Texas ranks dead last when it comes to access to mental health care in the U.S., but a new state program is working with schools to provide free mental health services year-round.

About 63% of Texas public school students — 3.3 million children — now have access to the program, which includes free telemedicine visits with a behavioral health specialist. Students can receive one-on-one counseling, medication management and treatment for some of the most common issues like anxiety, depression and attention deficit hyperactivity disorder.

Rural areas of Texas are particularly hard hit by the shortage in the mental health care workforce. That's one area of focus for the new Texas Child Health Access Through Telemedicine school program, known as TCHATT.

"We're actively targeting those smaller rural areas as we know they have less resources," said Lashelle Inman, senior program manager for the Texas Child Mental Health Care Consortium that oversees the TCHATT program by partnering with Texas medical schools and local and state mental health organizations.

School districts sign up to participate in TCHATT, but about 140 of the state's 1,221 districts have not responded, Inman said. Another 50 have declined to participate, according to the TCHATT website that provides a map showing the status of individual school districts in Texas.

The pandemic proved the need for access to telemedicine, said Dr. Sarah Wakefield, who leads the Department of Psychiatry at Texas Tech University Health Science Center School of Medicine and is part of the consortium supporting TCHATT.

"What came out of the pandemic was the need to do it," Wakefield said, speaking of telemedicine. "And realization that you could provide a lot of great care to a lot of people."

The Texas Legislature created the consortium in 2019 and used federal pandemic relief funding to expand the program in 2021. By the mid-summer this year, the program was more than halfway to its goal of serving 5.2 million public school students in grades K-12.

This year, the Legislature fully funded the consortium's $337 million budget request, which includes $173 million for TCHATT.

"State government is making huge investments," Wakefield said.

Tough choices

The Texas Health and Human Services Rural Mental Health unit joined community conversations about accessibility to routine mental health services in 2022, according to Tiffany Young, the agency's press officer.

The challenge for rural Texas remains lack of internet access in some areas, Young said. In poorer areas the barriers to care are lower wages, more uninsured families, and lack of transportation. During the school year, public schools can "offer a haven of safety, supervision, nutrition and access to other resources," Young said.

"In some families, it is a choice of placing food on the table or accessing mental health services," Young said.

According to child mental health statistics compiled by the Centers for Disease Control and Prevention, mental health issues were on the rise before the COVID-19 pandemic, and they've just gotten worse.

In Texas, 71% of youth with mental health issues will go untreated, compared to a national average of about 61%, according to Mental Health America, a national nonprofit dedicated to the promotion of mental health, well-being and illness prevention.

The American Academy of Child and Adolescent Psychiatry estimates that the country needs 47 child and adolescent psychiatrists per 100,000 children, but the state has roughly 10 per 100,000.

Advice for parents

The TCHATT section of the consortium's website has a list of resources for parents on topics including ADHD, anxiety, depression, shootings and violence, as well as trauma and grief. Parental consent forms are included there in English and Spanish. Parents provide consent before children work with TCHATT clinicians.

Dr. Giancarlo Ferruzzi, an associate clinical professor specializing in child and adolescent psychiatry at the University of Texas Health Science Center at San Antonio, said TCHATT is providing very useful services and reducing the wait time for mental health appointments for children and adolescents.

With concerns about ADHD, depression and anxiety, parents often make appointments with a doctor they're already comfortable with — often a pediatrician or primary care doctor — because there's already a level of comfort there, Ferruzzi said.

He urges parents to not put off mental health care.

"I wish more parents would not wait until they know for certain that there is a problem because sometimes waiting too long, the scope of the problem is more significant than it needed to be," he said.

Lisa Anderson, 40, a psychiatric mental health nurse practitioner who works at the Family Wellness Center in San Antonio, said parents should take the first appointment they can get.

"Don't give up. Your kids need that help," she said. "Get in with the first clinician who can see your child."

Terry Bertling teaches journalism at Texas State University and is the lead reporter for Texas Community Health News, a collaboration between the School of Journalism and Mass Communication and the university’s Translational Health Research Center. TCHN stories, reports and data visualizations are provided free to Texas newsrooms.