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For Austin State Hospital, Building a Newer, Bigger Facility is Not Enough

Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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The long-overdue redesign of the Austin State Hospital is nearing completion. Together with several other new and renovated state mental health facilities across the state, Austin State Hospital will soon provide modern space to support the care of Central Texans in need of inpatient treatment during a mental health crisis. However, opening the new facility is not the end of improving Texas’ mental health care, but rather a first step toward the transformation envisioned by the 2018 ASH Brain System Health Campus Redesign plan.

The plan outlined recommendations for how to best serve the needs of people with serious mental illness. Although the new facility was a first priority, it is just a single component within a broader system of care redesign that the plan recommended – a “continuum of care” that would be responsive at every level of need, not just acute inpatient care. The aim of the Austin State Hospital campus and the emphasis behind the master plan was to create a platform for best practices within the broader mental health system that can then be replicated throughout the service area, the state and beyond.

It is time to move forward with the redesign’s next steps. Developing a robust continuum of care will create efficiencies for not only the new facility but throughout the state – optimizing the value of all new state hospital investments.

Imagine the care one initiates for the flu or COVID-19. You call up your doctor and see what can be done to eliminate the illness. Treatment options can be minor or intensive. The same is true for mental health – sometimes one needs an outpatient provider and maintenance or preventive care, sometimes a specialty provider for ailments that just won’t go away, and sometimes acute or long-term care for illnesses that require a longer time for recovery. Mental health can be confusing, but what is commonplace for general health should be so for mental health – because mental health is health care.

In other words, continuum of care means more than hospital capacity. It means increased access to outpatient care to assist in prevention and eliminate care deserts. It means enhanced crisis outreach with joint law enforcement and clinical response teams. It means opportunities for reintegration into the community once someone is discharged from the hospital.

There are far too few options for people to leave the hospital that are clinically appropriate. The Austin State Hospital redesign’s original recommendation included a step-down residential facility to discharge people who need a lower level of care. Without alternative options to discharge individuals, people remain at the hospital beyond their need for hospital-level care, and waiting lists continue to increase.

It is true that additional funding will be needed to develop a residential facility. However, the dollars spent are not only a sound investment in the well-being of Texans, but also a sound investment of limited state funds. For example, the cost of a person residing for a year at a hospital is approximately $275,000, whereas in a step-down facility, the same person’s care would cost approximately $55,000. In addition to these direct operational costs, substantial indirect costs are incurred by our communities. The criminal justice system alone spends more than $300 million annually to address unmet mental health needs for individuals in the ASH service area who could most often be better served in community mental health settings.

By making these investments, a continuum of care with Austin State Hospital as its hub will serve as a model for best care of some of Texas’ most vulnerable people. Now’s the time to continue with the redesign envisioned and approved five years ago.

Octavio N. Martinez, Jr. is executive director of the Hogg Foundation for Mental Health and senior associate vice president for diversity and community engagement at The University of Texas at Austin.

Stephen M. Strakowski is a professor and the associate vice president for regional mental health in Dell Medical School at The University of Texas at Austin.

A version of this op-ed appeared in the Austin American-Statesman.

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Texas Perspectives is a wire-style service produced by The University of Texas at Austin that is intended to provide media outlets with meaningful and thoughtful opinion columns (op-eds) on a variety of topics and current events. Authors are faculty members and staffers at UT Austin who work with University Communications to craft columns that adhere to journalistic best practices and Associated Press style guidelines. The University of Texas at Austin offers these opinion articles for publication at no charge. Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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