AUSTIN (KXAN) — Mental illness has been a growing crisis in the nation, prompting calls for care, including the recent launch of a mental health emergency hotline.

The growing crisis is being reflected in jails, including here in Travis County. Research from Dell Medical School at the University of Texas at Austin (UT) shows that in Travis County, 37% of people incarcerated in October 2021 were receiving mental health care in jail. By May 2022, the rate had increased to 42%.

A disproportionate number of people living with mental health and substance use disorders end up in jail instead of getting the mental health treatment and support they need, Dell Med said. About two million people with serious mental illness are incarcerated annually in the U.S. One in five adults will experience a mental illness within a given year.

Addressing mental health crises within jails has been a growing problem for years. In Texas, if a person is found incompetent to stand trial, the state is most often required to send them to a state hospital for treatment, called competency restoration. A person cannot proceed through the criminal justice system without being able to understand and aid in their own defense, but that often leads to individuals being added to a waitlist for a bed at a mental health treatment facility, prolonging their time held in jail.

Mental health experts at Dell Med joined with the Travis County Commissioners Court and a wide range of community partners to address this issue.

The goal of the effort, known as the Travis County Forensic Mental Health Project, is to establish solutions rooted in person-centered and evidence-based care for people stuck at or repeatedly cycling through this intersection.

“This planning effort brings innovators, experts and advocates together to understand the challenges and the opportunities and to help us achieve a coordinated system of mental health care in Travis County for people who have been stuck in or are cycling pointlessly through jail,” said County Judge Andy Brown.

Steve Strakowski, M.D., associate vice president for regional mental health and professor in the Department of Psychiatry and Behavioral Sciences at Dell Med, said that in order to address the complexities around the criminal, legal and mental health system intersection, experts will need to step back and work collaboratively across both systems.

“It will take a ‘people-first’ approach to find actionable solutions to this mental health crisis, with health equity as a guiding principle,” Strakowski said.

This approach is based on a proven model, Strakowski said. Since 2016, Dell Med has collaborated with the Texas Health and Human Services Commission, along with other partners, to develop an innovative model for a continuum of mental health care at the Austin State Hospital (ASH). The state-funded project includes a new 240-bed hospital facility to support a new way of treating mental health issues.

The plan comes at a much-needed time, as the Travis County Jail has been facing overcrowding and staffing shortages. A half a million-dollar grant that would have supported a counsel at first appearance pilot program in Travis County was recently pulled by Texas A&M’s Public Research Policy Institute because of staffing shortages in the jail.

The grant was awarded in December 2021 and would have allowed the county to test a program that would provide representation to people at their first appearance hearing. That’s the first time someone accused of committing a crime goes before a judge, who decides bond and possible conditions for release.

Having representation at first appearance ensures bond and conditions of release are fair and reflect the crime allegedly committed. As Judge Andy Brown pointed out, the program would have largely impacted people who don’t have the money for a lawyer.

Without the pilot program, people in Travis County’s jail be staying longer than is required by law. Which, as Travis County’s chief public defender noted, is often traumatizing time spent from family and without work.

Construction of the new ASH is expected to be completed in late 2023. 

The ASH Brain Health Redesign model’s use of a steering committee of community stakeholders from all backgrounds and expertise to support collaboration across the complex system. By using a similar model for Travis County, it engages more people than usually possible to support and provide insights into the best solutions for Travis County residents.

The steering committee includes more than 15 experts and organizations spanning academia, law enforcement, the judicial system, health care systems, advocacy groups, substance use experts and people with lived experience and their families, among others. 

“The lack of adequate behavioral health care for people experiencing mental health crises in the criminal justice system has forced jails into being among the largest mental health care providers in the state,” said Travis County Sheriff Sally Hernandez. “Jails were never designed to function in this manner. It’s a travesty that causes needless suffering and seriously depletes resources. This is a program that’s desperately needed.”

The project may result in expanding existing programs or creating new programs or services, a central building space for services, as well as other innovative and community-distributed components, said Strakowski, who leads the steering committee. The group hopes to form a scalable, replicable model of care for the nation’s mental health system.