The state of Texas continues to face a severe crisis in mental health care. Each year, thousands of individuals with mental illnesses are arrested and incarcerated before receiving the medical attention they need. Sheriff Jim Skinner of Collin County notes the problem is particularly acute in his jurisdiction. “We don’t have a county hospital, we don’t have a psychiatric hospital,” Skinner explained. “So the biggest psychiatric hospital is the county jail.”
At the time of his interview, Skinner estimated that roughly 40% of those in his custody were mentally ill or developmentally delayed. Assistant Chief Deputy Michael Sepulvado confirmed that many inmates with psychiatric issues are housed in specialized units that were originally designed for disciplinary purposes. “It’s not ideal,” he said, “but it’s the only place we have to put them.”
To reduce the risk of suicides, the jail added fencing along the upper levels of housing units. Lead psychiatrist Dr. Trina Bivens has worked in correctional mental health care for 30 years and continues to advocate for treatment over punishment. “I like being the doctor for someone who is very sick, who needs my help a lot,” she said.
Inmates Waiting Months for Psychiatric Hospital Beds
Upon intake, every inmate undergoes a medical screening to assess both physical and psychiatric fitness for incarceration. When a person is deemed incompetent to stand trial, a judge may order an evaluation for possible hospitalization. Those awaiting psychiatric competency restoration are then placed on a waitlist for forensic hospital beds — secure psychiatric facilities serving criminal defendants.
As of May 2025, about 1,700 individuals in Texas were waiting for forensic beds. The average wait time was six and a half months for minimum-security facilities and over eight months for maximum-security placements.
“Fifteen years ago, I thought it was bad that my patients had to wait two to four months,” said Bivens. “Now we go years without being able to transfer anyone to a state hospital.”
For minor charges such as criminal trespass, the waiting period for treatment often exceeds the maximum jail sentence of 180 days. “We see they’re very psychotic; they need treatment,” Bivens explained. “But we’re stuck until they time out on their charge.” In such cases, she frequently files emergency detention orders, allowing for civil rather than criminal commitment.
Tarrant County Confronts the Same Challenge
In neighboring Tarrant County, Sheriff Bill Waybourn reported that up to 70% of inmates receive some form of mental health service. The problem is most severe for inmates needing high-security psychiatric care. “We have two inmates who have been with us over 1,000 days,” Waybourn said, “because there’s not an opening for a state bed with the required security level.”
While a new private hospital in Arlington has added 36 beds for low- and medium-risk inmates, Waybourn emphasized that many individuals in custody will never regain legal competency. “They may have the mind of a five-year-old and the body of an adult,” he said. “As a society, do we really want those people in jail? I don’t think so.”
Psychiatrist Dr. Carol Nati, who oversees treatment programs in the Tarrant County jail, said her team works to provide active therapy and restore competency internally. “Within 24 hours, we try to restart any medication that was previously effective,” she said.
State Hospitals Turning Away Patients
The shortage of psychiatric beds extends beyond the criminal system. In early 2025, nearly 1,200 people voluntarily sought admission to state hospitals, but one-third were turned away due to lack of capacity. Experts warn that limited access to outpatient services only worsens the crisis. “If those elements are failing, the last-ditch effort will always be the jail,” Bivens said.
Dr. Nati echoed this sentiment: “We need more hospital beds, but we also need public awareness so resources go where they’re most needed.”
Sheriff Skinner added, “Everyone knows someone who suffers from mental illness. As a society, we must face this issue realistically and compassionately.”
Texas Health and Human Services Commission Responds
The Texas Health and Human Services Commission (HHSC), which oversees the state’s psychiatric hospitals, stated that it is working to expand forensic bed capacity. Since 2017, the Texas Legislature and Governor Greg Abbott have allocated over $2.5 billion for hospital renovations and new construction projects in Amarillo, Dallas, Wichita Falls, and Terrell. Once completed, these efforts are expected to add more than 680 beds statewide, including over 300 in maximum-security units. “All of our operating state hospitals continue to accept patients as capacity allows,” HHSC said.
While construction offers hope, law enforcement and mental health professionals agree that true progress will depend on earlier intervention — ensuring that Texans with mental illness receive treatment before they end up behind bars.
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