During the Dec. 10 Bexar County Commissioners Court meeting, officials presented recommendations from the Adaptive Reuse Study on the former San Antonio State Hospital grounds, which includes multiple options for expanded mental health services.

The overview

Located at 6711 S. New Braunfels Ave., the former hospital was rebuilt by the Texas Health and Human Services Commission into a new $357 million facility and reopened for use on April 9, 2024. According to state documents, the three-story, 454,000-square-foot facility includes a 300-bed nonmaximum security unit. Since reopening the hospital, county and state officials have been in discussions on how to repurpose the remaining vacated buildings and surrounding properties.

The Adaptive Reuse Study offers multiple options on how best to utilize the additional space on the campus. This includes a master plan concept that breaks the campus into a high-acuity forensic psychiatric hospital with surrounding buildings and a low-acuity recovery village. The addition to the forensic hospital will cost approximately $881.4 million and the proposed recovery village concept would cost approximately $709 million.

Psychiatric hospital concept includes:
  • Three buildings, including a replica of the new-state-of-the-art facility
  • 300 beds in the forensic hospital addition
  • A 30 day substance use disorder residential treatment center, with 50 beds
  • A 150-bed civil hospital addition


Recovery village concept includes:
  • 10 residential halls, with 40 beds each
  • A wellness and fitness center
  • Retail centers
  • Three integrated health service facilities
  • Renovating 520 Ferguson Hall into an administrative office
  • A group hall


County officials also discussed the current reimbursement system with the state for fiscal year 2024-25, which reimburses the county $895 per occupied bed per day. According to county officials, future negotiations with the state could include a request to increase reimbursement from $895 to $1,000 per occupied bed per day.

What are the options?

Other options include renovating seven existing plaza buildings, with 48 beds per building and an approximate cost of $8 million per building; and the construction of a new 227-bed psychiatric center for adults, adolescents and children.
During the presentation, county officials said the plaza building renovation plan is the most cost-effective option.


The proposed new psychiatric center would include space for voluntary and civil commitments and has an approximate cost of $258.5 million. This option also allows for expanded access to current community programs, including intensive outpatient programs, treatment for substance use disorders and crisis stabilization services.

Additionally, the study also offered a recommendation for a new medical behavioral health facility at the Bexar County Adult Detention Center, 200 N. Comal St., with an approximate cost of $284.7 million.

The proposed medical behavioral health facility includes:
  • 843 beds
  • A clinic
  • An infirmary
  • Dialysis equipment
  • A pharmacy
  • Dental and laboratory space


The study also recommends the county fund expansions at various locations outside of the detention center as well as the potential for a diversion center outside of the jail to serve as a transition and a pathway for community based care.


Stay tuned

County staff requested a plan of action from the Commissioners Court—to be presented at its Jan. 7 meeting—to help steer future discussions with the state.