Demand vs. Supply

There is no doubt that Austin lacks enough inpatient beds to meet demand. In April alone, the city-owned University Medical Center Brackenridge emergency department saw 284 unique psychiatric patients in the ER, says Dr. Christopher Ziebell, medical director of the department. The number is about the same at St. David's South Austin Hospital, the city's second busiest ER. In 2009, the Travis County Sheriff's Office alone transported more than 100 people per month on average to local ERs; in total, TCSO handled more than 3,000 mental health cases in 2009, including repeat customers. For the Austin Police Department, the 2009 mental health caseload topped out at 7,203, also including repeats. Not all of these people were transported to hospitals, and fewer were actually committed to a psych hospital either voluntarily or involuntarily (for example, of APD's 7,203 cases, 1,690 – almost five a day – resulted in emergency, involuntary commitment to a psychiatric hospital).

For both law enforcement agencies, the number of cases handled each year continues to grow; in 2002, the first year for which the office has stats, TCSO handled 2,386 mental health cases while APD handled 5,733. To TCSO's Sgt. Kitty Hicks, who supervises the office's Crisis Intervention Team, the only way to reduce the ever-increasing caseload is to create a stabilization unit, either attached to one of the hospitals or as a stand-alone unit: "What is needed, what has been needed since the beginning, is a crisis-stabilization unit," she said. "It seems like a no-brainer, but for whatever reason that has not happened." Sgt. Mike Turner, who oversees the APD Crisis Intervention Team, says that having some beds funded by the hospital district is a good start, but agrees more are needed. "It's like having a five-gallon bucket: It's full, and when you're taking one cup out, you're trying to put two cups [back] in."

Travis County Probate Judge Guy Herman, who reviews applications for mental health commitments, believes the best solution to handling the growing caseload is to put beds inside a medical hospital (most obviously at city-owned Brackenridge, which is run under contract by Seton). Having beds in the stand-alone private facilities, Shoal Creek and Austin Lakes, is great, he says, but Medicaid will only pay for beds attached to a general medical-surgical hospital. And that's not pocket change: According to the city/county-run Integral Care, roughly 42% of its clients receive Medicaid. "What we have is inefficient, and it's a boondoggle on the taxpayer," says Herman. "It's not the treating people while they're in the hospital that's the problem, but it's inefficient, especially when you can get one-third of your cost back if the beds were in a medical-based facility. It's not cost-effective."

Mental Health Cases of Local Law Enforcement

Total number of mental health cases handled by the Austin Police Department and the Travis County Sheriff's Office by year:

	2009	2008	2007	2006	2005
APD	7,203	6,558	6,361	5,765	6,003
TCSO	3,323	3,117	2,574	1,956	1,799
TOTAL	10,526	9,675	8,935	7,721	7,802

Source: APD & TCSO