842 in-patient psychiatric beds at Texas state hospitals are offline, according to data from the Health and Human Services Commission. These are beds that the hospitals are set up to operate, but a continued staffing shortage has left these many of these beds empty for months.
"In my experience, this is unprecedented," said Andy Keller, President of the Meadows Mental Health Policy Institute. "Over 800 beds offline, that's over a third of their beds."
The agency first announced the dire situation in late June during a presentation to the House Human Services Committee. At the time, 717 of these beds were not in operations.
Hard-to-fill position has been the primary reason for the dramatic reduction in capacity, according to an email from an agency spokesperson. The biggest vacancies are for positions like nursing assistants, nurses, psychologists, social workers, behavioral health specialists and laundry workers. The state hospitals have approximately 1,400 fewer full-time staff members compared to late November 2019.
"HHSC is working to return to pre-pandemic staffing levels in state hospitals by offering employment incentives including pay raises, recruitment bonuses, and flexible shifts," said Jose Araiza. "In addition, we have asked the Texas Legislature to fund pay raises in the upcoming session."
In September, the agency requested over $34 million from the legislature to address "critical workforce needs."
Araiza said that spikes in COVID-19 infections and construction have also contributed to the dip in capacity.
The hospitals with offline beds are all state-run facilities. However, beds run by partners like UTHealth Houston and UTHealth Northeast are fully online.
"Those partner operated facilities are operating at 100% capacity because they’re being run by people who know how to run hospitals," Keller said. "And frankly, they're run by people who don’t get paid unless the beds are operated."
Keller said a big reason why the state is struggling to staff beds is because of hiring inflexibilities.
"So it’s not just a matter of money, it’s a matter of operational acumen," Keller said. "I think the state needs to look at how to partner with safety net providers who have the flexibility that the state does not."
The waitlist of people waiting for a bed has grown to over 2,500. Most of these people are waiting for "forensic" beds, where Texans deemed incompetent to stand trial go to receive mental health care and get their competency restored.
As a result, hundreds are languishing in jail cells.
"These individuals are all sitting in jails right now," Keller said. "It’s one thing to be incarcerated. It’s another thing to be incarcerated with a mental illness. You’re more likely to be a victim of violence, you’re more likely to be a cause of violence."
He said the backlog affects the overall safety of prison facilities too, impacting inmates and staff alike.
"The ripple effects for everybody — from the individual to their families to the other people within the jail to the community — are profound and are getting worse every day," Keller said.
12/23/2022 Editor's note: A previous version of this story incorrectly identified the University of Texas Southwestern as being fully-staffed and that staffing shortage is the only reason for all the offline beds.