Mental health hospital system in Texas needs to be replaced
Legislature has the opportunity to transform a broken operation
Imagine this common, tragic scenario. Your previously healthy son, daughter, or spouse has developed increasing difficulty managing her finances, job or relationships. A doctor sees her and diagnoses depression or another mental illness. The doctor learns that she is at risk of hurting herself or others. Or maybe she committed a minor crime such as trespassing, and the police arrested her. At the police station, she is diagnosed as having a mental illness.
In both cases, your loved one will likely be sent to a state mental health hospital that is poorly designed for healing. She may share a small room with up to five other patients. The building where she’s sleeping was built almost 100 years ago and is run-down and out of date. The campus, which housed about 3,000 people when it was first built, now houses 300, but those unused wards were never torn down. Instead, they just rot and gradually fall down. If she’s at Rusk State Hospital, the ceiling in her room may have accessible pipes or other code violations. That means that the state is mandated to employ staff
to sit in the room, 24 hours a day, to prevent patients from harming themselves.
Because of the poor healing environment, your loved one stays in the hospital longer than needed. Taxpayer money is wasted because of the poor design of the facility and the length of stays, and staff and patients are more likely to be physically injured because of the crowded conditions.
Hundreds of times a day across Texas, people go into crisis and are placed in a state mental health hospital system that is itself in crisis. A 2015 report by the Department of State Health Services found that five of the 11 hospitals in the system were in such bad shape that repair wasn’t a realistic option. They have to be replaced.
That’s the bad news. The good news is that the Texas Legislature has the opportunity to transform this system this session. In the recent budget put forth by Senate Finance Chair Jane Nelson is a proposed $1 billion for the state mental health hospital system. That amount would be transformative for the state and the mental health of our people.
The Governor’s budget recognizes this fact, as does the interim report of the House Select Committee on Mental Health. Both highlight the reform of the state hospitals as priorities.
To start replacing these hospitals would make an immense difference in the lives of the people who end up there. It would also position Texas to be a national leader in mental health reform and innovation. Key stakeholders in Texas have been working for years to envision a system that would transform the hospitals into a model for the nation in providing humane and effective care.
At the center of this vision is collaboration between the state hospitals, state and local agencies, and academic health centers. In some regions this state-academic collaboration may involve building entirely new hospitals on the grounds of an academic campus. In others it may involve expanding psychiatric residency programs at the academic health centers to place physicians-in-training directly in the hospitals or with local mental health authorities. Psychiatrists from universities could provide telehealth support to the hospitals. Existing collaborations could be scaled up.
Successful collaboration will require a thoughtful and deliberate approach, sensitive to local conditions and needs.
It will also require funding. In the context of the tight budget for the next biennium, $1 billion is a significant amount. It will be up to the Legislature and the governor to determine whether reforming the state hospitals is sufficiently important to merit that chunk of the budget or to devise another means of financing (e.g., tapping the Rainy Day Fund for this critical infrastructure investment or through the sale of state bonds that are still at near historic low interest rates). What we can say, from our end, is that the need is great, the opportunity is historic, and the key players and stakeholders are ready to go to work.