Redesigning Austin’s Mental Health System

The state psychiatric hospital, established in 1856, was designed for “a different era of health care,” says one of the leaders of a $15.5 million redesign that will transform the outdated and deteriorating facility to a cornerstone for a system of collaborative, community-focused care.
Concept rendering from the master plan of a future vision for the Austin State Hospital campus, reimagined as more than a hospital, but a platform for the entire continuum of care for a brain health system | Image by Page/Dyal for Dell Medical School

When you arrive at Austin State Hospital, one of nine inpatient state-run adult psychiatric facilities in Texas, you’re likely having one of the worst days of your life. Perhaps you’re suicidal, disoriented and frightened, or unable to care for yourself. Yet the campus does not match the complex needs of people in crisis who have arrived for inpatient psychiatric care or competency restoration — a process that assesses the ability of a person charged with a crime and with a mental health condition to understand and participate in the legal process.

The facility was designed for a “different era,” says Stephen Strakowski, chair of the Department of Psychiatry at Dell Medical School. He’s leading the redesign. “Some buildings are as many as 150 years old; the hospital buildings that house adults were built in 1958. There’s inadequate space to optimally deliver modern mental health care.”

But the project is about far more than a bigger, newer facility. The Texas Health and Human Services Commission and stakeholders including local mental health authorities, people receiving care, law enforcement and more have contributed to a plan to transform the campus into an integrated system of comprehensive brain health. The approach will be anchored by innovative, person-centered facilities and programs that better serve the continuum of needs across Austin State Hospital’s broad service areas, covering 38 counties for adults and 75 counties for youth.

“The No. 1 priority for the redesign is to improve the lives of people with mental illness,” says Mike Maples, deputy executive commissioner for the Health and Specialty Care System at the Texas Health and Human Services Commission.

Planning for a Continuum of Care

The Design Institute for Health — a collaboration of Dell Med and The University of Texas at Austin’s College of Fine Arts — spent much of 2018 doing fieldwork for the redesign, interviewing 65 people with mental health system experience, including people receiving care, family members, care providers, administrators, judges and law enforcement.

“The foundational insight was that brain health conditions are lived through the process of recovery, not quick fixes,” explains Director of Strategy and Mission/s Katherine Jones. “The team learned that a key design challenge is for a psychiatric hospital to simultaneously keep people safe and provide a healing environment. It must accommodate a wide range of needs while also enabling excellent care. And it must be embedded in a robust system offering care across the brain health continuum: understanding and preventing mental illness; identifying problems through early detection; healing and treating mental health conditions via outpatient therapies; and sustaining mental health recovery through supportive services.” Also necessary is care across the “crisis loop,” when a mental health condition becomes severe enough that emergency intervention and inpatient care is needed.

This vision, detailed in a 116-page report to Health and Human Services delivered early this year, will take years to realize; leaders see the construction of a new hospital facility as the first of many steps.

Their recommendation includes construction of a new hospital with space for 240 adult inpatient beds at a cost of $283 million. Additional proposals would add as many as 72 beds in a long-term residential building extension. If the Texas Legislature approves funding this session, construction could start later this year and finish by summer 2023.

Because a new building alone will not address all challenges, the report also champions systemic changes to ensure people receive the right care at the right time and in the right place, so that beds at the new hospital will be available to those who need them. It includes recommendations to improve operations; change the reporting structure; optimize the use of community psychiatric beds in the region; redesign competency restoration programs and processes; and increase residential care and supported housing capacity. It also advocates for the eventual transformation of the campus into one that provides brain health and social services for every recovery stage.

Strakowski is enthusiastic about the redesign’s potential. “Planning for a brain health continuum of care while we’re replacing the hospital is critical,” he says. “When we actualize it, it will be revolutionary.”