As demand for mental health care beds continues to rise, Bexar County officials are seeking funding to repurpose the now-vacant San Antonio State Hospital buildings. With a newly opened state-run psychiatric hospital in San Antonio since 2024, Bexar County commissioners plan to request at least $60 million from the state legislature this session for the renovation of these existing facilities, located on the same Southside campus. The goal is to alleviate overcrowding at the Bexar County Adult Detention Center and provide much-needed mental health treatment to local residents.
The Need for More Mental Health Beds
The opening of the new 300-bed state psychiatric hospital at 6711 S. New Braunfels Ave. in April 2024 was a major step in addressing the growing demand for mental health services. This modern facility replaced an older psychiatric hospital and includes single-patient rooms, common spaces, and outdoor areas designed to aid in recovery. However, while this new facility is a positive development, Bexar County continues to grapple with overcrowding at its detention center and long wait times for individuals needing psychiatric care.
Inmates, especially those with mental health issues, often face prolonged waits in jail before being transferred to appropriate care. A recent study conducted by the Meadows Mental Health Policy Institute and University Health highlighted the urgency of repurposing vacated hospital buildings for mental health and forensic care to meet the community’s needs. The overcrowding at the detention center further emphasizes the need for more accessible psychiatric care facilities.
Challenges with State Control of the Facilities
The proposal to rehabilitate the old hospital buildings is complicated by questions of ownership and management. Bexar County has limited control over these state-owned properties, and the state’s current control over them could potentially reduce access to the beds for county residents. According to County Manager David Smith, there are currently between 100 and 200 inmates at the Bexar County jail who need psychiatric care, but if the state fills the beds with patients from other counties, these beds would no longer be available for local use.
Commissioner Grant Moody (Pct. 3) emphasized the need for a solution that allows the county to control the use of a portion of the beds. He proposed a model in which the state would fund the renovation of the buildings, but the county would manage two or three of the seven buildings, allowing flexibility in prioritizing local patients. This arrangement would help ensure that more people in need of psychiatric care, particularly inmates, would be treated promptly.
Potential Solutions and Funding Needs
The estimated cost for renovating the buildings ranges from $56 million to $880 million, depending on the scope of the project. A more focused renovation to create 300 high-acuity psychiatric beds is projected to cost around $56 million. While this price tag may seem significant, Commissioner Moody believes it is a smaller ask from the state compared to other potential solutions, like building a new facility or a jail annex that could serve both inmates and forensic patients.
During the 2023 legislative session, the Texas legislature approved $15 million over two years for renovations to create a maximum-security unit for psychiatric care at the county jail. However, negotiations broke down due to disagreements about the county’s role as a non-medical provider. Despite this setback, Bexar County remains committed to finding a viable solution and is continuing to push for renovation funding from the state legislature.
Who Will Operate the Facility?
One of the primary questions surrounding the proposal is who would operate the repurposed facility. University Health, the public hospital system owned by Bexar County, is a potential candidate to manage the site. As a political subdivision of the State of Texas, University Health already has experience providing psychiatric services, making it a logical choice for operating the facility.
However, the county has not yet reached an agreement with University Health on this matter, and negotiations will likely be part of a broader discussion on addressing general population needs, jail reform, and mental health care services.
The Road Ahead
At this stage, the county’s proposal relies heavily on the state’s willingness to make the vacated hospital buildings available for repurposing. While state leadership at the Texas Health and Human Services Commission (HHSC) has shifted recently, county officials continue to advocate for a solution that balances the county’s need for psychiatric beds with the state’s broader goals for mental health care provision.
Commissioner Rebeca Clay-Flores (Pct. 1) echoed the sentiment that her primary concern is not who operates the facility but that Bexar County needs more psychiatric beds for both forensic patients and those in need of community-based mental health care. The funding request for renovations is an important step, but securing operational control and coordination with state agencies and health systems will likely be the next major hurdle in the process.
As discussions continue, Bexar County officials are hopeful that they will be able to secure the funding and logistical support needed to transform the old hospital buildings into a vital resource for mental health care in the region. The proposal has the potential to significantly reduce overcrowding at the detention center while also providing critical services for individuals in need of mental health treatment.
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