A man holds his phone as he talks about receiving help from Integral Care, Travis County’s local mental health authority. Community-based services alone cannot replace the inpatient psychiatric capacity our region desperately needs, Integral Care CEO Jeff Richardson writes.
Ricardo Brazziell/Ricardo B. Brazziell
The recent investigation that Nicole Villapando and Meredith Roberts published in the Austin American-Statesman was not a surprise to those of us on the front lines of behavioral health in Travis County. It confirmed what clinicians, first responders, families and patients have experienced for years: people in acute psychiatric crisis are waiting in emergency departments for days, jails have become de facto psychiatric facilities, and our most vulnerable neighbors are cycling through a system that too often fails to provide what they need: stabilization, treatment and a path to recovery.
As CEO of Integral Care, Travis County’s local mental health authority since 1967, I want to be direct: the status quo is unacceptable, and we have both the obligation and the opportunity to do better.
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The numbers behind the reporting are stark. Inpatient psychiatric bed use increased nearly 12% between 2023 and 2024, but capacity did not keep pace. In 2023, more than 60% of adults treated in state hospitals came from jails or prisons. This is not a law enforcement success story. It is a systems failure. In one of the fastest-growing regions in the country, the gap between need and available care continues to widen.
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Integral Care and our partners are not standing still. Every day, we work to intervene as early as possible, helping people stabilize in the community and reducing the need for hospitalization whenever it is safe and appropriate.
Integral Care is a Certified Community Behavioral Health Clinic, or CCBHC. That means we provide mental health and substance use services to anyone seeking care, regardless of their ability to pay. Our model includes comprehensive treatment, care coordination, and 24/7 crisis response.
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Texas has been a national leader in advancing this model, which offers a smarter, more sustainable way to organize care for people who have historically been underserved.
When crises do occur, we partner with the city of Austin through our Expanded Mental Health Crisis Outreach Team, or EMCOT. These specialized clinicians are integrated into Austin’s 911 response system.
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In fiscal year 2025, EMCOT handled more than 3,800 calls and resolved nearly 90% of them without police involvement or involuntary hospitalization. That is the kind of response system we need more of — one that connects people to care rather than deeper involvement in emergency rooms, jails or the criminal justice system.
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But community-based services alone cannot replace the inpatient psychiatric capacity our region desperately needs. People cannot be diverted from emergency departments if there is nowhere appropriate to send them. A behavioral health system works only when every part of the continuum is available, adequately funded and properly staffed. Today, important parts of that continuum remain strained or missing altogether.
One of the most solvable barriers is the federal policy known as the IMD exclusion, which limits Medicaid funding for inpatient psychiatric care for adults. Dozens of states have pursued federal waivers to address this restriction, including many that have done so for substance use disorder treatment. Research suggests these efforts can reduce psychiatric costs and decrease involvement with the criminal justice system. Texas would benefit from pursuing similar solutions, and state leaders have an opportunity to advance that conversation.
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How a state responds to people in crisis reflects its values. Texas can improve a system that leaves too many people with serious mental illness cycling through emergency rooms and jails because appropriate psychiatric care is unavailable.
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We know what works: integrated crisis services, coordinated community-based care and sufficient inpatient psychiatric capacity. Texas helped build the framework for this approach and has the opportunity to strengthen it. The need is clear. What remains is the will to act.
Jeff Richardson is chief executive officer of Integral Care, the local mental health authority for Travis County. Integral Care provides mental health, substance use, and intellectual and developmental disability services and operates crisis care programs serving residents across Travis County.