How Kirk Watson wants to transform the aging Austin State Hospital

Austin State Hospital

  • Austin State Hospital was founded in 1857 as the Texas State Lunatic Asylum. At the time, the hospital was located in the countryside north of Austin. The hope was to keep patients in a stress-free and quiet environment.
  • In 1925, the facility was renamed Austin State Hospital.
  • The hospital had the most patients — 3,000 — during the 1960s.
  • Although the original hospital building still stands, buildings primarily used by patients today were built in the 1950s and 1970s.
  • The state funds the hospital at 299 beds (adults, teens and children) but only about 259 beds can be used largely because of staff shortages and poor conditions of the buildings.
  • On average, a third of beds are filled with forensic patients, those who were committed involuntarily by the criminal courts.
  • In fiscal year 2015, the average length of stay at discharge was 49.3 days. The average cost per patient served was $19,224.
  • Patients come from 39 counties.


Source: Texas Department of State Health Services and the Texas Legislative Budget Board

Austin’s state-run psychiatric hospital has long shown its age.

The 160-year-old Austin State Hospital — the oldest state psychiatric hospital — is plagued by deteriorating conditions and staffing shortages, limiting the number of people admitted for care and raising questions about its future.

State Sen. Kirk Watson, D-Austin, wants to save the Central Austin campus and remake the hospital into a cutting edge facility for research and treatment of mental illness. He plans to ask lawmakers to approve funding to replace the facility with an institution he’s calling the “MD Anderson of the brain,” referring to the renowned cancer research and treatment center in Houston.

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No longer would the state be alone in running the hospital, but rather, organizations like Travis County Central Health, Austin Travis County Integral Care and University of Texas Dell Medical School would serve as partners, according to Watson’s vision. The latter would train health care professionals to meet the community’s demand.

“This isn’t just about building another building. This is about taking an opportunity,” Watson told the American-Statesman. “We have an energized mental health community and I think if we spend some time planning, yes, we end up with a model that can be replicated nationally.”

Aging facility

Replacing the hospital is estimated to cost between $300 million and $400 million, according to the Texas Health and Human Services Commission.

Austin State Hospital is a 300-bed facility for people with severe mental illnesses, accepting only people who are in danger of hurting themselves or others. Patients usually stay a few weeks, get stable on medication, and then are released to get services in the community.

The Austin hospital has struggled for decades. Staff turnover is high, wages are low and patients and staffers have been routinely injured when patients get violent. Last year, the Centers for Medicare and Medicaid Services threatened to withhold federal money if the facility didn’t fix major issues, including severe nursing shortages and violating policies on restraining patients.

In 2014, a state-commissioned report stated that five state psychiatric hospitals — including the Austin hospital — needed to be replaced because they were in such poor physical condition. Austin’s hospital was established in 1857 as the State Lunatic Asylum. Additional structures were built in the 1950s and 1970s. Sprinkled throughout the 80-acre campus are empty buildings or those repurposed for storage, and functional buildings are sometimes spread apart.

The report found that the hospital was “poorly suited to support contemporary care.”

“Our state hospital system is deteriorating and needs to be fixed or replaced,” said Carrie Williams, spokeswoman for the state’s health commission. “Patients need psychiatric care in the right setting. We need to have a broad vision and be open to taking the system and mental health services to the next level.”

Watson’s big idea

Watson hopes the Legislature will authorize some money next session to start planning, but acknowledges that replacing Rusk State Hospital should be the priority. The Rusk hospital is in such poor condition that the federal government has determined that the hospital didn’t meet requirements as a Medicare provider.

Watson hasn’t outlined any specifics for his plan to remake Austin State Hospital. Even so, many stakeholders have lauded the former Austin mayor for aiming to reinvent mental health care in Central Texas.

Mental health advocates and policy experts told the Statesman that among their biggest wishes for the future of Austin State Hospital is to keep it at its current location at 4110 Guadalupe St.

“We need to keep it there. The best opportunity to involve family members and friends into the care of their loved ones is to keep it in a centrally located place that is accessible by public transportation,” said Greg Hansch, public policy director for the advocacy group National Alliance on Mental Illness Texas, which is based on the Austin hospital grounds.

Last month, the Health and Human Services Commission released the findings of a feasibility study to explore a variety of options for Austin State Hospital, including moving it to another location or consolidating it with Austin State Supported Living Center. Keeping Austin State Hospital at its current location was the least expensive option.

But selling the land could mean more money for the state’s coffers. The state’s General Land Office valued the land at $21 million.

Watson, too, wants to keep the hospital where it is.

In recent months, Watson has met with local health providers to drum up ideas of what a new hospital campus would look like, including ensuring that there is a continuum of care for patients that have a range of mental health conditions. Some of the suggestions include offering better substance abuse programs and more services for people with less intense psychiatric needs.

Putting a psychiatric emergency room on the campus or building some supported housing for clients there might make sense, said Dr. Jim Baker, chief medical officer for Austin Travis County Integral Care. There may be a better way to work with the courts for patients accused of committing crimes, he said.

Watson said it’s also possible that Dell Medical School or some other organization could run the new hospital.

Hansch said that medical students can help fill the need of more health care workers.

Andy Keller, president and chief executive officer of the Dallas-based Meadows Health Policy Institute, said that one of the largest advantages of integrating the state psychiatric hospitals into a medical school or a medical center is leaving behind the stigma of mental illness.

“It would be great that no one ever talked about the Austin State Hospital ever again after this happens. They talk about Dell Medical Center,” Keller said. Mental health is “medical care. As long as the mental patients are off somewhere else, that’s somehow unusual. But people with mental illness also have a lot of physical needs. They’re people.”

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