Galveston County, Texas James Wilson

WGU000295445

A. Identification of Community
Galveston County is located in the south Gulf Coast region of Texas and is ranked 17 in population in the state of Texas with a population of 291,309 residents, according to the 2010 Census Bureau. The average age of the community is between 35-64 years old, which is a little older than that of the average age of the population of Texas. The county is made-up of mostly white residents at 58%, Hispanics come in second at 23%, and African Americans at 14%. More than of the residents are white collar workers with the median household income at approximately $58,000 annually. According to Galveston County demographics, 12.8% of all Galveston County residents live in poverty. Although the African American population makes up the smallest percentage of residents in the county, they have the greatest percentage at or below the poverty level at 28.5%. Almost half of the residents qualify for public assistance at 40%, however, according to the County-by-County review of SNAP/ Food Stamp Participation report only about 10% actually receive aide. The unemployment rate is remarkable at only 6.9%, which is less than the nation’s unemployment rate but slightly more than the 6.2 % reported for the state of Texas. The county has a good high school graduation rate and the proportion of the population that achieves a Bachelor’s, or graduate degree, is comparable to the rest of Texas and the US. There are two state prisons located in the county with the capacity of 820 inmates. The rate of individuals incarcerated in local jails is slightly higher than the Texas rate. Recreation facilities are greatly accessible as well as easy access to healthy foods. Also, the reported rates of excessive drinking, physical inactivity and adult smoking are similar to the averages for the state of Texas. (QuickFacts, 2013)
Concerns of illness and communicable diseases is reportedly higher than the state’s rate with Galveston County reporting in the bottom 25% of all Texas counties with high concerns in pediatric blood lead levels (eight out of 24 zip code areas), and syphilis infection and varicella. Galveston County has the second highest incidence of Mesothelioma among all 254 counties in Texas with cancer rates being amongst the worst for all cancers. Galveston County’s mortality rates were among the worst compared to all other Texas counties with preterm birth rates, low birth-weight rates, and infant mortality reportedly being higher than in Texas and in the US. (healthypeople.org, 2013)
The rates of uninsured residents in the county are lower than the state of Texas but remains significantly worse than the US average for children under the age of 18. There are also eight census tracts in the county that are designated as “Medically Underserved Areas (MUAs)”. (Texas Department of State Health Services, 2010). The reason of not being able to see a doctor due to concern of cost was reportedly lower than the state average but the rate of preventable hospital stays for the county is higher.

Galveston County is a federallydesignated Health Professional Shortage Area (HPSA) in
full for primary care, and partially for dental and mental health providers. (HRSA, 2013)
Providers for both primary care physicians and specialty care are reportedly low for the population; also for dentists. In conjunction with mental health, 31 licensed psychiatric beds for every 100,000 population are available and seven facilities that provide treatment for substance abuse. (SAMHSA, 2013) Thirty day re-admission rates for medical discharges was about average, but the discharges for surgical patients and diabetics were higher.

The overall understanding from the community is that good health as an outcome (overall physical, mental, and social wellbeing) which stems from good health behaviors and adequate
access to preventative medicine and healthcare services. Although this is the understanding, most of the community does not meet the criteria of the definition of health whereas health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 2003) The barriers to this community being healthy are: insurance and closed systems; education about disease, medicine, and available resources; access to healthy foods, recreation, and transportation; poor choices and attitudes; age, chronic diseases, obesity;
continuity and polypharmacy; inappropriate use of the emergency department and overuse by
those who are wellinsured. A map for improving community health in Galveston County
include educational resources, provide late available hours to primary and preventative health
services, increase locations providing healthy foods, providing access to weight-loss programs, and better transportation options.

Within the parameters assessed, Galveston County Texas is an overall unhealthy community, not to mention mentally unhealthy. Because there is a lack of mental health treatment facilities in the county, most of the patients are transferred to other counties to obtain treatment. According to healthypeople.gov, access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Limited access to health care impacts people’s ability to reach their full potential which negatively affect their quality of life. Barriers to receiving help include: lack of availability, high cost, and lack of insurance coverage. These barriers lead to unmet health needs which delays the patient in receiving appropriate care and their inability to get preventive services and hospitalizations that could have been prevented. The 2010 census Galveston county population count was 291,302. That means that there are 72,825 (1/4 of the population) people in Galveston County affected by mental illness. Anyone may be susceptible to a mental illness. Psychiatric problems affect people of all ages, all income groups, all ethnic groups, all religious groups,urban and rural, male and female. No one is immune to a mental illness. However, in Galveston County it is the young adults that are most affected and mostly male. Most of the individuals diagnosed have been incarcerated at some point making the jails a hub for mental illness. Most of the patients in Galveston County are of poor socioeconomic status and do not attend any college. There are facilities that treat these individuals, however, due to the abundance of the affected, treatment is very hard to find and patients can be put on a long waiting list or just simply overlooked all together. Because of the lack of available facilities, it is necessary to have partnerships with other counties to provide these services. Harris County receives many mentally ill patients as an overflow from Galveston County into the inpatient hospitals available. Because there is an abundance whom seek help, other counties, such as Brazoria, are invited and participate in this partnership as well.

Some of the resources available include The United Way of Galveston, Gulf Coast Center, and Substance Abuse and Mental Health Services Administration (SAMHSA), just to name a few. The Family Service Center, connected to the United Way, is the only mental health agency in Galveston County that will provide counseling services to all ages regardless of their ability to pay. Other centers do not treat both children and adults, but rather one or the other; and definitely not if one does not have the funds. The Gulf Coast Center’s services and programs include day activity programs, coordination of services and employment assistance for individuals with intellectual and developmental disabilities and mental illness. There are several programs for individuals diagnosed with intellectual and developmental disabilities and mental health issues (dual diagnosis), a transitional and permanent housing program for homeless individuals with mental illness in Galveston County. The Gulf Coast Center also provides services for children and adolescents for a fee. SAMHSA is a program that was established by Congress to provide mental health services to individuals whom are most in need. Over the years, this program has proven that behavioral health services improve health status while reduces health care costs to society. These are just a few of the resources available, but with two-thirds of the county’s population with mental issues, there are not nearly enough sites to treat all that are effected.
Although these resources are available, getting in to receive treatment is a challenge. The minimal inpatient treatment facilities are almost always full and most have to be put on a waiting list, which could take months before any availability is realized. Unfortunately, by this time, patients can become out of control and may become a repeat inmate in the county jail or even a repeat patient in a local emergency department. Another obstacle preventing proper care is transportation. Because most of the residents of Galveston County are of poor socioeconomic status, many do not have their own transportation to get to the facilities that provide care nor do they have cab money to take a cab. One goal of the county is to significantly improve access to mental health services. This means making available mobile response teams (MRTs) that provide patient care or transportation to the appropriate medical setting. Gulf Coast Center (GCC) also worked with UTMB and partners to develop a virtual mental health network designed to expedite treatment, reduce crisis episodes, streamline referrals, boost enrollment in entitlement programs and most importantly, implement comprehensive, communitywide case management for GCC clients who had fallen off the patient rolls. (UTMB Health, 2014)
One thing that healthcare professionals can do to help this situation is to volunteer their time in the MRTs. Providing volunteer services reduces cost to the community while the mobile units go to them eliminating transportation needs. These services could be provided through many programs and facilities such as Red Cross, Salvation Army, or even teaming up with the mental health professionals at UTMB. The Red Cross not only helps on a local level, but also on a national level as well. Any time there is a disaster nationally the Red Cross is one of the first responders to help with mental health issues, such as helping people cope with their new reality if everything of theirs was lost. This is one of the major corporations that run on volunteerism, and it works. The impact of these programs would be to decrease unnecessary visits to local emergency rooms and reduce admissions to the psychiatric hospital after a major disaster. After implementing these programs, by evaluating the data for a year of who visited these MRTs and how many healthcare professionals volunteered, Galveston County can determine how effective, if at all, these programs are to the community.
After all the fieldwork that I have experienced my opinion about the availability of mental health facilities and treatment has changed. It was my opinion prior to the project that many mental health patients didn’t receive care due to lack of desire or denial of their status. It is evident, now, that the reasons are because of the lack of treatment centers in close proximity, lack of transportation and lack of funding for such programs. Although surrounding counties do have treatment centers available, the residents of Galveston County deserve to obtain local, cost-effective treatment.
Galveston County, Texas
-44456921500Population/ Economic Status
Located southeast Texas
Population 291,309
Predominantly white
Next largest ethnic groups are Hispanics then African Americans
Median household income $58,000
12.8% households at or below poverty level
6.9% reported unemployment rate
Estimated 1,430 homeless
37,371 receive basic food assistance
Cultural Assessment
Slightly more females than males
Predominantly white Christian
Subcultures Mexican and African American
Many understand how to achieve good health- ranked 86th healthiest out of 221 counties
Majority know how and where to obtain medical care
Alcohol and drug use is about average with state
Has 8 census tracts federally designated as MAUs.

Neighborhood/ Community Safety
Health department very involved for providing health services and info
Air quality is poor
Water quality is poor
Wildlife potential for disease
Many bodies of water; potential for drowning
Potential for severe weather events
Potential for toxic exposure and explosions r/t chemical plants
Good fire/ police response
2,256 cases of domestic violence reported in 2010
Disaster Assessment and Planning
Disaster/ emergency preparedness plan in place
Teamed up with Harris County and Brazoria County emergency agencies
Following federal guidelines
Emergency communication, medications, and transport assistance
Working with communities to develop plans for receiving, staging, distributing, and dispensing plan
Aware of hurricane disaster plan
Mental Health
The Gulf Coast region’s psychiatric care is
coordinatedby twocommunity mental health
andmental retardation (MHMR) centers.

There are two inpatient public psychiatric state
hospitalsthat serve the Gulf Coast region;both are
locatedoutside the region:
Rusk State Hospital
Austin State Hospital
Both provide crisis stabilization and long-term
psychiatriccare for adults
Austin State Hospital provides these services for
childrenfor all Gulf Coast counties in the region
exceptHarris County.

Health professional shortage contributes to mental
healthcare shortage.

There are 313 physicians for the entire population
ofGalveston County. (Combs,2014)

Nearly two-thirds of all people with a diagnosable
mentaldisorder do not seek treatment. (NAMI, 2012)


References:
Bureau of Labor Statistics. Local Area Unemployment Statistics: Latest Numbers. 2013. www.bls.gov/lau/
Citydata.com. Galveston County, Texas. 2013. www.city-data.com/county/Galveston_County- Texas.html
Combs, Susan. Texas Comptroller of Public Accounts. Window on State Government. Texas in Focus: Gulf Coast Region. 2014. http://www.window.state.tx.us/specialrpt/tif/gulf/healthcare.php
Evans, Thayer. Houston Chronicle. Counting Homeless. 2002. http://groups.yahoo.com/neo/groups/HomelessNews/conversations/topics/1598
Galveston County Health District. Public Health Preparedness. 2013. http://www.gchd.org/bt/btindex.htm
HRSA. United States Department of Health and Human Services. Find Shortage Areas: HPSA by State and County. 2013. http://hpsafind.hrsa.gov/
Kirk, Chris. Slate. How Many People Around You Receive Food Stamps? 2013. http://www.slate.com/articles/news_and_politics/map_of_the_week/2013/04/food_stamp_recipients_by_county_an_interactive_tool_showing_local_snap_data.html
National Alliance on Mental Illness (NAMI). Gulf Coast. 2012. http://www.nami.org/MSTemplate.cfm?Section=Annual_Report4;Site=NAMI_Gulf_Coast;Template=/ContentManagement/ContentDisplay.cfm;ContentID=158433
New York Times. The New York Times County SNAP/ Food Stamp Data. 2010. http://frac.org/wp-content/uploads/2010/07/ny_times_snap_poverty_formatted.pdf
Sperling’s Best Places. Health in Galveston County. 2013. http://www.bestplaces.net/health/county/texas/galveston
References Continued
Texas Department of State Health Services. MUA list: MUA and MUP Designations. 2010. http://www.dshs.state.tx.us/chs/hprc/MUAlist.shtm
US Census Bureau. State and County Quick Facts: Galveston County, Texas, 2013. http://quickfacts.census.gov/qfd/states/48/48167.html
US Department of Health and Human Services. HealthyPeople.gov. 2020 Topics and Objectives: Access to Health Services. 2014. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1
UTMB Health. Health Policy and Legislative Affairs: Galveston County Health Information Exchange. 2014.http://www.utmbhpla.org/oth/Page.asp?PageID=OTH000822
Wikipedia. The Free Encyclopedia: Galveston County, Texas. 2013. http://en.wikipedia.org/wiki/Galveston_County,_Texas
World Health Organization. WHO Definition of Health. 2003. http://www.who.int/about/definition/en/print.html