San Antonio’s mental health challenges are bigger than needing more inpatient psychiatric capacity alone, experts said last week.
Business leaders, healthcare executives and mental health experts met for a panel discussion on the loss of psychiatric beds in San Antonio following Laurel Ridge Treatment Center losing federal funding.
Panelists were blunt about the challenges Bexar County is facing in treating serious mental illness. San Antonio is more than 700 psychiatric beds short following the loss of beds at Laurel Ridge, Texas Vista Medical Center in 2023 and Nix Hospital in 2019, according to Eric Epley, executive director of the Southwest Texas Regional Advisory Council, or STRAC, which manages the emergency healthcare system in the region.
“This is coming like a freight train, and it’s going to affect you,” Epley told the crowd, which was made up mostly of local healthcare and business leaders.
The panel was put together by the Greater San Antonio Chamber of Commerce, which recently established a committee of experts that will meet regularly to find solutions to the area’s mental health challenges.
“When I listen to all the [capital] being spent across this community in healthcare systems a minute ago, that’s great,” chamber board chair and FirstDay Foundation CEO Kevin Dinnin said, referencing the prior panel of local healthcare executives.
“We’re getting ready to spend money to improve our water system: Giddy up. But aside from that, we’d dang well better fix this behavioral health issue,” Dinnin said. “It is not fair to San Antonio EMS, SAPD [and] emergency room physicians that are not equipped to care for these kinds of patients.”
Despite the alarm over bed counts, several experts stressed that more beds alone won’t solve the mental health crisis and could even pull money away from less obvious solutions. Epley also stressed that insured patients experiencing mental health crises are most impacted by the recent Laurel Ridge closure — not just the uninsured population.
Three-legged stool
Epley described his vision for addressing serious mental health issues in Bexar County as a three-legged stool that’s anchored first by a dedicated, locally owned psychiatric hospital, second by a center to divert people in crisis away from jail, and third by wraparound services like transitional and permanent supportive housing, prescription drug assistance and food security.
“If we build a hospital, we’ll fill it up, and it’ll just be full in two weeks,” Epley said. “We’ll be right back where we are. We need wraparound services like food care and prescriptions and things like that. It’s not sexy, but it’s what’s going to actually fill the gap.”
University Health President and CEO Ed Banos, who was not on the mental health panel but spoke with the San Antonio Report in a separate interview, made a similar case that more beds by itself would be more expensive and less effective than other avenues.
Hospitals get billed roughly $1 million to $2 million per bed, Banos said, putting the bill for a new psychiatric hospital in the range of $300 million to $600 million. It would also take years to build.
And bed capacity without follow-up care and a system to keep these patients off the streets, out of jail and emergency rooms would result in the same cycle the city is grappling with now, Banos stressed.
If Laurel Ridge, Texas Vista and Nix all reopened tomorrow, Banos said, the beds would fill, “and they would be discharged 10 days later, and they wouldn’t have treatment. They don’t have outpatient doctors to take care of them, they don’t have alternative housing.”
The inpatient bed piece, though important, is “one piece of a 1,000-piece puzzle” that involves housing, courts, social services, addiction and detox programs, the healthcare system and more, Banos said.
He pointed to existing models he said deliver more care per dollar, like behavioral health clinics that can be run for roughly half a million dollars a year and treat thousands of patients a year, such as UT Health’s psychiatric urgent care, the NOW Clinic.
He also pointed to step-down programs like at SAMMinistries, which University Health pays to house and treat uninsured patients discharged from its psychiatric unit for stays of 30 to 60 days; and detox and addiction treatment centers.
Insured patients hit hardest
Laurel Ridge largely served patients with insurance, while public systems such as University Health absorb the uninsured, Banos said. When Laurel Ridge lost its federal funding, only a small share of its patients were uninsured.
Epley echoed that point during the panel, explaining that the squeeze was largely falling on patients with private insurance, not the uninsured as many might assume. He said one Austin psychiatric facility took 110 referrals from San Antonio in the month of May alone.
“The loss of Laurel Ridge is not, strictly speaking, super impacting my unfunded capability,” Epley said. He said the average wait time to get from an emergency department into a psych bed has remained largely steady at around 30 hours over the last several months. “This is a funded patient crisis.”
He added that these issues have economic implications.
“We’re really trying to recruit other industries to come here,” Epley said. “They’re going to look at this and go, ‘I hear you can’t even get a psychiatrist visit, you can’t get into outpatient care if you have Blue Cross [Blue Shield]. Why would we want to move our company there?’”
Dr. Rene Olvera, a practicing child and adolescent psychiatrist and chair of the Department of Psychiatry and Behavioral Sciences at UT Health San Antonio, said that all of the department’s therapy services have waitlists, and that it’s difficult to find therapists in town who aren’t cash pay only, “because private insurance just doesn’t cover them,” he said.
‘That’s criminal’
Jelynne LeBlanc Jamison, president and CEO of the Center for Health Care Services (CHCS), the local mental health authority for Bexar County, said the loss of beds at Laurel Ridge “shed light on a system that is already very fragile.”
The real shortfall, she argued, is in the pre-crisis and outpatient services that keep people stable before they ever need a hospital, investments she said the community has not made at the level it should.
CHCS serves about 40,000 people a year and is capped by its state funding, forcing it to refer patients out to community partners, LeBlanc Jamison said.
She stressed the need for a diversion center, a place where law enforcement could take people who commit low-level offenses such as criminal trespassing and who live with mental illness or substance use disorders, rather than booking them into jail.
“Many of those individuals … could have been eligible to be directed to treatment versus being taken to jail and sitting there with a $200 bond or $35 bond that they cannot pay to get out of jail,” LeBlanc Jamison said. “That’s criminal.”
