With a new state-run psychiatric hospital open in San Antonio since last year, officials are looking at how to reuse the old facility as the increased demand for mental health care beds tests the county.
Bexar County commissioners plan to ask the state legislature this session for at least $60 million in funding to rehabilitate vacant San Antonio State Hospital buildings, which are located on the same Southside campus as the newly-built hospital.
The hope is that it would relieve overcrowding at the Bexar County Adult Detention Center and make treatment more readily available.
But it’s unclear whether the county or the state, or some other entity, would operate the facility, which could come at a cost of $25 million in its first year.
In April 2024, the Texas Health and Human Services Commission (HHSC) opened the doors of a new 300-bed State Hospital that replaced an aging psychiatric facility.
The new $357 million hospital at 6711 S. New Braunfels Ave. features single-person patient rooms, furnished common rooms and outdoor spaces designed to promote healing and recovery.
Patients can voluntarily admit themselves or, in the case of “forensic patients” can be referred through the courts when deemed incompetent to stand trial or after committing a crime and being found not guilty due to insanity.
It’s not unusual for those patients to languish in jail before ever being moved to a hospital for treatment and care. Reduced capacity, growing demand and staffing challenges at the jail often lead to lengthy waits and leads to overcrowding and delayed care for inmates.
A recommended solution outlined in a 2023 study by the Meadows Mental Health Policy Institute and University Health includes repurposing vacated state-owned hospital buildings for behavioral health care and detention-level support.
After several weeks of repeatedly requesting a copy of the Meadows/UH study, a county spokesman said the report is “proprietary information” and an open records request must be filed with University Health.
A University Health spokeswoman previously said because the county funded the study, it should be provided by that entity.
Commissioners approved a request for proposals in February 2022 to conduct the state hospital reuse study in an amount not to exceed $200,000 from the American Rescue Plan Act.
In the study, according to the county’s Facilities Management Department Director Dan Curry, a seven-building recovery village concept came with a price tag of $700 million and a psychiatric hospital that would cost $880 million.
Another recommendation calls for renovating the collection of smaller buildings for use in housing forensic patients. The study estimates the cost to renovate and establish 300 new, high-acuity beds would come in around $56 million.
“I think that makes a lot of financial sense, both for the county and it’s a smaller ask for the state,” said Commissioner Grant Moody (Pct. 3).
There’s only one problem. “As long as [the state] controls that asset and owns that asset, then we don’t have really much ability to fill those beds [with county patients],” he said.
At a recent commissioner’s court meeting, County Manager David Smith said there are “between 100 and 200 people in the jail who need these beds,” and if they’re filled by the state with patients from other counties, “they’re no longer available to us.”
“If we don’t run it, we don’t control the prioritization,” Smith said.
Moody said he wants to propose a model in which the state pays for the renovation but allows the county to control the use of two or three of the seven buildings, which could house 40 people each.
“Then we’d have more flexibility and ability to fill those beds,” he said.
The other remaining question is who would manage the facility. Moody said University Health could be one solution and has shared the Meadows study with the hospital leaders.
University Health is owned by the people of Bexar County, said a spokeswoman. While it is officially recognized as the Bexar County Hospital District, University Health is a separate governmental entity and a political subdivision of the State of Texas. It is governed by a seven-member board of managers appointed by the Bexar County Commissioners Court.
Commissioner Moody said he’s also interested in an option to put an estimated $280 million into building a jail annex that could be used for both inmates and forensic patients as needs arise.
“But I think that that is also going to be part of this broader discussion study around general population and what we can do on that front,” Moody said.
During the last legislative session, lawmakers approved $15 million over two years for renovations to turn 40 beds into a maximum-security unit for psychiatric care.
But the county and the state could not agree to the contract terms because the county is not a medical provider, said Andrea Guerrero-Guajardo, director of Bexar County’s Preventative Health and Environmental Services Department.
Smith told commissioners that the county could go the route of asking the legislature for renovation funds and later decide which entity would operate the facility.
“Because it’s going to take years to build these out anyway,” he said. “Finding partners to actually operate this and funding to do this will be the next big challenges.”
Commissioner Rebeca Clay-Flores (Pct. 1) said that she doesn’t care who runs the facility as long as more psychiatric beds are established in Bexar County for both forensic and community mental health care. She supports looking to University Health for support.
The entire proposal hinges on whether the state would make the buildings available to the county in the first place, Guerrero-Guajardo said.
“Given a change in leadership at HHSC, they asked us to pause those conversations so we don’t have complete affirmation that those buildings would be available for this purpose,” she said.
