Austin mental health facilities now operating at full capacity

"We have so many gaps in the current health care delivery system, and that is especially prominent for behavioral health," Wolf said. "This [emergency department] is filling one gap, but there are still so many more. If you look at just plain outpatient care, it is hard for people who have their first [psychotic] episode or an anxiety episode. They are really dependent on getting that care treatment from their primary care doctors because there is such a huge shortage of mental health professionals."

The UMCB department opened April 29 and is intended to reduce overcrowded general emergency rooms and connect patients with follow-up care after they are stabilized. Prior to the ED opening, people in psychiatric crisis often ended up in general emergency rooms, which are not equipped with psychiatric medical staff. The new ED, located on the second floor of the hospital, is staffed with psychiatrists, psychiatric family medicine advanced practice nurses, social workers, nurses and clinical assistants. The 17,600-square-foot facility has 17 beds and serves anyone age 18 and older, including people experiencing mental health symptoms such as anxiety, suicide threats or a psychosis, Wolf said.

Although the department provides some relief to the overburdened mental health sector, people in need of their services are still grappling with challenges. Because of a shortage in psychiatrists, many psychiatrists do not accept commercial health insurance, and patients often have to pay cash for counseling treatment, Wolf said. The psychiatrist shortage also creates difficulty in appointment availability.

"Some of that is driven by market," she said. "They can afford to do that because there are so few and the need is so high, so people are willing to pay cash."

Central Health, Travis County's public funded health care district, and its Psychiatric Stakeholders Committee are continuing to identify county needs. CH has earmarked at least $8 million for integral care to fund inpatient psychiatric care and other crisis services in Travis County, said Brenda Coleman-Beattie, chairwoman of CH's board of managers.

She said other challenges for people with mental illness include availability of affordable and stable housing. Some people who have financial challenges may not have a stable home in which to recuperate after outpatient services, she said.

Wolf said stable housing might help people avoid psychiatric crisis all together.

"Many people who have chronic mental illness are affected by unstable housing," Wolf said. "Couch surfing with friends or living under a bridge—it's a problem. It's hard to take care of mental health needs if you can't even meet your basic needs of food, clothing and shelter."

People who have been incarcerated also struggle with the scarcity of mental health resources, said Karen Ranus, executive director of the Austin affiliate of the National Alliance on Mental Illness, a volunteer grass-roots organization that offers education, support and advocacy.

"It's this vicious cycle because so often you have people who have mental health conditions and they also have some kind of background of being incarcerated, which doesn't allow them to have access to some of the supportive services or affordable housing or any number of things that they might have access to otherwise," Ranus said.

Collaboration for resources

Austin Travis County Integral Care is working with Austin Police Department and Emergency Medical Services to increase jail and hospital diversion for people experiencing a mental health crisis. For example, if someone commits a victimless crime such as criminal trespassing and a police officer believes the person may be in psychiatric crisis, an ATCIC licensed professional counselor or social worker can be called to the scene to conduct an assessment. If the counselor believes the person is experiencing a crisis, he or she is transferred to a treatment facility rather than jail.

"This project is designed to, instead of just picking them up when they come out of jail, to divert them from ever going into jail," said Sherry Blyth, an ATCIC director of practice management.

Since July ATCIC has received 220 referrals from EMS, and its jail and hospital diversion success rate is 85.6 percent, according to April data. ATCIC could see an increase in its diversion rates because as of May, any EMS commander can dispatch counselors. Previously, counselors could only be dispatched through five specialty paramedics through the Community Health Paramedic Program.

Programs such as ATCIC's are possible because of an increase of $259 million in the state's mental health services budget during the last legislative session, and the passage of the 1115 Medicaid waiver, Ranus said. The 1115 Medicaid Waiver is a federal reform of Medicaid that changes how funds are allocated in hopes of encouraging more affordable and efficient community-based treatments. However, because Medicaid was not expanded in Texas, people with mental illnesses still struggle, she said.

In the next year, ATCIC and CH hope to find a location to build a 16-bed extensive observation unit, or EOU, which is less expensive than inpatient admission and psychiatric ED visits and provides less restrictive care for patients, said Dawn Handley, ATCIC's chief program operations officer. The closest EOU is Bluebonnet Trails in Williamson County, which just has three or four available beds, she said.

"We really need the funding to expand our capacity to fully serve our community members," Handley said. "... There's a shortage. Until we can get our psychiatrists, our physician and social work concerns addressed, we are going to continue to struggle."