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 "long-range plan" report in August, which will project the future need for state hospitals – facilities that provide care to people experiencing "acute psychiatric crises or chronic mental health conditions." During a Wednesday public hearing, advocates pleaded with the state to make care more accessible to Texans in a mental health crisis — 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's mental health system on behalf of his son.
"I'm here to address the critical gap in the mental health service continuum that is directly contributing to the criminalization of mental illness in Texas," 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 "forensic commitments," meaning their stay is associated with the legal system.
In its draft report released in March, the Texas Health and Human Services Commission said now, more than 70% of patients are forensic commitments.
"It's really alarming to see that this has become an extension of the carceral system," 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 – but Gundu said the organization has had to focus more and more on Texas' public mental health system.
"Your report makes it very clear why," she said.
Long-range planning report and recommendations
The report is expected to guide Texas' nine state hospitals for six years, including projections on the need for beds in the future and maintenance costs, as well as recommendations to "maximize the use of institutional facilities."
The projections won't be published until the final report.
"Long-range planning helps ensure that our state hospitals are positioned to meet current needs and future demands," said Kristy Carr, associate commissioner of state hospitals, "by 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."
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 "modernize and integrate" technology to improve care, data analysis and performance.
In addition, HHSC advocates for consolidating certain high-acuity or specialty populations into "designated regional hubs to improve clinical expertise and operational efficiency," which the agency describes as an emerging trend across state hospitals.
The state has already invested in addressing access issues with its state hospitals. Since 2017, lawmakers have approved more than $2 billion to replace and renovate the state's 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 has anosognosia – a condition where the brain doesn't 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 his schizoaffective disorder.
Barrows said his son has been hospitalized 23 times and arrested 21 times – once for a felony. He waited for more than a year for "competency restoration" in Denton County.
"My son's story is not unique," he said.
Barrows said his son is part of a population that falls through a gap in the state's system. He said this population may not appear to meet the criteria for long-term inpatient psychiatric care – but also aren't "effectively served" by the criminal justice system.
"The result is the county jails have become the default long-term care facilities for Texans with severe mental illness," 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't 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 "state 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," the report said. "Over 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."
Citterece McGregor, whose son died while in custody of Harris County Jail, said that shift in demand didn't happen on its own, but is caused by what she said are "deliberate policies" and people not having access to the level of care they need.
McGregor's son also had anosognosia. She said he "cycled" in and out of jails, while only being hospitalized for "emergency detentions."
"When you talk about a shift of demand, it's an insult to families like mine because we did not ask for it," McGregor said.
She also raised concerns about how long people wait for inpatient care, and how many people are waiting for that care.
HHSC's 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 "deterioration, increased involvement with emergency departments, and heightened strain on local crisis systems, including law enforcement."
In the most recent data from fiscal year 2025, people needing inpatient care waited 1.5 times longer than those "able to divert into other levels of care settings."
Katherine Godby, co-founder of the Justice Network of Tarrant County, 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.
"Recently, our sheriff mentioned that over 60 people are waiting between 400 and 1,000 days for a transfer to an HHSC facility," she said. "These people should not be in our jail. They should be in your facilities."
Godby also said recent renovations to the area's closest state hospital resulted in Tarrant County having fewer beds despite the growing need in the area.
"We need help," she said. "It'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."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
KERA News is made possible through the generosity of our members. If you find this reporting valuable, consider making a tax-deductible gift today. Thank you.
Copyright 2026 KERA News