EHF has identified behavioral health as a key focus area for our work.
EHF takes an inclusive view of behavioral health which encompasses strategies to support mental health and to reduce the impact of substance use disorders.
We offer the following guidance as a preview of how we hope to work with you to make an impact in the communities you serve. These are not exclusive guidelines, and we welcome your input and hope to learn together throughout this process.
If you see alignment with your work and you would like to discuss your ideas with a member of our staff, please email us. You are also welcome to move forward without staff consultation. The next step in the application process is to submit a Letter of Inquiry (LOI) to EHF by July 21, 2017. If your LOI is approved, you’ll be invited to complete the full application process. That completed application is due September 15, 2017 with funding decisions anticipated at the EHF Board meeting on December 14, 2017.
Our commitment is to community-based approaches and to those that reconsider the traditional separation between primary care and behavioral health providers. We want to help communities take action to reduce the impact of mental illness and substance use disorders, reduce stigma around behavioral health issues, and to collaborate to increase access to behavioral healthcare. This transformation will take time to fully realize, and we look forward to working with provider partners and communities within the Episcopal Diocese of Texas that share our commitment to a healthier future for all our neighbors.
There are compelling reasons to prioritize behavioral health for residents who live within the Episcopal Diocese of Texas. In that 57-county region alone, data suggest that:
- 1.4 million adults (17.6% of the adult population) have a mental health disorder 
- 510,000 adults (6.4% of the adult population) per year experienced a major depressive episode which the Substance Abuse and Mental Health Services Administration (SAMHSA) defines as experiencing most of the symptoms for depression for 14 or more consecutive days 
- 95,000 adolescents between the ages of 12 – 17 (10.5% of adolescents) experienced a major depressive disorder 
- 668,000 adults (8.4% of the adult population) have a substance use disorder, which occurs when repeated consumption of alcohol or illicit drugs leads to significant clinical and functional impairments 
- 48,000 adolescents (5.4% of adolescents) have a diagnosable substance use disorder 
- Throughout the state, 61.7% of Texans with mental illness do not receive any mental health treatment or counseling, and 93.6% of Texans with alcohol use disorder and 91.4% of Texans with illicit drug use disorder do not receive any treatment or counseling 
We know, too, that mental health and substance use are inextricably connected to an individual’s physical health. Studies demonstrate that in one year close to 20% of adults have both mental health and physical disorders and document the high co-occurrence of behavioral health issues and medical conditions, suggesting that this is “the rule rather than the exception.”  Epidemiological studies go even farther, showing that having one type of disorder acts as a risk factor for developing the other—ultimately connecting physical and mental health. 
For these reasons, EHF supports efforts to formally bring behavioral healthcare together with primary care in an integrated model and to support additional efforts to increase access to behavioral healthcare services. We welcome requests for programmatic and systemic interventions and for the planning and evaluation necessary to do this work successfully.
Priority 1: Integrated Behavioral Healthcare
Integrated behavioral healthcare (IBH) includes ways of promoting well-being by preventing or intervening in mental illness, substance use disorder or other addictions, and co-occurring morbidities. EHF wants to support IBH practices and approaches that are developed within communities through a process that is inclusive, representative and focused on vulnerable populations.
We define IBH as: “the care a patient experiences as a result of a team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.” 
The SAMHSA-HRSA (SAMHSA-Health Resources and Services Administration) Center for Integrated Health Solutions has developed a framework to help primary and behavioral healthcare provider organizations improve outcomes by helping them understand where they are on the integration continuum. The “Standard Framework for Levels of Integrated Care” can be accessed at: http://www.integration.samhsa.gov/resource/standard-framework-for-levels-of-integrated-healthcare. Applicants interested in applying for this priority should review this website when developing their proposals.
Examples of how EHF’s funds may be used include, but are not limited to:
- Development of team-based IBH practices
- Adoption or adaptation of financial and business practices supportive of IBH
- Development or optimization of population health systems and approaches to IBH
Priority 2: Access to Behavioral Healthcare Services
Access to comprehensive, quality behavioral healthcare services is essential for promoting and maintaining health, preventing and managing physical disease, and achieving health equity for all. Improving access to effective behavioral healthcare services will help individuals lead productive lives, contribute to community well-being and safety, and make better use of scarce healthcare resources.
We seek to support innovative ways to increase access to high-quality behavioral healthcare services, particularly outside of urban areas. We are most interested in approaches that move beyond simply meeting unmet needs.
Examples of how EHF’s funds may be used include, but are not limited to:
- The provision of effective and efficient evidence-based behavioral healthcare implemented in community settings
- A mental health organization’s forging of new bonds with community-based organizations to locate services in accessible settings
- Addressing stigma associated with getting help for mental illness/substance use disorders
- Changing an organization’s administrative practices to offer services on evenings/weekends/walk-in basis
- Technical assistance to revise business practices related to revenue generation or participation in payment reform efforts that support behavioral healthcare.
Thank you for your interest in EHF and our behavioral healthcare strategy. We look forward to working with and learning from you as you consider and begin our application process.
References and Additional Sources of Information:
Center for Behavioral Health Statistics and Quality (2016), 2012-2014 National Survey on Drug Use and Health Substate Age Group Tables. Substance Abuse and Mental Health Services Administration. Retrieved from http://www.samhsa.gov/data/
Druss, B.G. and Reisinger Walker, E. (2011) Mental disorders and comorbidity. The Synthesis Project, Robert Wood Johnson Foundation. Retrieved from http://www.ibhpartners.org/wp-content/uploads/2015/12/co-occurring-disorders-Druss.pdf
Best Practices in Integrated Behavioral Health, Identifying and Implementing Core Components, Meadows Mental Health Policy Institute, August 2016, http://texasstateofmind.org/wp-content/uploads/2016/09/Meadows_IBHreport_FINAL_9.8.16.pdf
The SAMHSA-HRSA Center for Integrated Health Solutions (CHIS) http://www.integration.samhsa.gov/resource/standard-framework-for-levels-of-integrated-healthcare.
 Center for Behavioral Health Statistics and Quality (2016), 2012-2014 National Survey on Drug Use and Health Substate Age Group Tables. Substance Abuse and Mental Health Services Administration. Retrieved from http://www.samhsa.gov/data/
 Substance Abuse and Mental Health Services Administration (2015). Behavioral Health Barometer: Texas, 2015. HHS Publication No. SMA-16-Baro-2015-TX. Retrieved from https://www.samhsa.gov/data/sites/default/files/2015_Texas_BHBarometer.pdf
 Druss, B.G. and Reisinger Walker, E. (2011) Mental disorders and comorbidity. The Synthesis Project, Robert Wood Johnson Foundation. Retrieved from http://www.ibhpartners.org/wp-content/uploads/2015/12/co-occurring-disorders-Druss.pdf
 Agency for Healthcare Research and Quality. The Academy Integrating Behavioral Health and Primary Care. (n.d.). The definition of Integrated Behavioral Health Care. Retrieved from https://integrationacademy.ahrq.gov/resources/ibhc-measures-atlas/what-integrated-behavioral-health-care-ibhc
 Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions. March 2013