Hundreds of patients in Texas state hospitals have been admitted for more than a year, according to state data shared Wednesday.
There are 10 state-operated hospitals for people with mental health issues, as well as one youth residential treatment center. Of the nearly 2,000 patients in state hospitals, almost 800 are considered “365-plus” — meaning they’ve had a stay that’s longer than a year, according to Vinay Vuriti, a data analyst for the Offices of Forensic Services and Coordination.
“[The 365-plus population’s] average length of stay is 1,591 days, which is over four years,” Vuriti told the Joint Committee on Access and Forensic Services, which monitors and makes recommendations regarding service access to the Department of Health and Human Services.
Windy Johnson, a member of the committee and the Texas Conference of Urban Counties, said this can limit capacity for new patients — leading to a waitlist for services.
“A lot of people have been there for three years, which obviously delays a new person getting into the state hospitals,” Johnson said.
The committee has been working to eliminate the waitlist: The average waitlist for Texas state maximum security unit beds peaked in fiscal year 2023 with more than 1,000 people. It’s since dropped to about half that.
For non-maximum security unit beds, the average waitlist dropped from about 1,400 in 2023 to about 1,200 in 2024 – but has since increased.
Despite progress, there are several barriers to opening up beds in state hospitals. Vuriti said more than 250 long-stay patients are considered “ready for discharge” by the treatment team but haven't been released.
Most of the 365-plus population are forensic patients, which means their hospital stay is related to or associated with the legal system. For forensic patients, a discharge is authorized by a judge.
However, length of stay can be influenced by more than just a judge’s determinations.
Dr. Jeffery Matthews, the Chief Medical Officer for Texas state hospitals, implemented patient discharge needs forms to understand what may prevent patients from leaving a hospital.
“What do these individuals need?” Matthews said. “What living setting would be appropriate for them? What clinical considerations [should we] take into account? What medical considerations?”
In addition to lack of capacity in state hospitals, Matthews said there aren’t enough places for people to go once they’ve been discharged. Many might not have a caregiver or insurance.
About one-third of patients in state hospitals didn’t need continued inpatient hospitalization because support and monitoring were available outside the hospital, according to the December patient discharge needs form.
“If we could start looking at these barriers to discharges, we could help people transition out of the hospital,” Matthews said.
The state has expanded the number of beds in state hospitals in the last few years and is. in the process of building new facilities to increase capacity – including the first state hospital in the Dallas-Fort Worth Metroplex.
State officials are developing a long-term plan for state hospitals, with a public comment session scheduled for Feb. 2.
Johnson said the process to develop the new plan should include consideration of the entire system to make services more accessible to Texans.
“If we don't have anywhere to discharge people that have been sitting in a state hospital,” she said, “then the waitlist is not going to reduce in a timely fashion.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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