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Reimagining Mental Health

One in five Texans — more than five million people — experience a mental health condition each year, requiring increasing state investment to help its residents’ manage these conditions. These numbers have dramatically increased since the beginning of COVID-19 in March of 2020; recent estimates suggest that for every 1% the unemployment rate increases, an additional 700 Texans could die from overdose or suicide (Meadows Mental Health Policy Institute, 2020). As part of that response, the Texas Legislature has invested $2.5 billion in mental health since the 85th Legislative Session to improve the state’s psychiatric hospitals. In 2018, the Texas Health and Human Services Commission (HHSC) contracted with Dell Medical School at The University of Texas at Austin to lead a collaborative to redesign the Austin State Hospital (ASH), a facility that serves 26 counties for adults, 57 counties for adolescents, and 75 counties for children.

Dell Med convened a steering committee of key stakeholders from the region — all of whom see the ASH Brain Health System Redesign (ASH Redesign) as a unique opportunity to reimagine not just a hospital, but also the entire continuum of care for brain health. Using a “People First” approach, the ASH Redesign aims to optimize the overall operational budget through efficiencies that serve more people per tax dollar by delivering the right care at the right time in the right place. The priority on person care guides every aspect of the design of the physical structure and delivery of care services. For example, the plan includes single rooms, outdoor access, better sightlines for nurses, evidenced-based models of care, and care that is sensitive to a person’s life experiences. This approach is especially useful in redesigning how the state cares for brain (mental) health illnesses. Brain disorders are among the most misunderstood and stigmatized medical conditions.

Dell Med’s primary task in the preplanning and planning effort was to convene a team and then deliver a master plan and recommendations for the Austin State Hospital to HHSC. As a result of the 86th Legislative Session, $165 million was appropriated to begin construction on the new Austin State Hospital. In the 87th Legislative Session, $124.1 million was appropriated to complete the hospital construction.

The three reports of the ASH Redesign provide recommendations and priorities for the newly constructed Austin State Hospital to operate efficiently within the continuum of care. Recommendations focus on the functional bed capacity of the hospital through improvements to the continuum of care, peer engagement, and the historical significance of the ASH campus and environment. Construction will complete in May 2024, and the redesigned Austin State Hospital will begin serving the catchment area soon after. This new hospital is a milestone representing Texas caring for its most vulnerable and preparing for the potential to continue the master plan of the ASH campus.