Jails: Texas’ Largest Mental Health Providers

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Jails: Texas’ Largest Mental Health Institutions

January 2019

Emma Nye

By Emma Nye (@emmadnye)
Center for Health and Social Policy Ambassador


If you looked into Texas jails any day in 2015, you would find between 12,000 and 16,000 people with mental health disorders – between about 6.5% and 7.4% of the total Texas prison population. That may not sound like a lot, but it means that Texas jails have become the largest mental health institutions in the state. It costs Texas about $650 million per year to care for these individuals; and they also tend to stay in jail longer and have a higher rate of recidivism. To counter this trend, Dallas County was one of over 250 counties in the country to pass a resolution to implement programs aimed at reducing the number of people with mental health disorders in Texas jails.

A New Approach in Dallas

With twenty-five detention centers in Dallas County and only three hospitals that offer psychiatric drop-off sites, it is frequently infeasible for law enforcement officers to bring people experiencing mental health crises anywhere other than detention sites. And after release, there is no set method to follow-up with people with mental illness awaiting trial or to ensure they get treatment. As a result, the Dallas County Jail (Lew Sterrett Justice Center) has become the county's primary mental health treatment provider for individuals with any involvement in the criminal justice system. It is also the second largest mental health facility in the entire state.

Contributing to the problem are the existing gaps in available community-based mental health care services in Dallas County. The county has insufficient mobile crisis units, long-term psychiatric care, and supportive housing and job services. These shortfalls are particularly troubling for “super-utilizers.” Using data from Dallas mental health and jail utilization services, the Meadows Mental Health Policy Institute (MMHPI) identified over 6,000 “super-utilizers:” people who have extreme and under-managed mental health care needs who, therefore, repeatedly call for services, use emergency services and hospitals, and are frequently reincarcerated. Simply put, there are not enough resources to meet the need of people living with mental health disorders, especially those with criminal records.

In 2015, emergency services in Dallas received over 12,000 mental health calls for service. Law enforcement officers, the primary responders to mental health crises, not only also experience the same strain on limited resources, often lack the skills necessary to care for individuals in crisis and face high risks of liability. With the increase in mental health-related calls, many of which were from “super-utilizers,” emergency services saw many of the same faces constantly in crisis and often stuck in a cycle of reincarceration. 

Working with MMHPI with support from the W.W. Caruth, Jr. Foundation, Dallas County aimed to start a program that would change their approach to mental health crises.

The RIGHT Pilot Program

Through a collaboration including the Meadows Mental Health Policy Institute, Dallas Fire-Rescue Department, Dallas Police Department, and the Parkland Health and Hospital System, the Rapid Integrated Group Healthcare Team (RIGHT Care) pilot program was launched in January 2018. The City of Dallas employed mental health care professionals, who were then partnered with a police officer and a paramedic to respond to calls that police dispatchers identify as mental health crisis calls. Mental health clinicians also work at call centers to triage mental health cases and assess urgency, allowing RIGHT to address the direst calls. These mental health counselors also follow-up with callers to make sure they are receiving the long-term care they need.

In the program's first seven months, RIGHT already proved itself invaluable having addressed 709 mental health calls with only 21 cases (3%) ending in an arrest. The program will run through the next three years, working hard not only to reduce the number of people with mental health disorders in jails, but also to fill the gaps of care currently so pervasive in Dallas County. Ultimately, more people with mental health disorders in Dallas County will be able to receive care without incarceration.

Hopefully, RIGHT continues to be a success and the rest of Texas can follow its lead because prison is not the place to treat mental health disorders.

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    Emma Nye is a first-year candidate for the Master of Public Affairs (DC Concentration) and CHASP Ambassador at the LBJ School of Public Affairs. She is a cum laude graduate in Rhetoric Studies from Whitman College. Emma is interested in improving access to mental healthcare, particularly in communities with high rates of substance abuse. As an undergraduate, she worked at the local hospital, which kindled her interest in the intersection of drug abuse and psychiatric health. After graduating, Emma continued her work in the medical industry at Cape Cod Healthcare. She also assisted in research on Congressional voting and public opinion at the Kennedy School at Harvard University, where she examined mental care and approaches to drug use from a policy standpoint. Emma hopes to work in advocacy for greater accessibility to and coverage of mental healthcare, especially for those who have a criminal history of substance abuse.

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      The views, information, or opinions expressed by blog contributors are solely those of the individual authors and do not necessarily represent those of the Center for Health and Social Policy, the LBJ School of Public Affairs, or The University of Texas at Austin or affiliated employees.

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