Austin State Hospital Reopens This Summer

Texas overhauls psychiatric system aiming to free up jails

A room at Austin State Hospital (photos courtesy of Department of State Health Services)

On May 15, state leaders finally unveiled the new Austin State Hospital, a renovation project six years in the making and integral to Travis County’s efforts to divert people with mental illness away from the criminal justice system.

Opened in 1861, ASH is the oldest psychiatric hospital in the state. Its new, $305 million building is part of a larger $2.5 billion overhaul of the state’s entire psychiatric hospital system that has been in the works since 2018. The new building, accepting patients later this summer, offers 240 beds in an environment meant to replicate homelike situations to help patients with recovery. Each room houses one person and has its own bathroom, and the complex offers recreational options like a gym, salon, basketball courts, chapel, and a “downtown” styled shopping area. It’s expected to serve more than 600 people a year.

The chapel at Austin State Hospital

Jail officials across the state kick-started the redesign, urging the Legislature to help reduce overcrowding in their facilities caused by the drastic waitlist for ASH. The majority of ASH’s patients are “forensic hospitalizations” – people charged with a crime and deemed mentally incompetent to stand trial. And when ASH doesn’t have a spot for those people, they’re forced to wait in county jails without a trial. (ASH also houses people who have already been found not guilty by reason of insanity.) As of May 27, Travis County jail had 85 on the waitlist for ASH. The longest wait time was 253 days.

“The new ASH is a wonderful facility ... but it is only one part of what is needed.”  – Dr. Stephen Strakowski

In 2018, UT-Austin’s Dell Medical School and the Texas Health and Human Services Commission began working on a Legislature-funded study of needs for the new facility. One priority was to ease the backlog by not allowing patients to languish at ASH unnecessarily. The Meadows Mental Health Policy Institute found in 2019 that “from a clinical perspective, many of these people do not need to be in a state hospital setting,” and could instead be treated as outpatients. And from a financial perspective, when patients sit in an emergency room for 24 hours or more waiting for an ASH bed to open, it costs local hospitals and law enforcement more. To that end, ASH aims to establish a formal 60-day inpatient competency restoration limit.

Crucially, the new ASH does not increase the number of beds available. However, the number of counties it will serve has decreased from 38 to 26 due to new facilities being built elsewhere, including a 300-bed hospital in San Antonio. More than physical capacity, state and local officials have stressed building out a robust continuum of care outside of both the jail and the hospital. Initiatives like Travis County’s mental health diversion pilot will strengthen that continuum. The county aims to reduce the number of people needing psychiatric care in the jail, thus shortening the waitlist for ASH as well. “While the new Austin State Hospital is a wonderful facility that vastly improves the care provided, it does not change the need for a robust mental health diversion center and crisis stabilization care facility here in Travis County,” said County Judge Andy Brown. That facility won’t be built for a while, but phase one of the pilot is already underway, serving about 25 people under a contract with Integral Care.

A map inside Austin State Hospital

Dr. Stephen Strakowski, who worked on the Dell Med study, co-authored an op-ed last May that urged a residential step-down facility (like a diversion center) to accompany ASH. The op-ed also stressed increased access to outpatient care for prevention, enhanced crisis outreach with joint law enforcement and clinical response teams, and better opportunities for reintegration into the community once someone is discharged. Strakowski told the Chronicle projects like the diversion center “will be needed to ensure all citizens of Central Texas have the opportunity for the best care. The new ASH is a wonderful facility ... but it is only one part of what is needed.”

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