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Austin, TX, struggles to care for mentally ill; ERs see result

Karen Branz Leach, for Texas Healthflash, May 23, 2008

A partnership between Austin, TX, hospitals, government groups, nonprofits and the Travis County Healthcare District is working to alleviate a severe shortage of psychiatric beds and a shortage of psychiatrists willing to see inpatients.

The shortage has resulted in psychiatric patients landing in emergency rooms where there are no contracted psychiatric consultants and where physicians have little experience with anti-psychotic drugs, hospital officials say.

Jim Van Norman, MD, medical director of Austin/Travis County Mental Health and Mental Retardation Center, says the county has recently been able to contract for 11 beds per day at two private non-profit psychiatric hospitals, funded by $3 million from the healthcare district. That is in addition to its allocation of 63 beds per day at the Texas State Hospital. Van Norman says that is still about 65 beds short of what is needed for Travis County's population of nearly a million.

During 2006 and 2007, the county used significantly more than its allocated inpatient days at the state hospital, garnering itself a $2.5 million bill for the excess coverage. Recently, the state has waived those fees because the coalition added 11 beds at Seton Shoal Creek Hospital and The Lakes, located adjacent to St. David's Hospital. Travis County MHMR has also launched an Integrated Behavioral Health Program, funded by St. David's Foundation, at People's Free Clinic, a non-profit primary care center in Austin. They also created a mobile crisis team to help head off the need for inpatient care.

Van Norman says mental health services in the county have suffered from chronic under-funding exacerbated by explosive population growth, a situation made worse by the fact that none of the city's general hospitals have inpatient psychiatric beds. "That's in striking contrast to most counties," says Van Norman. Also, Travis County has a shortage of psychiatrists, and many of those practicing in the county do not see hospitalized patients.

Trish Young Brown, president and CEO of the healthcare district, says the coalition is focused on finding the money to pay for 27 new beds, which could be available at The Lakes and Shoal Creek. The Department of State Health Services has awarded the county a $1.9 million grant for 2008, and those funds are expected to be ongoing, says Young Brown. That leaves another $5.1 million needed to fund the 27 beds. "That's a big gap. And that's if we can find psychiatrists and psychiatric nurses to staff the beds," says Young Brown.

Currently, inpatient psychiatric coverage at Shoal Creek is provided by the faculty and residents in the Austin Graduate Medical Education program. "We hope to increase the number of residents in the near future, to add more psychiatrists to the Austin area," says Young Brown.

Karen Branz Leach