Donna Spencer and Iliana Gilman work with Austin Travis County Integral Care, the agency that provides mental health services for low-income residents in the area. They recently walked through the site of Integral Care’s soon-to-open $2.4 million facility, inside what used to be a Wal-Mart and a Sam’s Club.
It’s in the southeast Austin neighborhood of Dove Springs. This low-income, majority Latino neighborhood is getting its first mental health care facility. It’s in large part because of a federal initiative, the Medicaid 1115 waiver program, that funds experimental clinics like this one. It will offer mental health care and substance abuse treatment, along with routine primary care.
"These are monies that are made available by the federal government for new projects that are providing mental health services for a Medicaid, low-income uninsured population," says Hugh Simmons, who oversees Integral Care's waiver projects. "The idea is that when these projects are up and running after five years, that they’ll be self-sustaining. So currently that’s the funding source. But ultimately it’ll be a self-sustaining clinic."
To continue its work, the clinic will depend on other city, county, state and federal funding. The aim of the program is to encourage states to come up with projects that decrease dependence on emergency care.
"That’s the crux of it: that it started out as a hospital federal incentive so that people were not accessing very expensive services and utilizing more of the prevention and wellness and ongoing maintenance that’s required with mental health," Gilman says.
Integral Care already services about 2,300 people from Dove Springs at its other clinics who may transition to this one. People like Frances Acuña, who's lived in the neighborhood for 12 years. She says her battle with depression dates back to when she was a teenager, but she never sought treatment. It wasn’t until last week that a colleague drove her to a downtown clinic to get help.
"I usually jump, dance, sing, scream, so I can help those chemicals to go to my brain and help to cope with it," Acuña says. "But it wasn’t helping so I decided to get some medicine. I had to accept that I needed that help."
She said no one ever taught her that depression needs medical attention.
"I do believe, as a Hispanic, we go through so many things. Our parents teach us to be … we don’t talk about certain things," Acuña says. "You don’t seek help because it’s embarrassing. What are they going to say?"
That’s something Jill Ramirez hears a lot. She directs the Latino Health Care Forum -- a group with deep roots in Dove Springs.
"I think that traditionally that has happened where people don’t want to talk about mental illness, whether it’s very mild depression to more severe bipolar," Ramirez said. "We have that idea that what happens in our family stays within our family and nobody talks about it."
Meantime, access to mental health services in Texas have become harder for low-income people to access in recent years. Texas ranked near the bottom out of all the states in per-capita spending on mental health services from 2006 to 2009, according to the Kaiser Family Foundation.
But that’s starting to change. Last legislative session, lawmakers dedicated more than $250 million additional dollars for mental health over the next two years.
Iliana Gilman with Integral Care says she’s cautiously optimistic about how much that will trickle down to Austin.
"Really we’re playing catch up, at this point. It’s not like we’re increasing services because we’ve gotten a bump in funding," Gilman says. We’re saying, maybe now we can get to our wait lists. Maybe now we can start doing our job a little more adequately than before where we were really having to stretch our staff and our resources." The clinic’s doors will open in late November.
In the meantime, Frances Acuña believes the funding that made the clinic that’s now being built in Dove Springs clinic possible could have a lasting impact.
"It’s an opportunity for us to get out of that hole," Acuña says. "Out of that stigma that I’m crazy."