People often say the best way to determine where the next major development in health care will occur is to follow the reimbursements. If Medicare or third-party payors significantly raise reimbursement for a particular service or facility fee, one can be fairly certain that exponential growth in that area will soon follow. Payors typically raise rates only when there is a pressing need for the service. One such area in Texas that has a need but has not yet received a significant increase in reimbursement rates is adolescent mental health care facilities, where the number of available beds and qualified providers falls far short of demand.

Between the self-isolation stemming from teens’ dependence on phones and tablets and the lingering effects of the COVID-era lockdowns, more Texas adolescents than ever are experiencing mental health challenges. Texas is not alone, as CDC data shows that nationwide, roughly 20% of teens report symptoms of anxiety and 18% report symptoms of depression.

Despite this increasing need, most Texas teens are not receiving adequate mental health care. Multiple factors contribute to this problem: the continued stigma surrounding mental illness, insurance plans that do not meaningfully cover mental health services, and providers who choose not to accept government or third-party payors. These barriers make it especially difficult for families in low-income households to access the appropriate treatment their children need.

There is an urgent need for more accessible adolescent mental health services in Texas – as anyone who watches the local news can attest, given the frequent reports of both thwarted and tragic school-violence incidents. In addition to individual therapy and medication management by licensed psychiatrists, other treatment models exist for children with more severe mental health needs. Texas needs more options that fall between weekly therapy and full psychiatric hospitalization. Without these intermediate levels of care, many young patients do not receive help until they are in crisis, jeopardizing their safety and increasing long-term costs to the State of Texas. Early intervention could save both lives and resources.

One such intermediate option is an intensive outpatient program (IOP). In an IOP, patients typically meet for several hours a day, three or four days per week. The patients are not in individual psychiatric sessions for the entire time; rather, they receive a myriad of therapeutic modalities. These programs often include group therapy, individual therapy, and “softer” interventions such as art therapy or meditation. A major benefit is that patients can continue living at home with their parents and may attend school depending on program scheduling. IOPs are ideal for adolescents who need structured, consistent care but not around-the-clock supervision.

For those patients needing more extensive treatment, residential treatment centers (RTCs) provide a step between IOPs and inpatient hospitalization. These facilities offer 24/7 care and are helpful for patients who pose safety risks, either to themselves or others. RTCs are also critical for adolescents whose home environments are not conducive to recovery. Without this level of care, many vulnerable children end up in the foster-care system.

With more than a million Texas youths reporting mental, emotional, developmental, or behavioral challenges, this is a large-scale issue that will not be solved overnight. Addressing it effectively will require collaboration between government and the private sector. The State should raise reimbursement rates to incentivize private investment in expanding access to IOPs and RTCs statewide. At the same time, the government must enforce rigorous standards to ensure parents feel confident they are sending their children to reputable, therapeutic facilities; not institutions reminiscent of One Flew Over the Cuckoo’s Nest or, for younger readers, the Netflix series Wayward.

The traditional service models currently in place are not meeting the escalating needs of adolescents facing mental health crises in Texas. Government leaders and health care entrepreneurs must work together to build out the full continuum of care, giving parents and guardians viable options for their children. If Texas can establish a robust network of high-quality IOPs and RTCs offering diverse therapeutic approaches, the state may finally be able to meet the mental health needs of its youth – preventing crises such as suicide and violence, reducing unnecessary foster-care placements, and supporting long-term healing and stability.