As demand for services grows, some Texas advocates and families said the state needs to improve capacity and access in state hospitals.
Texas expects to publish its 鈥渓ong-range plan鈥� report in August, which will project the future need for state hospitals 鈥� facilities that provide care to people experiencing 鈥渁cute psychiatric crises or chronic mental health conditions.鈥� During a Wednesday public hearing, advocates pleaded with the state to make care more accessible to Texans in a mental health crisis 鈥� many of whom can end up in county jails waiting for care.
Paul Barrows, a retired law enforcement officer, has spent more than a decade navigating the state鈥檚 mental health system on behalf of his son.
鈥淚鈥檓 here to address the critical gap in the mental health service continuum that is directly contributing to the criminalization of mental illness in Texas,鈥� Barrows said.
Limited capacity, gaps in access and growing demand can lead to people relying on the criminal justice system to get needed care. In 2006, less than 30% of state patients were 鈥渇orensic commitments,鈥� meaning their stay is associated with the legal system.
In its , the Texas Health and Human Services Commission said now, more than 70% of patients are forensic commitments.
鈥淚t's really alarming to see that this has become an extension of the carceral system,鈥� said Krishnaveni Gundu, executive director of the Texas Jail Project.
The Texas Jail Project is a grassroots organization focused on addressing mass incarceration in the state 鈥� but Gundu said the organization has had to focus more and more on Texas鈥� public mental health system.
鈥淵our report makes it very clear why,鈥� she said.
Long-range planning report and recommendations
The report is expected to guide Texas鈥� nine state hospitals for six years, including projections on the need for beds in the future and maintenance costs, as well as recommendations to 鈥渕aximize the use of institutional facilities.鈥�
The projections won鈥檛 be published until the final report.
鈥淟ong-range planning helps ensure that our state hospitals are positioned to meet current needs and future demands,鈥� said Kristy Carr, associate commissioner of state hospitals, 鈥渂y aligning infrastructure, clinical services, staffing models, and operational practices with our mission to deliver safe, high quality, and compassionate care while being responsible stewards of public resources.鈥�
HHSC offers several recommendations in the report, including hiring more staff, expanding discharge options and strengthening the continuum of care in communities. The agency said it wants to 鈥渕odernize and integrate鈥� technology to improve care, data analysis and performance.
In addition, HHSC advocates for consolidating certain high-acuity or specialty populations into 鈥渄esignated regional hubs to improve clinical expertise and operational efficiency,鈥� which the agency describes as an emerging trend across state hospitals.
The state has already invested in . Since 2017, lawmakers have approved more than $2 billion to replace and renovate the state鈥檚 psychiatric hospitals. Late last year, UT Southwestern was tapped to run the first state hospital in the Dallas-Fort Worth area, which is expected to open this summer.
System gaps and access issues
Barrows said his son 鈥� a condition where the brain doesn鈥檛 recognize one or more other mental health conditions a person may have. Barrows said it caused his son to struggle with treatment, and lead to inconsistencies in taking medication, making it difficult to manage
Barrows said his son has been hospitalized 23 times and arrested 21 times 鈥� once for a felony. He waited for more than a year for 鈥渃ompetency restoration鈥� in Denton County.
鈥淢y son's story is not unique,鈥� he said.
Barrows said his son is part of a population that falls through a gap in the state鈥檚 system. He said this population may not appear to meet the criteria for long-term inpatient psychiatric care 鈥� but also aren鈥檛 鈥渆ffectively served鈥� by the criminal justice system.
鈥淭he result is the county jails have become the default long-term care facilities for Texans with severe mental illness,鈥� Barrows said.
He said communities need to have access to the right level of care to help people transition and maintain rehabilitation, but right now the state isn鈥檛 meeting the needs of the population.
The report explained that state hospitals have experienced a significant shift in the population they serve.
A decade ago 鈥渟tate hospitals primarily operated as a safety net for individuals experiencing acute psychiatric crises in their communities and primarily admitted individuals under a voluntary or civil commitment,鈥� the report said. 鈥淥ver time, the role of the system has shifted in response to changes in demand and court-ordered treatment needs, with the majority of admissions now being criminal (forensic) commitments.鈥�
Citterece McGregor, whose , said that shift in demand didn鈥檛 happen on its own, but is caused by what she said are 鈥渄eliberate policies鈥� and people not having access to the level of care they need.
McGregor鈥檚 son also had anosognosia. She said he 鈥渃ycled鈥� in and out of jails, while only being hospitalized for 鈥渆mergency detentions.鈥�
鈥淲hen you talk about a shift of demand, it's an insult to families like mine because we did not ask for it,鈥� McGregor said.
She also raised concerns about how long people wait for inpatient care, and how many people are waiting for that care.
HHSC鈥檚 report shows almost 2,000 unique entries were added to the inpatient care waitlist in fiscal year 2025, with an average daily count of 85 people on the waitlist. The report said delays in care can result in 鈥渄eterioration, increased involvement with emergency departments, and heightened strain on local crisis systems, including law enforcement.鈥�
In the most recent data from fiscal year 2025, people needing inpatient care waited 1.5 times longer than those 鈥渁ble to divert into other levels of care settings.鈥�
Katherine Godby, co-founder of , said her organization is concerned about the number of people detained in the county jail while waiting for treatment beds managed by HHSC. She said they are often placed in solitary confinement.
鈥淩ecently, our sheriff mentioned that over 60 people are waiting between 400 and 1,000 days for a transfer to an HHSC facility,鈥� she said. 鈥淭hese people should not be in our jail. They should be in your facilities.鈥�
Godby also said recent renovations to the area鈥檚 closest state hospital resulted in Tarrant County having fewer beds despite the growing need in the area.
鈥淲e need help,鈥� she said. 鈥淚t's not appropriate that our residents and family members and loved ones who happen to be in the midst of a mental health crisis, languish for 400 to 1,000 days in the county jail, a facility that's designed for punishment. They need to be treated like the human beings that they are.鈥�
Abigail Ruhman is 四虎影院鈥檚 health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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