99. Bexar County Seeks to Expand Mental Health Services

99. Bexar County Seeks to Expand Mental Health Services—But Will the State Step Up?

This week’s Last Word commentary examines the growing demand for mental health services in Bexar County—and whether the state will provide the funding needed to meet it. Bob Rivard unpacks the county’s plan to expand in-patient mental...

Show Notes

This week’s Last Word commentary examines the growing demand for mental health services in Bexar County—and whether the state will provide the funding needed to meet it.

Bob Rivard unpacks the county’s plan to expand in-patient mental health services, why the need for more capacity has been a long-standing issue, and what it will take for Texas lawmakers to support these efforts. With statewide hospital bed shortages and increasing pressure on emergency rooms and law enforcement, how will Bexar County’s move impact care for those in crisis? And will the state step up to ensure these investments aren’t made in isolation?

Join us for a thoughtful reflection on mental health policy, local leadership, and the future of state funding for critical care services.

The Last Word: Bexar County’s Move to Increase In-Patient Capacity for Mental Health Care

Bexar County Commissioners’ request for $60 million in the next state budget to support the expansion of the county’s mental health hospital campus for desperately needed in-patient care seems like a relatively small sum in the scheme of things.

Texas legislators will have tens of billions of dollars in surplus funds to allocate during the current session. And that doesn’t count the state’s Rainy Day Fund, which will surpass the $20 billion mark and give the state’s Republican-controlled Senate and House another source of revenue to address the state’s mental health crisis, growing homelessness and the inability of cities and counties to respond with in-patient and out-patient services adequately.

Many of the state’s most unstable individuals are consigned to outdoor encampments, or they are housed in county jails, which lack the funding, and the specialists to treat people.

Locally, San Antonio is seen as a national leader, thanks to the Haven for Hope, which offers comprehensive treatment and housing programs and access to dozens of participating nonprofits that offer their pro bono services.

Yet city and county budgets are inadequate to meet growing needs. State legislators have the power to make a significant difference in this session. Of course, Republican state leaders could unlock tens of billions of dollars in federal Medicaid funds to remedy the fact Texas has more uninsured adults and children than any other state. state’s unfortunate status as home to most uninsured citizens of any state.

The state did agree to address badly funded and deteriorating mental hospitals in the major cities several legislative sessions ago. In April 2024, the Texas Health and Human Services Commission opened the new 300-bed State Hospital that replaced the county’s 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. Now county officials want to use the old, vacant buildings on the state hospital campus to expand in-patient care.

It’s a worthy endeavor, and if county officials win state funding, local officials and nonprofits will be able to reduce further the number of people living on the streets and reduce the number of people in the Bexar County jail whose offenses stem from their untreated mental illness.

Who would run the expanded facilities remains unaddressed. That could be worked out once the necessary funding is in place. Until then, people with severe untreated psychiatric issues will often find themselves on the streets or in detention.

We can do better, if only Texas legislators and the state’s top elected officials will acknowledge the problem, one growing worse with each passing year, and commit the resources needed to address our community’s mental health crisis.

That’s my Last Word.

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