Data: Texas state hospital backlog sees modest decrease

AUSTIN (KXAN) – The state mental hospital system has seen a modest decrease this year in the backlog of thousands of individuals waiting for a bed and stabilization. The improvement coincides with an uptick in the number of usable beds and higher staffing levels, according to state data and presentations at a Health and Human Services Commission advisory committee hearing Friday.

The forensic waitlist is composed of mentally ill who have been charged with crimes but were found incompetent to stand trial and ordered to a state hospital for competency restoration. Those people are put on the waitlist and sit in county jails until space opens up.

KXAN has been reporting on the hospital backlog for years, including multiple profiles of mentally ill individuals who were stuck in county jail on the waitlist.

There were 2,164 people waiting for a state hospital bed on Friday – a 15% decrease from the state’s all-time high of more than 2,550 people last October, according to state data presented during the Joint Committee on Access and Forensic Services meeting.

As of Friday, 540 of nearly 2,400 state hospital beds were offline – 314 were vacant due to staffing and 234 were unused because of maintenance or construction, said Kristy Carr, HHSC associate commissioner over the state hospitals.

In terms of staffing, HHSC instituted a second state hospital salary increase in January 2023, and has added more than 900 jobs since then, said Carr.

“I'm very happy and pleased to report that we are making some significant progress,” said Carr, who acknowledged there remain about 1,600 open positions. “We are seeing the fruition of all of our efforts in making a dent on this waitlist.”

The positive news discussed Friday stands in stark contrast to what the committee faced just one year ago when the waitlist had been swelling unabated for years. And while the current trends are a welcome change, some members voiced concerns about ongoing challenges and whether progress could stagnate.

“I just want to remind everyone that the waitlist are people sitting in county jails costing us money, and it is not the best place for anybody to be sitting,” said Windy Johnson, a committee member representing the Texas Conference of Urban Counties. “I definitely appreciate the staffing issues, which are getting addressed, and I appreciate the hospital expansions and new beds.

According to Carr’s presentation, hundreds of new and replaced beds will be brought online in the coming years. Construction projects include the following:

• Kerrville: 70-bed maximum security unit expansion, began taking patients in June 2023
• Rusk: 200-bed replacement of 100 maximum security and 100 non-maximum security beds began taking patients in August 2023
• San Antonio: 300-bed replacement expected to have substantial completion in January 2024
• Austin: 240-bed replacement expected to have substantial completion in February 2024
• Dallas: 296 beds, including 200 adult beds expected to have substantial completion in July 2025

As a result of legislation passed this year, there is also planning for construction in Amarillo, Lubbock, San Antonio, Terrell State Hospital, North Texas State Hospital, El Paso Psychiatric Center and Rio Grande State Center, Carr said.

Even with all those projects in the pipeline, Johnson questioned whether the rate of progress on the backlog was sustainable.

“We are just getting to the point, though, where we are going to hit capacity, and most people are going to have to wait,” Johnson said. “Are we getting to a point now where our waitlist is going to stagnate?”

Carr said her team does foresee the trend will slow because fewer beds are being added over time. However, the waitlist will also be helped by outside factors, like programs that can divert people before they need a bed or can handle restoration elsewhere, she said.

Anna Gray, a committee member representing the Behavioral Health Advisory Committee and the executive director of Prosumers International, said everyone would be “missing the point” if they focused excessively on building beds.

“We need to keep our eye on the fact that we will never have enough beds to treat everybody coming into the forensic system” Gray said.

Krishnaveni Gundu is co-founder and executive director of the Texas Jail Project – a nonprofit that helps assist people in the jail system. Gundu watched the meeting and said she was frustrated HHSC did not acknowledge major problems her organization sees within the waitlist data. For example, there was no discussion Friday of possible “step down” options to get long-term stay patients out of the state hospital when they've been there more than a year, she said in a statement.

Gundu said reliance on jail-based competency restoration – which is a county-jail-based alternative to going to a state hospital – is a “terrible band-aid.” Furthermore, HHSC should be finding people on the waitlist with intellectual or developmental disabilities and studying ways to remove them because they will not be restored to competence.

KXAN will continue monitoring and reporting on the waitlist and updates from the JCAFS quarterly meetings.