09. Statements of Need and Recommendations

Based upon our review of the current state against an idealized Brain Health System described in the previous section, clear gaps in mental health services are evident within the Austin State Hospital (ASH) Service Area; many of these gaps typically exist elsewhere in Texas and frequently, nationally. As discussed throughout this report and particularly in the “Financing” section of this report, these gaps create expenses in a variety of other venues. Although these expenses are difficult to fully quantify, we conservatively estimate that they exceed $300 million annually to local governments (particularly in justice and 911 systems) and hospitals (particularly in emergency departments). More importantly, by not being managed within a mental health care system, these expenses do not optimally benefit the people needing services. We recognize that it is not possible to close all gaps concurrently since solutions must be layered and implemented over time to optimize our care of people with mental illness while most effectively and efficiently using resources and investments. Nonetheless, we identified several opportunities within the context of the ASH Redesign to improve care delivery more broadly across the region. With these considerations in mind, we identified specific priority areas to address during this biennium in order to continue transforming our existing mental health care structures into an optimized brain health care continuum in the ASH Service Area, serving ultimately as a model for all of Texas. These recommendations are:

I.  Transform the Austin State Hospital (ASH) Campus.

• Replace the existing outmoded adult hospital with a new state-of-the-art facility.

• Improve ASH operations.

• Change the ASH reporting structure.

• Initiate a brain health platform on the ASH campus and beyond.

II. Optimize the Use of Community Psychiatric Beds in the Region.

• Expand the Community Psychiatric Bed-purchasing program (CPB).

• Expand CPB to provide short-term competency restorations.

III. Redesign Competency Restoration Programs and Processes.

• Engage the Judicial Commission on Mental Health (JCMH) to establish consistent competency standards and assessments across all courts.

• Establish a formal 60-day inpatient competency restoration limit.

• Create a regional competency restoration team to work across venues.

   

IV. Increase Residential Care and Supported Housing Capacity.

• Foster better use of the HCBS-AMH 1915(i) State Plan Amendment program.

• Finance expansion of evidence-based residential care and supported housing.

V. Caveats and Conclusions

Details for each of these recommendations follow. The $13M planning phase funding that has already been appropriated to the ASH Redesign is not part of the estimated project costs below.