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 and needing to go to a hospital.
In both cases your loved one may spend weeks or even months in jail before being sent to a state mental health hospital that is poorly designed for healing. At those hospitals, whole wards may be closed due to mold. She may share a small room with up to five other patients. The campus, which housed about 3,000 people when it was first built 50 or 100 or 150 years ago, now houses 300. Those unused wards were never torn down, though. 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, which 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. 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 (DSHS) 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 how reforms of the state hospitals would make an immense difference in the lives of the people who end up there.
They 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 wouldn’t simply update the state hospitals, but would transform them into a model for the nation in providing humane and effective care.
At the center of this vision is collaboration between the state hospitals and academic health centers. In some regions this state-academic collaboration may involve building entirely new hospitals on the grounds of an academic campus. Expanded psychiatric residency programs at the academic health centers could 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. 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.
Andy Keller, PhD, is president and CEO of the Meadows Mental Health Policy Institute.
David L. Lakey, M.D., is associate vice chancellor for population health for the UT System and senior vice president for population health for UT Health Northeast.