>>Becky>> Mental health is a growing concern worldwide and here at home, some estimates suggest that as much as half of the population will experience a mental illness in their lifetime.

So what are West Texans doing about it?

Something big.

The Permian Basin Behavioral Health Center will open its doors next spring.

It's the culmination of years of effort on the part of West Texas health officials, state elected officials and local philanthropists.

Located between Midland and Odessa, near the Wagner Noel Performing Arts Center, the center will provide inpatient and outpatient mental health services to help individuals of all ages overcome their challenges.

It will be the first of what is expected to become a sizable complex of health care facilities, in what will be known as The Beacon.

Tonight we'll learn about both.

I'm Becky Ferguson, and this is One Question.

[Intro Music] - Welcome to One Question.

Here to tell us more about plans for addressing West Texans mental health challenges and other health care needs are Russell Myers, p resident of the Permian Basin Behavioral Health Center, and Doctor Stephanie Caples Cinical Programing Consultant for the Permian Basin Health Center.

Thank you both so much for being here today to help us learn more about The Behavioral Center and The Beacon.

Russell, I want to start with you.

If you could just give us sort of a nutshell explanation of the Permian Basin Behavioral Health Center.

>>Russell>> Okay.

Um, gosh, it's hard to encapsulate, but it's uh it's the realization of about ten years worth of work that started back in 2015 when we did the first real comprehensive study of Midland's behavioral health capabilities and, and demand.

And we have known from ER traffic over the years that we were not meeting all the needs because people were showing up regularly in crisis.

We didn't always have a place to put them.

We had to send them out of town and pay for it.

Oftentimes.

And so we began the work to build awareness and build toward doing something about this massive problem, which most people would tell you even today is the single, worst unmet health care need that we have, right?

Not just here, but all over the state of Texas.

So beginning in ‘21, we began to seek funding, uh first from the legislature.

Uh, great.

Great uh, beginning story there, the Covid, uh recovery, uh programs that came from the federal government.

ARPA was the the one that was available in ‘21, that gave a lot of money to the states to be used for behavioral health and other things that were related to Covid recovery.

Uh, and we petitioned the state and got some of that money and then began building philanthropic support.

Uh, got some more money from the state in ‘23, but the eventual objective here was to build a substantial, full service inpatient psychiatric facility, uh to do the things that we couldn't do here.

Uh, acute care, you know, crisis care for psychiatric patients of all ages, plus becoming the hub for this full continuum of care so people didn't get into crisis, or if they did, we were ready to manage it.

Uh, and then we had a place to refer them after the crisis was passed and keep them uh, in ongoing care.

So it's a very ambitious goal to create a legitimate behavioral health system here to serve the whole Permian Basin.

- Stephanie, if you'd go into a little bit more detail, Russell sort of alluded to the need.

But if you could sort of flesh that out, the need for such a facility in the Permian Basin.

>>Stephanie>> Well, sure, uh so, you know, I spent 15 years or so in clinical practice, and what I saw regularly was for more intensive treatment, we had nowhere to send anyone.

And when you're doing outpatient clinical practice, you don't have the ability to see people on a in an intensive way.

So statistically, uh in the nation, you can safely say about 1 in 5 people has a mental health crisis in their lifetime.

1 in 5 people have depression, 1 in 4 anxiety.

Uh.

In Texas, it's 1 in 4 in the Permian Basin.

We're supposing it's 1 in 3.

So we have a higher rate, a prevalence of depression and anxiety.

And because of our economy, because of our lifestyle here in the Permian Basin lot with the oil and the reduction in in health care, particularly around mental health, we tend to experience crisis more often in our community because of the untreated need.

So when just like any other medical condition, when it's a chronic condition and it's not treated, you'll go into crisis a lot more often.

Um, and typically you need more intensive care.

- I want you to talk a little bit more about why you think depression and anxiety are more prevalent in this part of the world.

- Well, I think a lot of it has to do with our lifestyle, our expectations, and our work habits.

Honestly, um, I know I'm sitting here with Russell, who's my boss, but, a lot of the work life integration, I don't know that we value that as much, uh as we say that we we do or that we want to.

A lot of people don't practice self-care.

Self-care is huge.

It's a need that we all have.

A lot of people understand the term, but they don't practice it.

And when you ask them, what do you do for self-care?

If they don't really know, they don't have an answer?

So there's not a lot of intentional acts for caring for your body.

We go to the doctor, we go to our primary care physician once a year for a physical and get our labs and and all of that, or when we're sick, but we don't do the same for our mental health.

- A couple things I would add to that.

One is the the rootlessness of our population.

We're very transient here.

Many of us have families elsewhere.

Uh, you know, I, I spend a lot of time in Houston where my family is.

And when I come and go on the Southwest flights back and forth to Houston, they are filled with people who are coming out here to work for the week or going back home after having worked here for the week.

And when you're displaced from your roots, from your support system, from the people that care about you day in and day out, uh.

you're more likely to to suffer from those concerns and then to act inappropriately on them, you know, to abuse substances, to, uh to fail, to take care of yourself.

And and I think that's a big part of of the reason why things are a little more challenging here.

Plus the the sort of, you know, sort of West Texas pull yourself up self up by your bootstraps, don't have to ask anybody for help kind of mentality that that certainly adds to it.

- Well, since we're talking about this, let's stay with it for just a moment.

Why don't you tell us a little bit about what self-care would look like?

- Well, you know, it can actually really be very simple and and fit into your day.

I tell people all the time, a lot of times people think you have to have this great workout plan or eat super healthy and do meal prep and do all of these extra things, but it can just be as simple as practicing gratitude at the end of your day, right?

Gratitude has been shown to change the chemistry in your brain.

Uh.

it can be enjoying the simple things, listening to your favorite song, or if you enjoy cooking then cook the meal.

And so really, I think it's really about putting things around you that you enjoy and that you can remember to stop and look like, look at people that have pictures of loved ones in their work environment and home environment typically are more happy in those environments.

So it's doing small things like that, but being intentional about it, I think we lose the intentionality in it.

um, I love music, so on my way from the office to home, I turn it up loud and I sing.

And I am a phenomenal singer in my head.

And so I, I do this thing.

[laughs] - And so am I going to hear the bass starting from your car when I pull up next to you?

- Probably Yeah.

Yeah, probably.

That's probably me.

[laughs] You wouldnt suspect it, you know.

But the kids all enjoy it too.

But you know, it's doing those simple things.

But then I have learned to practice gratitude for myself.

And that's very simple.

And you can do that anywhere.

It's just some thinking.

But it's the intentionality, like I said, behind it.

So self-care can have a full range of what you do.

You can get the massages, you can make sure you work out.

You can lead a healthy lifestyle.

But out here, like Russell was just talking about how, you know, our we have a transient population, but the work hours are long out here too, right?

A lot of us work a lot of hours.

[sniff] We're tied to our phones.

You're constantly checking emails, so doing small things in your day can really help promote that care.

- Russell, a minute ago, you alluded to uh your awareness being raised by visits to the emergency room when you were - hmm - head of the hospital.

- Right.

- What do those visits look like?

- They're horrible.

They're really with the, our friends at the Meadows Mental Health Policy Institute who were with us from the very beginning on this, had a chart uh we were using a lot early on that showed that the path of a typical physical medicine patient, you know, go see your primary care doc.

If you got a little something going on, maybe they send you to a specialist, maybe you have an elective procedure.

You know, it's all kind of systematized.

And there's a payer for it for most people.

And and it's it's it feels normal.

The, the, uh parallel in the mental health world is, uh ignore your symptoms, don't get any primary care, go into crisis, get arrested, [laughs] come to the E.R.

in handcuffs.

Uh, be confined to a room where you're locked in, uh so you can't hurt yourself.

Spend hours and hours waiting for placement for your crisis.

Because the acute care hospital can't deal with your concerns.

Uh, and then repeat that cycle over and over.

So, I mean, you couldn't design two more different and and one more dysfunctional system [laughs] than the one we have in behavioral health.

And so that as that became more and more apparent to us with our mission in Midland of, uh, leading health care for greater Midland, we really meant that we've been I've been saying that as long as I've been here.

And the point of it is that as the, the, the major provider, really the sole significant provider in this county, we have a responsibility to assure that all the county, the community's health care needs are met, whether we're doing it ourselves or helping other people do it.

Somebody's got to be doing it.

[clears throat] And behavioral health, we were failing at that.

You know, that's and that was apparent to me.

And it was apparent to our E.R.

staff who were regularly dealing with these patients who didn't look like the rest of the patients they cared for and for whom they really couldn't do very much.

And that wasn't satisfactory to anybody.

And so we decided it was time to do something about that.

- So we're doing something very big, uh 200 bed facility.

Uh, Stephanie, could you describe, um what it's going to look like and to use sort of a shallow word design decisions that are made for therapeutic reasons.

So describe, if you will, that facility.

- Yeah.

This is my favorite part about it.

I mean, I think we took a lot of time and a lot of effort.

We had a great architecture and design team, uh, who was, you know, well versed in health care that helped guide us on this.

And they were, you know, we had this mission to make sure everyone felt comfortable in our community there.

We don't want anyone to feel as though this is not the place for them.

And, um, and we have a very diverse community here.

So we wanted the entire Permian Basin to say, I can come here if I need to.

We want it to be very welcoming.

Uh, and so even in the language that we use.

But in the design, I think it was very important to us for it to not look like a hospital.

- Okay.

- We didn't want it to look like a hospital.

We didn't want it to look like an institution.

The idea of, you know, the old school asylums.

[Laughs] - Like One Flew Over the Cuckoo's Nest - Right Right.

We definitely didn't didn't want that.

So it's one story.

And I think that that helps a lot.

I mean, we have a two story for outpatient services on the second floor, but the entire inpatient area is is one story that makes it feel more residential.

It's very familiar.

The color schemes, the layout, the floor plan, even the way that we're we're not calling them patients, we're calling them guests.

But even the way that our guests maneuver through the the Behavioral Health Center, I think it's going to feel very much like a home.

We have proper security measures in place, of course.

Uh, but the colors, the tones are very warm, um.

There's a lot of natural light.

It's just it's really exciting.

There's a lot of outdoor spaces for that therapy to happen as well, because we do want people to feel comfortable in that environment.

Esthetics are huge for your mental health, uh and for your healing.

- I think I also read that you would have a homelike atmosphere for dining.

What would that look like?

- So, each patient space, each guest space where the the rooms are, we have a, I guess we call it a dining area.

We call it an activity space, a very open area, uh to where the patients can eat on the unit.

They don't have to be transported.

I hate using those words, but - Right, right.

- but it's.

You have to take the proper security measures.

Right?

- Right.

So if if your guests are moving throughout the facility, you they have to be with someone that works there, right?

I'm just to ensure their safety.

Uh, but we're not doing that.

We're going to have very open spaces within the units so they can eat there.

But that space is multi-purpose, so we'll be able to do activity therapy.

They will be able to sit out there when there's non dining time and watch TV or movies or whatever is streaming at the moment.

So we've put a lot of attention into making sure they can just move around and be very comfortable in their space.

- It sounds very cutting edge and so I understand it's going to be a 200 bed facility, - Right.

- but the inpatient and outpatient treatment, can you talk a little bit about that.

- The the 200 beds are that's inpatient - Thats inpatient.

- capacity, - Okay.

- and that's divided.

It's I like to describe the facility as kind of two hands.

Uh, each of the fingers is a neighborhood, uh where individual patient populations are served.

So we'll have a unit for children and a couple of them for adolescents and multiple adult units and a geriatric adult unit.

Uh, and, on it goes.

So we'll be able to separate those populations, um by their inpatient space.

On the outpatient side, we've got, [clears throat] a variety of things, some that the hospital itself is doing what we call intensive outpatient therapy, and, um, partial hospitalization They're kind of the steps down from inpatient care.

So people ease their transition back into to the rest of the world into their regular activities while still getting some ongoing, fairly intensive treatment going home at night, but coming to the hospital for extended periods during the day.

Beyond that, on the outpatient side, uh we're going to have, therapists and and psychiatrists available there.

Texas Tech is moving its local psychiatry program almost 100% onto our campus.

And growing it pretty dramatically.

So upstairs, there'll be multiple psychiatrists and residents that see patients in clinic and other kinds of therapists who can see patients on an outpatient basis, uh as well as developing relationships with the variety of providers that are around our community, so that patients always have a place to go after their acute visit, not necessarily always on our campus, maybe closer to where they live.

- I'm going to stick with you for a second.

Russell and I want to talk about the money end of this, - Mmhmm - because it's a very expensive facility, [clears throat] and uh there are lots of folks that have helped with that.

Could you detail that for us?

- It's it's incredible how much, uh support we've had from every imaginable corner of the community.

And, and I would credit some of that to those years of awareness building that we had.

I would credit a lot of it to Covid, frankly, that, uh you know, it was right in all of our faces all of a sudden in 2000 and beyond that, that those behavioral health concerns that exist everywhere in our community and have always have, um, when we couldn't leave our homes, when we were confined, um, when we had these disruptions in our day to day life, we became more acutely aware of how concerning those issues are and how much they need attention.

So, uh all those things together, I think, helped people become aware that this was really important.

Uh, I mentioned earlier the state funding when the federal government distribute the ARPA funding, which was the big Covid Recovery Act, uh, they gave a lot of money to the states and to local governments with very few strings attached, except one of the strings was behavioral health is a really important part of this.

You should use some of this money for that.

So we went to the legislature, got $40 million for that.

That made the project real, you know.

And that was our first vision was 100 bed hospital.

Uh, and they we began to raise funds.

Um, we got major support from our big foundations locally.

At the top of that list was the Mabee Foundation, who, who had was really in a big way, reintroducing themselves to the region in honor of their 75th anniversary.

They gave us our biggest private gift.

But we had gifts from Permian Strategic Partnership and FMH Foundation and Scarborough Foundation and Abell-Hanger Foundation and lots of different individuals.

[coughs] The legislature came back in 23 having caught the the behavioral health uh bug, if you will, especially, uh from the Lieutenant Governor's perspective, he actually got in touch with us on his own, uh, before, the ‘23 session and said, I appreciate what you all are doing.

I want you to do it bigger.

And so please ask the state for more money to double your capacity.

And we did.

And it came.

So we got another $86 million from the legislature in ‘23.

Uh, we continue to raise money privately, um.

And we had close to 100 different donors.

We've been working on donor recognition in the facility, and there's a lot of names on that wall, uh of all different sized gifts, people who've given us as little as $25 and as much as $25 million, uh to make this thing a reality.

Total budget is $232 million.

This is an expensive place to build.

Uh, making it a home.

Making it to appear to be a home like atmosphere.

But still be safe is really costly.

[laughs] A lot of the furniture providers, a lot of the building material providers that are building things specific to behavioral health and its unique security and safety precautions, they they're proud of their stuff.

Yeah.

It's really expensive to do this.

- Well, it sounds like it's going to be just an unbelievable facility.

Uh, but now we need to talk about staffing.

[Laughter] Oh, who is going to work there?

Where are we going to find them?

How are we going to train them?

Stephanie?

- Yes.

That keeps me up at night.

Okay.

A lot of times you know, we have great health care providers in our community right now.

And a lot of them have the focus on on mental health, but they don't necessarily have the specialty training.

So there's a lot of efforts going into the workforce development.

And so we're we're doing a lot there to develop people in the area that are already in training.

Um, nurses and PAs even and, you know, nurse practitioners to do the work.

And obviously the psychiatry department with Texas Tech, the local, uh residency program, they're going to grow that, as Russell just mentioned.

But there's a lot of effort and there's a lot of attention going into the workforce, not just to produce more people, but for quality, quality training.

So we've upped the standards for quality training.

Um, Midland College has a behavioral health department now, which is really exciting.

So they are training behavioral health techs.

So in the behavioral health world, in an inpatient place, I like to say the techs are the most important people.

Maybe the psychiatrist might fight me on that.

But the techs are very important.

And there's going to be more techs employed than any other, uh clinical discipline employed at the Behavioral Health Center.

The techs are the eyes and ears.

- And what are the techs?

- Yeah.

- Tell us a little bit more about that.

- I will.

Yeah.

So the it's an entry level position honestly.

But they're the eyes and the ears of the facility.

So before when I was talking about, having helping the guests move around the facility, for instance, the techs are the ones to do that.

- Right.

- Right?

And so they're regularly interacting.

uh, they will be the first line of command if there is a crisis emerging.

A lot of times people think that a crisis happens, you know, quickly.

It doesn't.

There's a slow build, but if operationally you're doing it the right way as a tech, they see that and they they will have de-escalation skills.

And, and a lot of training goes into how you just interact with someone who's inpatient.

If they're inpatient, they don't feel well.

Right.

And so you have to be very attentive to that and approach them a little differently.

So communication is key.

So they're interacting with the the guests.

They're a lot more than their therapists.

You might just see them in group than a lot more than the psychiatrist.

He may see them on rounds once a day.

Right?

So so the behavioral health techs are doing a lot.

They're constant interacting.

They're watching meals.

Um, they're they're transporting back and forth around the facility.

They're at night, they have to do 15 minute bed checks to make sure everyone's safe.

So it's a big job and it's very, very important.

So Midland College is developing that.

They are also developing what we call a qualified mental health professional.

These people get to really be on the first hands at the crisis, um.

If a crisis is going on, they get to determine they, basically doing the assessment and determine the least restrictive level of care.

We don't want people to have to be in the hospital, - Right.

- We need the hospital for people that need it.

But we really want the least restrictive level of care, and we really want to heal people so they don't have to need the hospital.

So Midland College is doing those those different things.

Texas Tech is really doing a lot of great things with partnering with UTPB to help counselors be trained.

So that's a very neat initiative going on there.

Like I said, the nursing program, um we're putting a lot of focus on developing kind of like a psychiatric residency for, for nurses, uh.

We were just talking with the regional Dean, Russell and myself last week, uh of Texas Tech saying, hey, the PA program, can we help do something with them and train them?

So there's a lot of initiative going on to train our local learners for the workforce to be able to serve our community.

- Well, you had mentioned that the Texas Tech psychiatry department is going to be involved.

What about the psychology department?

- Well, so the psychology department is in Lubbock.

- Okay.

- And so we don't have a psychology department per se on the main campus.

Now, what we do have is we do have a fellowship that trains counselors.

- Okay.

- Right.

And so it's in the School of Medicine.

It trains counselors and we have really expanded that, which is a really neat program.

So we had two maybe counselors in training per year.

So we will now have received funding from Scarborough Foundation, El Abell-Hanger and Emery Hall.

I was looking at Russell with the like the let me forget anyone.

To expand that up to 20 per year over the next three years.

- Oh wow.

- So to make sure that these counselors are getting the highest quality training.

- The exciting part about that, to me, is not just that we're training counselors who really didn't have a path to finish their their training and get into to active practice before, because there's a there's a very substantial amount of postgraduate clinical training required to get a license.

Ah, and during that time they can't bill for their services.

- Oh.

- And so that's been a very difficult path for them.

UTPB has had a program for a long time to to give people the education they need.

But then once they finished, - Where did they go to work their hours.

- workable path to get a license So we're creating that.

This is all Stephanie's brainchild.

She should be talking about it more than me, but what's exciting to me about it is not just that, but the fact that we've heard for years from our primary care doctors that their practices are filled with patients who have mental health concerns for which they're very poorly equipped to, to manage, uh, and so they want a mental health resource to be right in their practice.

If you think you're going to your family doctor, you've got whatever physical concerns that that he or she is dealing with every day.

If you've got a mental health concern underlying all that, it may be really difficult for you to comply with the directions they give you to keep up a medication regimen or or whatever else they might want you to do.

And and so would directly affect your physical health.

And those doctors see that day in and day out and feel hamstrung to deal with it.

So now we're giving them a resource to make people healthier overall, - Wow, right.

- not only in their minds, but in their bodies, because it all fits together.

And that's it's we're still proving the model clearly.

We've got uh to work on this for a while, but it's really promising and I think could revolutionize primary care in a lot of ways.

- Russell, I understand that this is going to be part of what we hope is a much larger project that you all are calling The Beacon.

So if you could tell us about The Beacon.

- The uh Behavioral Health Center is the first element of The Beacon.

Um, Beacon is a lot of things.

It begins, I think, with, the vision that was promulgated by the Permian Strategic Partnership, really in many ways, its reason for coming into existence, which was to make life better here, uh you know, because the the oil and gas companies have a long standing challenge with getting and keeping a workforce here.

Those people on those planes that I talked about earlier, - Right.

- they don't live here.

The companies would love for them to live here, uh and to establish families and roots and, and make more of a of a community here for the long term.

Uh, and as PSP built its vision, health care was a big part of it.

And, uh Diamondback, Diamondback Energy, one of the the founding members of the Permian Strategic Partnership, had a lot of surface land, uh between the airport and the UTPB campus, where the Wagner Noel Performing Arts Center is, um and they identified 250 acres, roughly.

But they were willing to give to this project.

Uh, and so Diamondback subsidiary Rattler uh Midstream, has made a pledge to give this 250 acres of land.

The first chunk of that was the 50 acres we needed for behavioral health.

But the rest of it is going to form the heart of this vision, to do even more, uh to advance health care in the region, to build around it.

Uh, supportive of things like higher education facilities as UTPB expands, hospitality, residential, retail, really a full planned community out there at that site at the intersection of State Highway 191 and FM 1788 between the airport and the college, uh, has great potential to do, all kinds of things.

But in the health care, uh arena, we're really talking about things that we either don't do now or don't do well enough that we can enhance their behavioral health.

Best example, but we're also talking to uh M.D Anderson Cancer Center right now about, a bigger and more comprehensive cancer.

Outpatient cancer center that they might consider bringing here.

Uh and things like that.

Will will be the heart of that development over time.

- And this is, I take it, a long term plan.

- Very long term.

Well beyond any of our time here, I suspect that probably 20 years worth of development, uh that, that we're looking at there.

But it's really been, um boosted here in the past few months.

We asked the legislature to give us some funding to build the infrastructure to make this thing really go, to make it possible to develop.

- So roads - like a cancer center, roads and a park, roads, utility infrastructure underground, you know, - Right.

- water and sewer and stuff, and a park that runs, uh diagonally across the development following this natural playa system that exists out there.

The legislature did come through for us, I think, recognizing the the great importance of the Permian Basin to the state's economy and the need to support this kind of developmental effort.

So we have $123 million now appropriated for us to spend on three major roads in that park, and utility infrastructure.

Uh, and as that happens, uh it's going to become a very attractive place for the development of those projects we talked about.

- Lots to look forward to.

Thank you so much, Russell and Stephanie, for spending time with us today.

We really appreciate it.

- Thank you.

To learn more about plans for the new mental health facility, go to permianbehavioral.org.

and to get more information on plans for The Beacon, go to the beaconpermian.com.

Our thanks to Russell Myers, president of the Permian Basin Behavioral Health Center, and to Doctor Stephanie Caples, Clinical Program Consultant for the Permian Basin Health Center.

Thank you for joining us for this edition of One Question here on Basin PBS.

I'm Becky Ferguson.

Good night.

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