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Mental Health

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maintain optimal physical and behavioral health.

21% of adults in Travis County report poor mental health

Indicator: Percent of adults in Travis County who report poor mental health

Goal: Reduce the percentage of people reporting poor mental health

Target: 15% by 2017

Significance of Indicator: The United States Department of Health and Human Services states that good mental health is essential to overall health and personal well-being. It also contributes to the ability to lead a healthy, balanced, and productive life. Emotional problems can impair a person's thinking, feelings, and behavior and, over time, can become increasingly serious and disabling.

what the data tell us

Twenty one percent of Travis County residents report poor mental health. This is higher than the percentage of people who report poor mental health across the MSA (19%) or the State (20%).

Definition: Adults who report to have had 5 or more days of poor mental health which includes stress, depression, and problems with emotions, within the last 30 days.

Data Source: Texas Behavioral Risk Factor Surveillance System (BRFSS)

Data Considerations: The BRFSS collects data through phone interviews. In 2011 the surveying process was expanded to include people with cell phones as well as people with landlines. As a result, this data is not comparable to BRFSS data from years prior to 2011. The sample sizes for BRFSS data are very small. Changes shown in this graph fall within the margin of error for the data and are not statistically significant.

the story behind the indicator

In general, people with low-incomes are more likely to report poor mental health. Reports of poor mental health can signal that there are deeper issues in the community with mental illness and substance abuse, which are often co-occurring. Children and youth in our community also struggle with behavioral health issues. Disciplinary issues in school or students reporting sadness or depression can be early indicators of poor mental health among children and youth. Suicides rates among children and youth indicate that there is more prevention and intervention work to be done.

In a report on the impact of the Affordable Care Act (ACA) on people with mental health and substance use disorders, the Center for Public Policy Priorities notes that insurers will no longer be able to deny coverage or raise premium costs for mental health conditions or other health status or health history factors. Also, the ACA will require that the majority of both private and Medicaid health plans include mental health and substance use coverage that is parallel with other medical benefits.

some local efforts to improve this indicator

  • In November 2012, Travis County voters approved an additional 5-cent property tax for Central Health.  Central Health reports that the tax rate increase will bring in an additional $54 million to be matched by another $76 million in federal funds, for an additional $130 million annually over the next four years.  Central Health is the lead agency for a six county Regional Healthcare Partnership Plan that describes how the region will transform healthcare delivery as part of a state-wide 1115 Waiver. The Plan includes several initiatives to expand behavioral health services and to integrate behavioral and physical healthcare. 

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  • In 2012, the Austin/Travis County Health and Human Services Department, in partnership with other health care partners, completed a Community Health Assessment (CHA) which found that the need for mental health services was one of the foremost community health concerns raised by residents. The partners have developed a Community Health Improvement Plan with strategies to deal with the issues identified in the assessment.

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  • Austin Travis County Integral Care's (ATCIC) mission is to improve the lives of people affected by behavioral health and developmental and/or intellectual challenges. In September 2011 ATCIC was awarded a $300,000 grant from the St. David’s Foundation to provide services for the 1,300 adults on the behavioral health waiting list. By August of 2012, the waiting list had been reduced to 391 individuals. Austin Travis County Integral Care, a key partner in this effort, plans to expand and enhance community-based services through integration of physical and behavioral health with chronic disease prevention programs, mobile outreach, tele-medicine, peer support services, and community outreach and education.

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  • The Indicator Improvement Initiative and the Child and Youth Mental Health Planning Partnership are local collaborations that help coordinate behavioral health planning needs.

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  • The Austin Recovery Oriented System of Care (ROSC) Initiative is a network that builds on the strengths and resilience of individuals, families and communities to achieve improved health, wellness, and quality of life for those with or at-risk of alcohol and drug problems through a long-term, community-based recovery approach.

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  • The Psychiatric Services Stakeholder Group, a collaboration of government, healthcare, and other organizations coordinated by Central Health, is working to create a stronger, more viable mental health crisis system including a round the clock crisis hotline, mobile crisis outreach services, 24-hour psychiatric emergency services, observation beds in a safe and structured environment, inpatient crisis services, crisis intervention teams, and crisis respite beds.

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  • Partnership between Central Health and Austin Travis County Integral Care has allowed the integration of health and behavioral health services in CommUnity Care Health Clinics, resulting in more people receiving mental health care.

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  • The Austin/Travis County Suicide Prevention Coalition is one of many coalitions and statewide agencies in Texas working together to implement the Texas Suicide Prevention Plan. This year the Austin/Travis County coalition has a goal of providing training to community and clinical service providers on the prevention of suicide and related behaviors. An example of such a training being provided is Mental Health First Aid.

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  • In 2007, Travis County became the first county in the nation to have a Mental Health Public Defender's Office.

a closer look at the story behind the indicator:

Click on one of the titles below for more information.

» Mental Health in Travis County - Behavioral Risk Factor Surveillance System Data

% of adults in Travis County who Report Poor Mental Health by Income

People with low-incomes report higher levels of poor mental health. In 2012, 27% of adults in Travis County with incomes less than $25,000 reported poor mental health. This compares to 23% of adults with incomes between $25,000 and $74,999 and 17% of adults with incomes of $75,000 or higher.

Definition: Adults who report to have had 5 or more days of poor mental health which includes stress, depression, and problems with emotions, within the last 30 days

Data Source: Texas Behavioral Risk Factor Surveillance System (BRFSS)

Data Considerations: The BRFSS collects data through phone interviews. In 2011 the surveying process was expanded to include people with cell phones as well as people with landlines. As a result, this data is not comparable to BRFSS data from years prior to 2011. The sample sizes for BRFSS data are very small. Changes shown in this graph fall within the margin of error for the data and are not statistically significant. .

% of adults who report poor mental health by age group

In 2012 older adults were the age group that was least likely to report poor mental health in Travis County. Fourteen percent of adults ages 65 and over reported poor mental health compared to 26% of 18-29 year olds, 23% of 30-44 year olds, and 19% of 44-64 year olds.

Definition: Adults who report to have had 5 or more days of poor mental health which includes stress, depression, and problems with emotions, within the last 30 days

Data Source: Texas Behavioral Risk Factor Surveillance System (BRFSS)

Data Considerations: The BRFSS collects data through phone interviews. In 2011 the surveying process was expanded to include people with cell phones as well as people with landlines. As a result, this data is not comparable to BRFSS data from years prior to 2011. The sample sizes for BRFSS data are very small. Changes shown in this graph fall within the margin of error for the data and are not statistically significant. In 2011, the data for the population ages 18-29 is considered unstable because it either has a relative standard error greater than 30% or because the denominator represents fewer than 50 respondents.

% of adults in Travis County who Report Poor Mental Health by race and ethnicity

Whites were most likely to report poor mental health in Travis County in 2012. Twelve percent of Blacks and 18% of Hispanics reported poor mental health compared to 25% of Whites.

Definition: Adults who report to have had 5 or more days of poor mental health which includes stress, depression, and problems with emotions, within the last 30 days

Data Source: Texas Behavioral Risk Factor Surveillance System (BRFSS)

Data Considerations: The BRFSS collects data through phone interviews. In 2011 the surveying process was expanded to include people with cell phones as well as people with landlines. As a result, this data is not comparable to BRFSS data from years prior to 2011. The sample sizes for BRFSS data are very small. Changes shown in this graph fall within the margin of error for the data and are not statistically significant. In 2012, the data for the Black population is considered unstable because it either has a relative standard error greater than 30% or because the denominator represents fewer than 50 respondents.

» Concentrations of Clients Receiving Behavioral Health Services from ATCIC

map of Austin Travis County Integral Care (ATCIC) clients

This map shows clients of Austin Travis County Integral Care (ATCIC) in Travis County. ATCIC serves populations with bipolar disorder, major depression, and schizophrenia. This population data also include clients with intellectual or developmental disabilities. ATCIC’s clients are largely concentrated along the I-35 corridor and in Del Valle.

Definition: Unduplicated number of clients served by ATCIC from January 1, 2012 to December 31, 2012

Data Source: Map was produced by Community Action Network. Data was provided by Austin Travis County Integral Care

Data Considerations: This data reflects only the number of people served in zip codes in and adjacent to Travis County. ATCIC reports serving some clients who reside in zip codes that are not displayed on the map.

legend clarifying the colors of the map

» Suicide Data

overall suicide rate per 100,000 people

Travis County’s suicide rate increased slightly in 2010, and is now higher than the State’s suicide rate once again after a dip in the suicide rate in 2009. In 2010, the suicide rate for Travis County was 12.4 deaths per 100,000 persons and the State’s suicide rate was 11.8 deaths per 100,000 persons.

Definition: The number per 100,000 of completed suicides for youths ages 15-24

Data Source: Texas Department of State Health Services

Data Considerations: The suicide rate is calculated using population numbers from 2000 Census data. As a result, suicide rates may actually differ from what this data shows.

» Substance Abuse Issues in the Greater Central Texas Region

% using illicit drugs in the past month - Ages 12 and up

Over time, Central Texas has had a higher percentage of people ages 12 and up who report using illicit drugs than the state and the nation. From 2008-2010, 10% of Central Texans ages 12 and up reported using illicit drugs compared to 7% in the state of Texas and 9% across the nation.

Definition: The percentage of people ages 12 and up who reported using an illicit drug (marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalents, prescription-type psychotherapeutics used non-medically, etc.) within the past month

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

% using illicit drugs other than marijuana in the past month - Ages 12 and up

When marijuana use is removed from drug use data, the percentage of people who report having used illicit drugs within the past month decreases substantially. Compared to previous years, use of illicit drugs other than marijuana was down during the 2008-2010 time period for Central Texas, the State, and the Nation. During the 2008-2010 time period, 4% of Central Texans reporting having used an illicit drug other than marijuana in the past month compared to 3% of Texans and 4% of Americans.

Definition: The percentage of people ages 12 and up who reported using an illicit drug (cocaine/crack, heroin, hallucinogens, inhalents, prescription-type psychotherapeutics used non-medically, etc.) other than marijuana within the past month

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

Alcohol Dependence in the Past Year - Ages 12 and Up

From 2008-2010 4% of Central Texans were alcohol dependent compared to 3% of Texans and 4% of Americans.

Definition: Survey respondents were defined as having alcohol dependence if they met three or more of the following criteria:

  • Spent a great deal of time over the period of a month getting, using, or getting over the effects of alcohol
  • Used alcohol more often than intended or was unable to keep set limits on alcohol use
  • Needed to use alcohol more than before to get desired effects or noticed that the same amount of alcohol had less effect than before
  • Inability to cut down or stop using alcohol every time tried or wanted to
  • Continued to use alcohol even though it was causing problems with emotions, nerves, mental health, or physical problems
  • Alcohol use reduced or eliminated involvement or participation in important activities
  • Experienced withdrawal symptoms (e.g. having trouble sleeping, cramps, hands tremble)

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

Illicit Drug Dependence in the Past Year - Ages 12 and Up

The percentage of people who are dependent on illicit drugs has remained at about 2% for Central Texas, Texas, and the Nation for all years represented on the graph below.

Definition: Survey respondents were defined as having illicit drug dependence if they met three or more of the following criteria:

  • Spent a great deal of time over the period of a month getting, using, or getting over the effects of illicit drugs
  • Used illicit drugs more often than intended or was unable to keep set limits on illicit drug use
  • Needed to use illicit drugs more than before to get desired effects or noticed that the same amount of illicit drugs had less effect than before
  • Inability to cut down or stop using illicit drugs every time tried or wanted to
  • Continued to use illicit drugs even though it was causing problems with emotions, nerves, mental health, or physical problems
  • use of illicit drugs reduced or eliminated involvement or participation in important activities
  • Experienced withdrawal symptoms (e.g. having trouble sleeping, cramps, hands tremble)

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

% needing but not receiving treatment for Alcohol dependence in the Past Year

More Central Texans need but do not receive treatment for alcohol use than Texans and the general U.S. population, however the percentage of Central Texans needing but not receiving treatment has declined in more recent years. From 2008-2010, 8% of Central Texans with alcohol dependence needed but did not receive treatment. This compares to 7% of Texans and Americans with alcohol dependence.

Definition: The percentage of people ages 12 and up meeting the criteria for alcohol dependence but not receiving specialty treatment for alcohol use in the past year

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

% needing but not receiving treatment for Illicit drug use in the Past Year

Over time roughly 3% of Central Texans, Texans, and Americans have reported needing but not receiving treatment for illicit drug use in the past year.

Definition: The percentage of people ages 12 and up meeting the criteria for illicit drug dependence but not receiving specialty treatment for drug use in the past year

Data Source: National Survey on Drug Use and Health (NSDUH)

Data Considerations: NSDUH does not survey people who are homeless, active duty military, or people who are in jails or hospitals. Small sample sizes may impact the accuracy of data, especially in smaller geographic regions. Central Texas denotes the 10 county region consisting of Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson.

» Behavioral Health Issues in Austin ISD

% of students with disciplinary actions that resulted in removal from classrooms

Negative behavior that results in a removal from the regular classroom is an early warning sign that should spur immediate action to: 1) understand what is contributing to the problem, and 2) correctly identify the positive/protective factors that will help motivate the child to change his/her behavior and regain confidence and belief in him/herself. Underlying mental health issues could be contributing to the negative behavior. Disciplinary rates have steadily declined over the past six school years within the Austin Independent School District (AISD). Some school districts have had lower disciplinary rates as a result of policy changes. Many local school districts are moving away from disciplinary actions of a punitive nature to actions that provide proactive help to students. This is in acknowledgement of the fact that often disciplinary issues are an indicator that a student has other unaddressed issues.

Definition: % of students who experienced disciplinary action that resulted in their removal from the regular classroom for at least one day

Data Source: Texas Education Agency

Data Considerations: Students removed from the classroom may experience one or more of the following disciplinary actions: in-school suspension, home-school suspension, expulsion, juvenile justice alternative education programs, or disciplinary alternative education programs.

% of students reporting that their ability to cope with stress or negative emotions is poor or very poor

While there is no measure of sad, unhappy, or depressed youth in our community, AISD surveys students on their ability to cope with stress and negative emotions. In 2012, 14% of both middle school and 16% of high school students reported that their ability to cope with stress or negative emotions is poor or very poor.

Definition: % of students reporting that their ability to cope with stress or negative emotions is poor or very poor

Data Source: Austin Independent School District, Student Substance Use and Safety Surveys, 2011

Data Considerations: A high percentage of students responding to the survey report that they “don’t know” how good their ability is to cope with stress and negative emotions. The data reported in this survey is not directly comparable to data reported for other demographic regions.

» Children's optimal health Maps on Substance Use in Austin ISD

Austin ISD Middle Schools: Percentage of students self-reporting alcohol use

This map provides two simultaneous representations of student self-reported behavior. Campus pie charts reflect the responses of students reporting alcohol use for that campus. Zip Code analysis reflects reported alcohol use within the past month, by the Zip Code of student residence. This allows understanding of student behavior by neighborhood, and can enable targeting of community intervention efforts to complement efforts at the school level to promote student health. In school year 2010-2011, 78% of students reported never using alcohol and 11% reported use in the past month. There was no change compared to students reporting in the prior year. Higher concentrations of students reporting recent alcohol use occur throughout the area, but especially among students living in the 78725 and 78703 zip codes.

Map showing Austin ISD middle schools and the percentage of students self-reporting alcohol use during the 2010-2011 school year

Definition: The campus pie charts relect the responses of student reporting alcohol use for that AISD campus during the 2010-2011 school year (never used/never heard of alcohol, used alcohol more than a year ago, used alcohol within the past year, or used alcohol within the past month). The zip code analysis shows the reported precentage of alcohol use within the past month by zip code for AISD students during the 2010-2011 school year.

Data Source: Data was collected by the Austin Independent School District. The map was created by Children's Optimal Health.

Data Considerations: This data is from Austin ISD's Student Substance Use Report which relies on students self-reporting of alcohol use. Students may not report using alcohol as freqently as use actually occurs. Data on alcohol use by campus does not necessarily reflect activity occuring on campus.

Austin ISD High Schools: Percentage of students self-reporting alcohol use

This map provides two simultaneous representations of student self-reported behavior. Campus pie charts reflect the responses of students reporting alcohol use for that campus. Zip Code analysis reflects reported alcohol use within the past month, by the Zip Code of student residence. This allows understanding of student behavior by neighborhood, and can enable targeting of community intervention efforts to complement efforts at the school level to promote student health. In school year 2010-2011, 56% of students reported never using alcohol and 26% reported use in the past month. Among students reporting alcohol use in the past month, there was a 2% decrease over students reporting in the prior year. There was a 4% increase among students reporting they have never used alcohol, compared to the prior year. Higher concentrations of students reporting recent alcohol use occur throughout the area, but especially among students living in the 78727, 78757, 78756, 78703, 78725, and 78652 zip codes.

Map showing Austin ISD high schools and the percentage of students self-reporting alcohol use during the 2010-2011 school year

Definition: The campus pie charts relect the responses of student reporting alcohol use for that AISD campus during the 2010-2011 school year (never used/never heard of alcohol, used alcohol more than a year ago, used alcohol within the past year, or used alcohol within the past month). The zip code analysis shows the reported precentage of alcohol use within the past month by zip code for AISD students during the 2010-2011 school year.

Data Source: Data was collected by the Austin Independent School District. The map was created by Children's Optimal Health.

Data Considerations: This data is from Austin ISD's Student Substance Use Report which relies on students self-reporting of alcohol use. Students may not report using alcohol as freqently as use actually occurs. Data on alcohol use by campus does not necessarily reflect activity occuring on campus.

Austin ISD Middle Schools: Percentage of students self-reporting marijuana use

This map provides two simultaneous representations of student self-reported behavior. Campus pie charts reflect the responses of students reporting marijuana use for that campus. Zip Code analysis reflects reported marijuana use within the past month, by the Zip Code of student residence. This allows understanding of student behavior by neighborhood, and can enable targeting of community intervention efforts to complement efforts at the school level to promote student health. In school year 2010-2011, 86% of students reported never using marijuana and 8% reported use in the past month. Among students reporting marijuana use in the past month, there was no change compared to students reporting in the prior year. Higher concentrations of students reporting recent marijuana use occur in the northern and eastern zip codes, but especially among students living in the 78725 and 78736 zip codes.

Map showing Austin ISD middle schools and the percentage of students self-reporting marijuana use during the 2010-2011 school year

Definition: The campus pie charts relect the responses of student reporting marijuana use for that AISD campus during the 2010-2011 school year (never used/never heard of marijuana, used marijuana more than a year ago, used marijuana within the past year, or used marijuana within the past month). The zip code analysis shows the reported precentage of marijuana use within the past month by zip code for AISD students during the 2010-2011 school year.

Data Source: Data was collected by the Austin Independent School District. The map was created by Children's Optimal Health.

Data Considerations: This data is from Austin ISD's Student Substance Use Report which relies on students self-reporting of marijuana use. Students may not report using marijuana as freqently as use actually occurs. Data on marijuana use by campus does not necessarily reflect activity occuring on campus.

Austin ISD High Schools: Percentage of students self-reporting marijuana use

This map provides two simultaneous representations of student self-reported behavior. Campus pie charts reflect the responses of students reporting marijuana use for that campus. Zip Code analysis reflects reported marijuana use within the past month, by the Zip Code of student residence. This allows understanding of student behavior by neighborhood, and can enable targeting of community intervention efforts to complement efforts at the school level to promote student health. In school year 2010-2011, 67% of students reported never using marijuana and 20% reported use in the past month. Among students reporting marijuana use in the past month, there was no change compared to students reporting in the prior year. Higher concentrations of students reporting recent marijuana use occur throughout the area, but especially among students living in the 78756, 78746, 78737, and 78725 zip codes.

Map showing Austin ISD high schools and the percentage of students self-reporting marijuana use during the 2010-2011 school year

Definition: The campus pie charts relect the responses of student reporting marijuana use for that AISD campus during the 2010-2011 school year (never used/never heard of marijuana, used marijuana more than a year ago, used marijuana within the past year, or used marijuana within the past month). The zip code analysis shows the reported precentage of marijuana use within the past month by zip code for AISD students during the 2010-2011 school year.

Data Source: Data was collected by the Austin Independent School District. The map was created by Children's Optimal Health.

Data Considerations: This data is from Austin ISD's Student Substance Use Report which relies on students self-reporting of marijuana use. Students may not report using marijuana as freqently as use actually occurs. Data on marijuana use by campus does not necessarily reflect activity occuring on campus.

vulnerable populations

turning the curve

ATCIC’s Local Service Area Plan for FY 2011-2012 and the Draft Austin/Travis County Community Health Improvement Plan recommend the integration of behavioral health and physical health services to ease access to healthcare for community members.

ATCIC’s Local Service Area Plan for FY 2011-2012 and the Community Action Network’s Frequently Asked Questions about Child and Youth Mental Health document recommend that the community be provided with more information about the various aspects of mental health, mental illness, intellectual and developmental disabilities, and substance abuse to improve the knowledge of and perception of these issues.