Your (Unofficial) Guide to State-Sponsored Therapy in Texas

There’s a way to get affordable mental health care that you might not know about. That’s Texas’s mental health system.

If you qualify, you can get mental health care at a local mental health authority for a small co-pay or a low sliding-scale fee. But even if you don’t qualify for services at a state-funded provider, Texas’s system can still give you information, referrals to affordable providers, and other essential help for free.

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If you’re in a hurry and want to get the most important information about what’s available at your local program and who it’s for, you can read our quick start guide below.

To learn more about public mental health services in Texas, keep reading. We’ve done the research to uncover essential facts about who’s eligible, what services you can get, when to go, where to call, and how it works so you can decide if Texas’s mental health system might be right for you.

Who Is Eligible?

You should consider looking into services at an LMHA in Texas if you (or a loved one) are having a mental health crisis, have a severe mental health condition, have Medicaid, or have a limited income.

Everyone in Texas can use the state-funded mental health emergency response system. If you or someone you love is in crisis, you can call your local crisis line to get the help you need, quickly.

PRO TIP

Public mental health services are usually the best option if you’re having a mental health crisis and need help right away.

State mental health programs are required to provide mental health crisis response services and are one of the fastest ways to get care when you’re having a mental health emergency.

The people who answer state and local crisis lines can provide caring attention and support as they help you determine the best response to a crisis, whether it’s inpatient treatment or an appointment with a counselor.

Even if you’re not in crisis, you can call your local mental health hotline for information about affordable mental health services in your area. When you call, you can find out whether you might qualify for state-funded mental health services, schedule an assessment, or get free information about other affordable local providers.

Other parts of the system have stricter eligibility requirements. You need to have a serious mental health condition (a diagnosable condition that affects your daily functioning) to qualify for public outpatient mental health care at an LMHA in Texas.

However, more people have a qualifying condition than realize it. Don’t assume you’re not eligible!

PRO TIP

Consider reaching out to your local LMHA if you:

Are having a mental health emergency
Have Medicaid or Medicare or don’t have insurance
Need to get information about affordable providers in your area
Have a significantly limited income (200 percent of the federal poverty level or less)
Have a serious mental health condition like major depression, bipolar disorder, or schizophrenia
Need specialty mental health care like day treatment, case management, or home-based services

While Texas’s mental health system has traditionally focused on serving people with one of three major mental health diagnoses (major depression, bipolar disorder, or schizophrenia), some LMHAs can serve people with other diagnoses when funding is available. So, it’s worth calling your local LMHA to ask if you might be eligible for services there. You can find their number in the directory below.

One of the most important requirements you need to meet to get services at an LMHA in Texas is to be a resident of the region it serves.

It’s a great option if you’re an area resident with a public insurance plan. All Texas LMHAs accept Medicaid, and they even give you priority if you have it.

Some LMHAs have financial eligibility requirements for outpatient or specialty services. To qualify, you usually either need to have Medicare or Medicaid or no insurance and limited financial means.

All LMHAs have clinical eligibility criteria. To qualify, you have to have a severe mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that affects your functioning or safety on a day-to-day basis.

You will be given priority if you have a diagnosis of schizophrenia, bipolar disorder, or major depression, but you may be able to get services for another diagnosis if enough funding is available.

DEEP DIVE

For decades, Texas has limited access to public mental health services to people with one of three diagnoses:

Schizophrenia,
Bipolar disorder, or
Major depressive disorder.

Over the last decade, a movement to expand services to a wider range of people has gained traction. In 2013, the Texas Legislature approved a policy that expands eligibility for public mental health services to people with other psychiatric diagnoses. In theory, you can now also get public mental health services in Texas if you have any of the following diagnoses:

Post-traumatic stress disorder (PTSD),
Obsessive-compulsive disorder,
Attention-deficit disorder, or
An anxiety disorder.

However, the law only requires programs to serve this expanded range of clients when they have “sufficient resources,” and many LMHAs continue to limit services to people with one of the “big three” diagnoses. Over time, more programs may update and expand their eligibility requirements. To find out whether your program is one of them, you’ll have to call and ask.

Local mental health authorities provide a wide range of mental health services including basic outpatient care like therapy and medication.

However, they strictly limit the therapy they provide to one of two types based on your diagnosis. Most LMHAs that offer counseling offer cognitive behavioral therapy (CBT) to people with major depressive disorder and cognitive processing therapy (CPT) to people with PTSD.

If you want another kind of therapy besides CBT or CPT, you may not be able to find it in the public mental health system in Texas. (Also note that some LMHAs still don’t have the budget to treat PTSD unless you also have one of the “big three” diagnoses.)

While LMHAs are limited in how much and what kind of therapy they provide, they are an excellent resource when it comes to specialty and intensive mental health services like community-based care. These services can really help when you’re readjusting to life at home after inpatient treatment or need extra help managing your symptoms.

PRO TIP

Local mental health authorities in Texas are great places to find specialized and intensive mental health services like case management and day treatment that can be hard to find anywhere else. These specialty programs can give you extra help when you’re dealing with severe symptoms.

If you don’t meet eligibility criteria to get services at an LMHA, it’s not your only option for affordable publicly-funded mental healthcare in Texas. According to the Hogg Foundation’s guide to the Texas mental health system (you can view the PDF here), there are three types of public mental health providers in in Texas:

Medicaid managed care providers
Federally qualified health centers
Local mental health authorities

Medicaid managed care providers are part of a network of organizations that contract with the state to provide services to people who have Medicaid. These managed care networks include a mix of private practices, public programs, and non-profit agencies. They’re a great option if you have Medicaid. You can find one by logging in to your managed care plan’s website.

Federally qualified health centers are community organizations that provide medical and mental health services to people in areas where quality healthcare was previously hard to find. They’re a great option if you have Medicaid or Medicare. They also offer sliding scale fees. You can search for one here.

Local mental health authorities are the primary state mental health agencies in Texas. In addition to directly providing services, LMHAs develop policy and direct state resources to address mental health needs in their communities. You can find which one serves your region in the directory below.

DEEP DIVE

The Hogg Foundation for Mental Health, a division of the University of Texas at Austin, is a mental health research organization whose goal is to increase awareness of mental health issues and inform Texas mental health policy.

They publish an exhaustive 500-page reference document about the public mental health system in Texas every two years. Their report provides detailed information about eligibility requirements and updates about state mental health funding. It also explains the different types of programs within the Texas mental health system.

If you want to learn more about the Texas mental health system or participate in mental health advocacy in Texas, their website is a great resource.

You can find the number for your LMHA in the directory below. We encourage you to call even if you think you might not be eligible.

Even if you’re not eligible, or if the program doesn’t offer the service you want, they can probably still help you. The people who work in these programs are knowledgeable about local resources and will often give you free information or even referrals to other affordable providers nearby, including local non-profits that provide free or low-cost counseling.

Where Do You Call to Get Started?

The easiest way to learn more about state-funded mental health services in Texas is to call your local mental health authority’s main number or crisis line. You can find which LMHA serves your county and their contact information in the directory in the next section.

For general mental health help or information, you can also call one of the statewide information, crisis, or support lines listed directly below.

PRO TIP

The statewide crisis hotline for Texas is 988.

The Crisis Text Line for the state of Texas is 741741.

The National Alliance on Mental Illness (NAMI) Helpline is 1-800-950-NAMI (6264).

You can reach the non-emergency NAMI Texas Helpline by calling (512) 693-2000.

To get help connecting with mental health programs and other resources in your area, you can call Texas 2-1-1 or visit their website.

You can speak with a peer Monday through Thursday, 12pm to 10pm, by calling the Hope Family Health Center’s Peer Support Warmline at (844) 755-4673.

You can speak with a peer Monday through Friday, 9am to 9pm, by calling Recovery Texas’s Peer Support Warmline at (833) 922-2557.

You can reach the Office of the Behavioral Health Ombudsman for the Texas Health and Human Services Commission by calling (800) 252-8154.

Public mental health services in Texas are managed on the state level by the Texas Health and Human Services Commission (HHSC).

For general information about state-funded health services in Texas, you can call HHSC’s main number at (512) 424-6500. For help with accessing Texas’s mental health system, you can contact the Office of the Behavioral Health Ombudsman at (800) 252-8154.

However, you’ll probably get the best results by calling your local program directly. You can find the number for your LMHA in the directory below.

Texas LMHA Directory

There are 254 counties in Texas and 39 local mental health authorities that serve those counties. Some programs serve a single county, but most serve a multi-county region. Each LMHA has a phone number you can call to get information about mental health services or to get help in a crisis.

Some regions have separate crisis and information lines, while others have a single mental health hotline you can call for either purpose.

You can find the website and contact numbers for your local program in the directory below. In the parentheses next to the program name, you can find a list of the counties that program serves.

If you need information after hours or aren’t sure whether you’re experiencing a mental health crisis, it’s okay to call a crisis line for help. The staff who answer are trained to quickly figure out what you need and can tell you what steps you need to take to connect with the right services.

Also Consider: Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are another great way to get affordable publicly-funded mental health services in Texas.

These federally-funded programs provide cutting-edge care in places where good primary healthcare was once hard to find. Most provide integrated care so you can get primary medical and mental health services at the same location.

Each FQHC accepts Medicaid and Medicare and offers low sliding-scale fees if you don’t have insurance. Their eligibility requirements are less strict than the requirements for LMHAs. You can search for FQHCs near you by using the online search tool on the U.S. Health Resources and Services Administration website.

Troubleshooting Guide

The state mental health system is complicated and can be confusing to navigate. If you’re having any issues, we’re here to help. Here are some of our solutions to common problems you might experience.

If you’ve run into a problem that we haven’t addressed, don’t give up. Call someone at the program (or a local hotline) and tell them what’s going on.

You’re much more likely to get the help you need when you advocate for yourself and are persistent. Tell the person you talk to what you need or what problem you’re having.

If they don’t help the first time, call them back and tell them. If you keep calling and keep calm and focused, you should eventually get through to someone who can help you.

Deep Dive: How Does the System Work?

To understand Texas’s mental health system, it helps to understand how it started and how it’s changed since then.

Public mental health services have been around for a surprisingly long time. But for over a hundred years in America, the only way to get them was in a psychiatric hospital.

In the 1960s, Americans started thinking differently about mental health care. Conditions in psychiatric hospitals were getting worse and new medications made it possible to provide mental health treatment on an outpatient basis.

In response, new laws were passed that required state and local governments to establish community mental health programs as alternatives to institutionalization for people with serious mental illness. The most important was the Community Mental Health Act, which President John F. Kennedy signed into law in 1963.

DEEP DIVE

To learn more about what the public mental health system was like in the early days—and how psychiatric inpatient care has evolved since then—you can read our article “Do Insane Asylums Still Exist? The Surprising Past and Present.”

To learn more about what inpatient mental health treatment is like now, and the differences between how it works in general hospitals and specialized psychiatric facilities, you can read our article “How Inpatient Mental Health Treatment Works.”

Many state mental health programs trace their origins back to the 1960s when these important changes started to happen. Texas is no exception.

In 1965, the Texas Legislature passed a bill establishing Comprehensive Community Mental Health Centers as an alternative to institutionalization. These centers started opening across Texas in 1970 and continued to grow and evolve over the following decades. Many ultimately became the programs Texas now calls Local Mental Health Authorities. Some closed and were replaced by other programs.

By 2003, there were over 40 LMHAs. However, that was the end of the period of growth for Texas’s community mental health system. That year, Texas made huge cuts to its mental health system that have affected mental health services in Texas ever since.

Over $400 million was cut from the mental health budget, significantly reducing which services were available through the Texas mental health system and eliminating access to counseling and therapy for over 100,000 adults statewide. Afterward, use of emergency rooms and state hospitals for emergency mental health care jumped significantly. Collectively, Texas county jails became the largest mental health provider in the state.

DEEP DIVE

Texas has historically dedicated fewer resources to its mental health system than many other states. As a result, Texas has ranked last or near-last in Mental Health America’s Access to Care rankings for years, and was again ranked last in 2023.

One reason for this is that starting in the 1990s, Texas restructured its community-based mental health system to focus more on services for people with serious and persistent mental illness (SPMI) in response to reductions in services at state inpatient facilities.

While a law passed in 2013 allows LMHAs to provide services to people with other mental health diagnoses when funding is available, most LMHAs continue to limit access and only admit people who have a diagnosis of schizophrenia, bipolar disorder, or major depression.

Because of these restrictions, LMHAs serve fewer people and provide fewer services than similar community mental health programs in other states. According to a 2019 report by the Legislative Budget Board, Texas is one of only 15 states to restrict its state-funded mental health services in this way.

In 2013, the Texas legislature made an effort to reverse these trends by increasing state mental health funding by $300 million. However, Texas didn’t continue investing in its system at that level, and other moderate funding increases since then have made little impact on access to mental health care.

Provider shortages continue to affect access to care across Texas, especially in rural areas, where many people are also uninsured. Over 80 percent of Texas counties are Mental Health Professional Shortage Areas. For years, low mental health spending and the provider shortage has also affected state hospitals and the legal system, causing long wait times for mental health care.

Fortunately, Texas’s trend of limiting state funding and access to mental health care may be coming to an end. In 2023, the Texas state legislature increased state mental health funding by $11.68 billion, which Senator Joan Huffman said was the largest annual increase of mental health funding made by a state legislature in U.S. history.

Texas is using $2.6 billion of these funds to expand access to inpatient care by increasing patient capacity at existing hospitals and building new inpatient facilities. The state is also investing in jail diversion programs and its crisis response system. It has also increased salaries for mental health workers in the hopes of hiring and retaining more workers to address the mental health workforce shortage.

DEEP DIVE

Local mental health authorities in Texas are required to plan, coordinate, and allocate funds for mental health services in their region.

Most also directly provide services. These range from basic outpatient mental health services like therapy, counseling, medication, and assessment to specialty and intensive services such as case management, psychosocial rehabilitation, and community-based support services.

Since the 1990s, the main focus of the Texas community mental health system has been to help people at risk of hospitalization maintain psychiatric stability while living in their home communities. Many of Texas’s mental health services are designed with this in mind.

Helping people who are experiencing a mental health crisis is another important focus of the Texas system. All Texas LMHAs also have crisis response services which typically include a 24-hour crisis line, a mobile crisis response team, and crisis residential or stabilization units.

Many LMHAs are now certified as CCBHCs, which means that in addition to crisis and outpatient mental health services, they also offer basic medical and primary care services.

Public mental health services in Texas are managed on the state level by the Texas Health and Human Services Commission.

However, while each LMHA has to meet certain HHSC requirements, each LMHA ultimately decides how its program works. Whether there are any exceptions to Texas’s generally strict eligibility requirements depends on your LMHA’s budget and policies.

To find out how your region does it, you can call your local mental health hotline. They know how the system works and will help you get where you need to go.

Conclusion

According to the Substance Abuse and Mental Health Services Administration, only 40 percent of people in Texas who have mental health conditions get treatment for them. Many of them qualify for public mental health services but don’t know about them.

You can make a difference by reaching out and connecting with local mental health resources to get the care you need. If you’re not sure whether you qualify for Texas state mental health services, call your local LMHA or crisis line. You may find out you can get mental health services through your local program or that there’s another affordable option nearby.

The most important thing is to get started—the help you need may be only a call or click away.

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Therapy with No Waiting Rooms or Driving. Take a quick quiz about your preferences and needs and get matched to a therapist in as little as 48 hours.

Your (Unofficial) Guide to State-Sponsored Therapy in Texas

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Have you been in therapy before?

Quick Start Guide

Who Is Eligible?

PRO TIP

Use the State System When You're in Crisis

PRO TIP

Fast Facts About Eligibility in Texas

DEEP DIVE

Texas Priority Populations

PRO TIP

Check Out the State System If You Need Specialized Services

DEEP DIVE

The Hogg Foundation

Where Do You Call to Get Started?

PRO TIP

Important Numbers in Texas

Texas LMHA Directory

Texas Mental Health Clinics and Crisis Lines

Also Consider: Federally Qualified Health Centers

Troubleshooting Guide

Problems and Solutions

Deep Dive: How Does the System Work?

DEEP DIVE

For More Information

DEEP DIVE

Access to Mental Health Care in Texas

DEEP DIVE

The Continuum of Care in the Texas Mental Health System

Conclusion

Are You Thinking of Online Therapy? Start Here to Get Matched with a Licensed Therapist Right For You.

Have you been in therapy before?

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