Harris County, Texas is the most populous county in the state and the third-most populous county in the United States. Its county seat is Houston, the largest city in Texas and fourth-largest city in the United States.
Harris County also has one of the most underfunded public mental health systems in a state that consistently ranks last, or almost last, in per capita mental health spending. Community-based mental health care is funded mostly by state government, and for years, the Texas Legislature starved its public system. In 2003 Texas lawmakers slashed funding, and thousands of people who relied on the system were suddenly ineligible.
Many went into crisis and were picked up by police or wound up in emergency rooms, where they stayed briefly, stabilized, and were released, still unable to get treatment in the community.
In Texas, a defendant found not competent to stand trial in a violent offense is supposed to be committed for treatment in North Texas' Vernon State Hospital in order to attempt to restore competency.
Texas’ mental health hospital system was designed and built a century ago, when Texas was very rural and good treatment options for mental illness weren’t available. Large campuses of 60 to 90 acres, often in rural areas of the state, were built to house 3,000 patients each. Most patients sent to these facilities weren’t expected to recover.
Although these hospitals still play an essential role in the mental health delivery system, many of them are functionally obsolete. Many are abandoned, decaying and considered a safety hazard. Buildings used for clinical care are in reasonable condition but poorly designed for modern care, with convoluted hallways with poor visibility from nursing stations. Higher-acuity patients require more caregivers, further crowding already limited common spaces.
A recent Department of State Health Services study determined that five state hospitals- Rusk, Austin, San Antonio, Terrell and North Texas at Wichita Falls - were beyond repair and should be replaced. Furthermore, the buildings and facilities at the Big Spring, Kerrville and North Texas at Vernon state hospitals, as well as the Rio Grande State Center, El Paso Psychiatric Center and Waco Center for Youth, should be repaired and renovated, and the unused, decaying buildings on these campuses should be torn down, the report said.
Because of the lack of beds in Vernon Hospital particularly, the Harris County Jail has now become the largest mental health facility in Texas and the second largest in the USA. It has more beds dedicated to the mentally ill than all other hospitals in the state, combined. Inmates may wait months before being transferred to Vernon.