services. Local mental health authorities may subcontract with substance abuse or behavioral health providers for OSAR services. Local mental health authorities are required to develop an integrated service delivery model that utilizes historical substance abuse providers when feasible. 5

6. Substance Abuse Funding Substance Abuse funding increased 5.6% from the nearly $308 million for the FY 14-15 biennium ‘New Money’ received to expand youth prevention and neonatal prevention services 6

7. Youth Substance Abuse Prevention ($7.8 million/biennium) DSHS-funded substance abuse prevention providers offer services in 173 of the 254 Texas counties (68 percent), with 81 counties receiving no services. Several of these are high-risk counties, comprised of rural midsized cities, military populations, and border communities. This funding is expected to serve: DSHS Exceptional Item Program TypeYouthAdults Youth Prevention Universal132,42030,060 Youth Prevention Select10,6922,7362,736 Youth Prevention Identified7,2367,2361,7441,744 Totals150,34834,540 7

8. Neonatal Abstinence Syndrome ($11.2 million/biennium) Screening and Outreach $1.3 million will increase work to engage high risk populations through street outreach efforts to target 1,111 women. Intervention and Treatment $2.9 million to increase the number of women served through existing Pregnant and Postpartum Intervention (PPI) programs by 2,417. $5 million will be used for 635 Opioid Substitution Therapy slots. Specialized Programs $1.5 million will support one residential treatment pilot program available to approximately 171 pregnant women using opioids in need of stabilization and specialized services. $500,000 to expand the Mommies program to 560 families in the five counties with highest incidence and costs for NAS cases: Bexar, Dallas, Harris, Tarrant, and Nueces. DSHS Exceptional Item 8

9. Community-Based Crisis and Treatment Facilities Review Comprehensive review of contract funding requirements and standards governing crisis and treatment facilities (MH&SA) Requires identification of best practices and unnecessary barriers Report (December 1, 2016) to include a summary of review and recommendations for statutory or regulatory changes DSHS Rider 80 9

10. State Hospitals The State Hospital Long-term Plan Expanded access through purchase of local beds Pursuit of academic partnerships Addressed workforce issues Begin repairing / replacement of aging state hospitals Substance abuse services in state hospitals and continuity of care 10

11. Behavioral Health Conditions Increase Costs *Presented by SAMHSA at NASADAD 2015 Annual Meeting

12. Vision for the Future Integration of behavioral health and physical health Access to substance abuse treatment Trauma-informed care Continuity of care (including nursing homes and youth and families in the DFPS system. Collaboration with other agencies, universities, and non-profits 12

13. Questions