Department of State Health Services

Overview

The Texas Department of State Health Services (DSHS) is one of two state agencies within the Health and Human Services (HHS) umbrella. The HHS system was restructured during the 2015 legislative session and many behavioral health services and programs were transferred to the Texas Health and Human Services Commission (HHSC). DSHS was restructured to concentrate on public health and is organized in six programmatic areas covering Laboratory and Infectious Disease Services, Regional and Local Health Operations, Consumer Protection, Community Health Improvement, the Office of Chief State Epidemiologist, and the Center for Public Health Policy and Practice. 1

The Division for Community Health Improvement encompasses a number of initiatives that play a role in addressing community conditions impacting individuals’ mental health and well-being, including maternal and child health initiatives, Texas Healthy Communities, and the Texas School Health Program.2 Additionally, DSHS provides public data and statistics on various health topics, including mental health and substance use to “plan and improve delivery of services, evaluate health care systems, inform policy decisions, and aid in research.”3

Maternal & Child Health

Maternal and Child Health (MCH) aims to improve the health of women of childbearing age, adolescents, children, infants, and children with special health care needs4. DSHS implements maternal health and safety initiatives within the Healthy Texas Mothers and Babies (HTMB) framework funded by the Title V Block Grant.5 Many of these initiatives consider mental health and well-being, including the Maternal Mortality and Morbidity Review Committee and TexasAIM.6 

Maternal Mortality and Morbidity Review Committee (MMMRC) 

The MMMRC is a 17-member multidisciplinary committee that is required by the Texas Health and Safety Code to study and review: 

  • Cases of pregnancy-related deaths 
  • Trends, rates, or disparities in pregnancy-related deaths and severe maternal morbidity 
  • Health conditions and factors that disproportionately affect the most at-risk populations 
  • Best practices and programs operating in other states that have reduced rates of death related to pregnancy 7

In December 2018, the MMMRC created the Subcommittee on Maternal Health Disparities to further focus on issues that lead to disproportionate health outcomes in mothers.8 The MMMRC released a biennial report in December 2022 with an addendum to include updates in October 2023.9 The report finds that “disparities persist in maternal mortality with Non-Hispanic Black women being most disproportionately impacted.”10 One of the notable report recommendations is to “improve integrated behavioral health access from preconception throughout postpartum for women with mental health and substance use disorders.” 11

The Healthy Texas Communities

The Healthy Living Unit focuses on tobacco, vaping, and community & worksite wellness. The Healthy Texas Communities (TXHC) program is housed within the Community & Worksite Wellness unit. The TXHC program was developed within DSHS in 2003 with the goal of reducing the burden of chronic disease in Texas.12 Communities can apply to be named a Texas Healthy Community and are then assessed on eight priority community-based policy, systems, and environmental change indicators vital to reducing the burden of chronic disease, including: 

  1. Physical activity areas and opportunities 
  1. Healthy food access 
  1. Worksite wellness programs 
  1. Environmental health 
  1. Access to quality healthcare 
  1. Healthy aging 
  1. Mental health 
  1. Emergency preparedness13

Texas School Health Program

The Texas School Health Program’s (TSHP) mission is to support education and public health partners with by using the “Whole School, Whole Community, Whole Child” (WSCC) approach.14 The WSCC is a framework for addressing health in school, focusing on the whole child, and highlights the role of the community to support the school. 15 While TSHP does not regulate schools or provide direct services, it provides “leadership, support, and guidance to Texas school districts,” including school health resources and tools for evidenced-based programs, practices, and policies16.  

School Health Advisory Committees (SHAC) and School-Based Health Centers (SBHCs) 

Every school district across Texas is required to establish a SHAC, which is an advisory group appointed by the district to provide guidance and recommendations on health education instruction.17 

The Texas School Health Advisory Committee (TSHAC) assists DSHS to support and coordinate school health programs and school health services. It also provides leadership to identify and disseminate school health best practices and resources for school policymakers. 

One of the strategies of creating safe and healthy schools is through School-Based Health Centers (SBHCs). SBHCs offer preventative and primary care, with other services varying by location, including oral health, mental health, nutrition, and asthma management.18

A grant program was created to support SBHCs with DSHS during the 76th Legislative Session, but only required its administration based on the availability of federal or state appropriations. During the FY22-23 LAR process, DSHS included the funding for this program when required to include a 5 percent reduction in its budget.1920 Funding for SBHCs was ultimately cut during the 87th Legislative Session and the grant’s administration ended on August 31, 2022.21 As of February 2024, DSHS does not fund SBHCs, does not collect data, and is unable to provide a current list of schools with SBHCs.22  

Federal COVID-19 Health Disparities Grant Funds 

In 2021, DSHS received over $45 million in federal funding from the Centers for Disease Control and Prevention (CDC) to address COVID-19 health disparities. The two-year, non-research grant was awarded through their National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities.23 24 While there was originally verification by the agency of an existing office being renamed the Office of Health Equity Policy and Performance (OHEPP) to oversee the distribution of these funds, the Office was ultimately renamed the Center for Public Health Policy & Practice (CPHPP).25 26 27 28

The COVID-19 Health Disparities Grant granted funds “to over 50 local and state partners to assist in engaging targeted communities facing health disparities, aiming to better understand their needs and priorities.”29 In 2022, the grant program became the “Community Conversation on Health” grant, and in January 2024, DSHS applied for a no-cost extension for the use of funds to run through May 2026.30

Texas Statewide Health Coordinating Council (SHCC)

The Texas Statewide Health Coordinating Council (SHCC) is a 17-member council, of which 13 are appointed by the governor and four are ex-officio members representing state agencies. The purpose of the SHCC is to ensure health care services and facilities are available to all Texans through health planning activities, and to make recommendations to the governor and the legislature through the Texas State Health Plan (TSHP). The most recent TSHP for 2023-28 can be found here and focuses on policy recommendations, addressing access to care, rural health, the mental and behavioral health care workforce, and teleservices and technology.31

Organizational Chart

To see the DSHS organizational chart, visit this page.

Fast Facts

  • As of February 2024, over 5,800 Texans lost their life to an overdose between September 2022-September 2023, a 7.6 percent increase from the previous 12 months.32
  • Texas reports 5,241 opioid-related overdose reversals between May 2017-August 2023.33
  • In 2022, there were 67,693 reported mental health professionals in Texas.34
  • In 2021, over 9,000 Texans visited an Emergency Department (ED) for opioid poisoning. Of those individuals, almost 60 percent were White, and almost 58 percent between the ages of 18-44.35
  • In 2022, over 3,000 youth ages 12-17 were estimated to need substance use treatment, with only 40 percent receiving it.36
  • In 2022, almost 40,000 adults over the age of 18 were estimated to need substance use treatment, with about 37 percent receiving it.37
  • In 2022, over 3,000 youth ages 12-17 were estimated to need substance use treatment, with less than half receiving it.38
  • In 2022, over 16 percent of Texans over the age of 18 reported having any mental illness within the previous year.39
  • In 2022, about 13 percent of Texans over the age of 18 reported receiving any mental health treatment in the previous year (treatment for mental health, emotions, or behavior through inpatient treatment/counseling; outpatient treatment/counseling; use of prescription medication; telehealth treatment; or treatment received in a prison, jail, or juvenile detention center).40
  • Not unique to Texas, the United States as a country has a high rate of maternal mortality, compared to other high-income countries, despite spending more per person on health care.41
  • Accounting for 22 percent of pregnancy-related deaths in 2019, mental health conditions were the leading cause in Texas.42 43
  • The top underlying mental health conditions in pregnancy-related deaths was depressive disorder, followed by substance use disorder (SUD), bipolar disorder, and psychotic disorder.44
  • SUD, including those with mental disorders, contributed to 11 percent of pregnancy-related deaths.45
  • Non-Hispanic Black women experience disproportionately high pregnancy-related mortality ratio (PRMR) rates in Texas. The PRMR for Non-Hispanic Black women is about 1.5 times greater than that of Non-Hispanic White women.46
  • The highest rates of PRMR in Texas also include women without private payer coverage for delivery, have a 12th-grade education or less, and are of advanced maternal age (35 or older).47
  • From April to December 2020, Hispanic women were disproportionately impacted by COVID-related SMM.48
  • Violent deaths by suicide or homicide represent 27 percent of pregnancy-related deaths in Texas, including intimate partner violence, overdose, firearms, and airway restriction.49
  • Postpartum depression in Texas has a prevalence rate of 13.2 percent within six months of delivery, compared to the national average of approximately 12 percent.50 51
  • As of 2019, there were 71 SBHCs in operation across the state.52 As stated above, DSHS is unable to provide a list as of February 2024.53
  • Since FY 1994, DSHS funds created 47 new SBHCs and expanded services at sites already in operation.54
  • During the 2018-19 biennium, 264 students made a total of 2,213 visits to a mental health provider. Each student visited a DSHS-funded SBHC for a mental health-related visit an average of four times per year.55

Policy Concerns

  • Addressing the impact of the non-medical drivers of health on community wellness, mental health, and mental health care access. 
  • Supporting DSHS and local communities to ensure timely mental health and substance use-related death and injury data collection and reporting to best inform policy decisions. 
  • Increasing utilization of community health workers, also known as “promotoras,” throughout communities. 
  • Increasing continuous screening, treatment, and recovery support for postpartum mental health and/or substance use conditions. 
  • Broadening access to peer support services for pregnant women and postpartum women for behavioral health support. 
  • Reinstate funding for grants to establish and operate school-based health centers. 
  • Addressing health equity and disparities through the COVID-19 health disparities federal grant funding from 2021. 
  • Supporting the statewide implementation of TexasAIM program. 
  • Implementing the recommendations put forth by the Maternal Mortality and Morbidity Review Committee. 

Legislative Overview

During the 88th legislative session, several bills filed were focused on the limited mental health or substance use-related DSHS functions and programs. Ultimately none of those bills successfully passed. However, the budget included the following DSHS riders of note that include: 

  • Article II, DSHS Rider 6: DSHS is required to collect emergency room data to measure and report potentially preventable emergency room visits, including potentially preventable mental health and substance abuse emergency room visits. 
  • Article II, DSHS Rider 21: DSHS was allocated $3.5 million in All Funds and 8 FTEs to implement and operate maternal safety initiatives statewide; develop and establish a high-risk maternal care coordination services pilot for women; increase public awareness and prevention activities related to maternal mortality and morbidity; and coordinate with HHSC and the MMMRC to collect postpartum depression screening. 
  • Article II, HHSC Rider 47: Require HHSC to submit an annual report of opioid-related expenditures from the previous fiscal year, including in DSHS, no later than June 1 of each year. 
  • Article IX, Sec. 10.04 (g): Requires DSHS to be involved in subcommittee to develop the Children Mental Health Strategic Plan by December 1, 2024. 

Passed

No bills related to mental health and substance use through DSHS programs were passed. 

Did Not Pass

HB 663 (THIERRY) – CONFIDENTIALITY AND REPORTING OF CERTAIN MATERNAL MORTALITY AND ESTABLISHING A MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY 

Would have defined “pregnancy-associated death” in the Health and Safety Code, providing authority for DSHS to allow voluntary and confidential reporting to DSHS of pregnancy-associated deaths. Would have allowed members of the MMMRC to conduct reviews of certain pregnancy-associated deaths and would have created the “Maternal Mortality and Morbidity Data Registry” at DSHS and established a workgroup with related duties. 

HB 1664 (THIERRY) – MATERNAL MORTALITY AND MORBIDITY AMONG BLACK WOMEN TEXAS STUDY 

Would have required DSHS and MMMRC to conduct a joint study to assess maternal mortality and morbidity rates of black women in the state with those of other racial and ethnic groups, and analyze them in relation to socioeconomic status and education level. Additionally, the study would evaluate the impact of social determinants of health on maternal health outcomes, including the correlation between pregnancy-related issues and insurance status. 

HB 2868 (THIERRY) – PROVIDING MENTAL HEALTH SERVICES AND EDUCATION AT SCHOOL-BASED HEALTH CENTERS. 

Would have included mental health services as allowable services within school-based health centers and allowed licensed mental health professionals to be included in local health education and health care advisory councils. 

Funding

DSHS Funding Trends: All Funds 56,57,58,59

DSHS Funding by Method of Finance (FY2024-25)60

References

  1. Texas Department of State and Health Services. (2022). Legislative appropriation request for Fiscal Years 2024-2025, volume 1 – submitted August 26, 2022. Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/legislative/lar/DSHS-LAR-FY24-25.pdf ↩︎
  2. Ibid.  ↩︎
  3. Texas Health Data. (n.d.) Texas health data.Texas Department of State and Health Services. Retrieved February 27, 2024 from https://healthdata.dshs.texas.gov/#   ↩︎
  4. Texas Department of State Health Services. (n.d.) Maternal and child health. Retrieved February 23, 2024 from https://www.dshs.texas.gov/maternal-child-health   ↩︎
  5. Texas Department of State and Health Services. (2022). Maternal health and safety initatives biennial report 2022. Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/Maternal-Health-Safety-Initiatives-Biennial-Report-2022.pdf ↩︎
  6. Ibid.  ↩︎
  7. Ibid.  ↩︎
  8. Ibid.  ↩︎
  9. Texas Maternal Mortality and Morbidity Review Committee and Texas Department Of State Health Services. (2023). Addendum – the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and Department of State Health Services (DSHS) joint biennial report 2022. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/Addendum-2022-MMMRC-DSHS-Joint-Biennial-Report.pdf  ↩︎
  10. Texas Department of State Health Services. (2023). Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services joint biennial report 2022. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/2022-MMMRC-DSHS-Joint-Biennial-Report.pdf ↩︎
  11. Ibid. ↩︎
  12. Texas Department of State Health Services. (n.d.). Texas Healthy Communities: About us. Retrieved February 27, 2024 from https://www.dshs.texas.gov/community-worksite-wellness-home/texas-healthy-communities   ↩︎
  13. Ibid. 
    ↩︎
  14. Texas Department of State Health Services. (n.d.). Texas school health program. Retrieved February 27, 2024 from https://www.dshs.texas.gov/texas-school-health  ↩︎
  15. Centers for Disease Control and Prevention. (n.d.). Whole school, whole community, whole child (WSCC). U.S. Department of Health & Human Services. Retrieved February 27, 2024 from https://www.cdc.gov/healthyschools/wscc/index.htm ↩︎
  16. Texas Department of State Health Services. (n.d.). Texas school health program. Retrieved February 27, 2024 from https://www.dshs.texas.gov/texas-school-health ↩︎
  17. Department of State Health Services. (n.d.) School Health Advisory Councils. Retrieved on May 8, 2024 from https://www.dshs.texas.gov/texas-school-health/texas-school-health-advisory-committee-tshac/school-health-advisory-councils ↩︎
  18. Texas Department of State Health Services. (n.d). SBHC history and DSHS program. Retrieved February 27, 2024 from https://www.dshs.texas.gov/texas-school-health/coordinated-school-health/school-based-health-centers/sbhc-history-dshs-program ↩︎
  19. Sheppard, D. (2020, November 5). Department of State Health Services joint hearing of the Governor’s Office and the Legislative Budget Board [Powerpoint slides]. Texas Department of State and Health Services, Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/legislative/lar/DSHS-Handout-for-OOG-LBB-LAR-Hearing-11052020.pdf  ↩︎
  20. Runnels, A. (2023, October 20). Why a North Texas suburban school district is opening a new health clinic for students on Medicaid. The Texas Tribune. https://www.texastribune.org/2023/10/20/denton-school-district-health-clinic-medicaid/   ↩︎
  21. School Health Program, Department of State Health Servces. Personal communication, February 28, 2024.  ↩︎
  22. Ibid. ↩︎
  23. Public Health Funding and Policy Committee. (2021, August 21). Public Health Funding and Policy Committee (PHFPC), item 6 [Video]. Texas Department of State and Health Services. https://texashhsc.swagit.com/play/08122021-506  ↩︎
  24. National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce. (September 2022). National initiative to address COVID-19 health disparities among populations at high-risk and underserved, including racial and ethnic minority populations and rural communities [Press release]. Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. https://www.cdc.gov/publichealthgateway/partnerships/COVID-19-Health-Disparities-OT21-2103.html  ↩︎
  25. Lopez, A. (2021, June 24). Texas officials will use federal grant to focus on health inequities during the pandemic. Houston Public Radio. https://www.houstonpublicmedia.org/articles/news/health-science/2021/06/24/401466/texas-officials-are-creating-an-agency-focused-on-health-equity/  ↩︎
  26. Public Health Funding and Policy Committee. (2021, August 21). Public Health Funding and Policy Committee (PHFPC), item 6 [Video]. Texas Department of State and Health Services.   https://texashhsc.swagit.com/play/08122021-506 ↩︎
  27. Texas Department of State Health Services. (2021, June 3). COVID-19 health equity funding [PowerPoint]. ↩︎
  28. Berlin, J. (May 2022). Dialing in on disparities: CDC grant helps Texas tackle COVID-aggravated health gaps. Texas Medical Association.   ↩︎
  29. Public Health Funding and Policy Committee. (2023, October 18). Public Health Funding and Policy Committee (PHFPC), item 7 [Video]. Texas Department of State and Health Services.  ↩︎
  30. Public Health Funding and Policy Committee. (2024, February 4). Public Health Funding and Policy Committee (PHFPC), item 4 [Video]. Texas Department of State and Health Services.  ↩︎
  31. Health Professions Resource Center. (n.d.). Texas Statewide Health Coordinating Council. Texas Department of State and Health Services. Retrieved February 27, 2024 from https://www.dshs.texas.gov/health-professions-resource-center-hprc/texas-statewide-health-coordinating-council ↩︎
  32. National Center for Health Statistics. (2024, February 4). 12-month provisional number and percent change of drug overdoses [Infographic]. Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm ↩︎
  33.  Texas Targeted Opioid Response. (2023). Outcomes [Infographic]. Texas Health and Human Services. https://etss.hhs.texas.gov/t/IDDBHS-ODS/views/TTORPrimer_16685487650260/Outcomes?%3Aembed=y&%3Aiid=2&%3AisGuestRedirectFromVizportal=y  ↩︎
  34. Texas Health Data. (n.d.). Mental health in Texas [Data dashboard]. Texas Department of State and Health Services. Retrieved February 27, 2024 https://healthdata.dshs.texas.gov/dashboard/mental-health/mental-health  ↩︎
  35. Texas Health Data. (n.d.). Opioid-related emergency department visits [Data dashboard]. Texas Department of State and Health Services. Retrieved February 27, 2024 from https://healthdata.dshs.texas.gov/dashboard/drugs-and-alcohol/opioids/opioid-related-emergency-department-visits ↩︎
  36. Center for Behavioral Health Statistics and Quality. (2024). 2021-2022 NSDUH: Model-based estimated totals for states (in thousands). Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt44485/2022-nsduh-sae-totals-tables-csv/2022-nsduh-sae-totals-tables.pdf ↩︎
  37. Ibid. ↩︎
  38. Ibid. ↩︎
  39. Ibid. ↩︎
  40. Ibid. ↩︎
  41. Gunja, M.Z., Gumas, E.D., & Williams II, R.D. (2023). U.S. health care from a global perspective, 2022: Accelerating spending, worsening outcomes. The Commonweath Fund. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 ↩︎
  42. Texas Department of State and Health Services. (2022). Maternal health and safety initatives biennial report 2022. Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/Maternal-Health-Safety-Initiatives-Biennial-Report-2022.pdf ↩︎
  43. Texas Department of State Health Services. (2023). Addendum: Texas maternal mortality and morbidity review committee and Department of State Health Services joint biennial report 2022. https://www.dshs.texas.gov/sites/default/files/legislative/2022-Reports/Addendum-2022-MMMRC-DSHS-Joint-Biennial-Report.pdf ↩︎
  44. Ibid. ↩︎
  45. Ibid. ↩︎
  46. Ibid. ↩︎
  47. Ibid. ↩︎
  48. Ibid. ↩︎
  49. Ibid. ↩︎
  50. Texas Health and Human Services. (October 2023). Maternal depression strategic plan for fiscal years 2021-2025: Fiscal year 2023 update. https://www.hhs.texas.gov/sites/default/files/documents/hb253-postpartum-depression-strategic-plan-update-oct-2023.pdf ↩︎
  51. Reproductive Health. (n.d.). Depression among women. Centers for Disease Control and Prevention, U.S. Department of Health & Human Services.  Retrieved February 27, 2024 from https://www.cdc.gov/reproductivehealth/depression/index.htm#Postpartum ↩︎
  52. Texas Department of State Health Services. (2020). Biennial report on school-based health centers: Fiscal years 2018-2019. Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/legislative/2020-Reports/Biennial-Report-on-School-Based-Health-Centers-FY2018-2019.pdf ↩︎
  53. School Health Program, Department of State Health Servces. Personal communication, February 28, 2024. ↩︎
  54. Ibid. ↩︎
  55. Ibid. ↩︎
  56. Texas Legislature Online. (2017). S.B. 1, General Appropriations Act, 85th Legislature, FY 2018-19.  https://capitol.texas.gov/tlodocs/85R/billtext/pdf/SB00001F.pdf#navpanes=0 ↩︎
  57. Texas Legislature Online. (2019). H.B. 1, General Appropriations Act, 86th Legislature, FY 2020-21.  https://capitol.texas.gov/tlodocs/86R/billtext/pdf/HB00001F.pdf#navpanes=0 ↩︎
  58. Texas Legislature Online. (2021). S.B. 1, General Appropriations Act, 87th Legislature, FY 2022-23. https://capitol.texas.gov/tlodocs/87R/billtext/pdf/SB00001F.pdf#navpanes=0 ↩︎
  59. Texas Legislature Online. (2023). H.B. 1, General Appropriations Act, 88th Legislature, FY 2024-25. https://capitol.texas.gov/tlodocs/88R/billtext/pdf/HB00001F.pdf#navpanes=0 ↩︎
  60. Ibid. ↩︎

Updated on December 16th, 2024



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