Editor's Note: The video above contains coverage from June 2025 when a bill to study Texas's psychiatric bed capacity fell short.
AUSTIN (KXAN) – The average number of people stuck in jail waiting for a state hospital bed – a stubborn problem that Texas’ leaders have spent years and billions of dollars to fix – has fallen but could be plateauing, according to a state hospital expert, state data and a recent legislatively mandated report from Texas Health and Human Services.
The waitlist peaked in December 2022, when more than 2,500 people were on it. At the end of August 2025, that number fell below 1,800, according to the report.
In addition to overall waitlist numbers, the report shows the census at each state hospital, broken down by the average daily number of child, civil, forensic and maximum-security patients. See below for an explanation of each category.
Civil/voluntary: non-criminal patients who were admitted voluntarily or civilly committed for mental health treatment. Forensic: these are typically criminally charged, non-maximum-security patients who have been found incompetent to stand trial or not guilty by reason of insanity. Maximum security: typically, these are criminally charged patients who are considered dangerous. There are a small number of civil commitments in this category. Child/adolescent: anyone under 18 admitted civilly, voluntarily or under a certain family code commitment.“It would be impossible to say that the wait list is not improving since their high in December of 2022, but I also know that it's now kind of become stagnant,” said Beth Mitchell, a supervising attorney with Disability Rights Texas. “If you look at just this year from January until now … the wait list hasn't moved much at all.”
In Texas, people charged with a crime and found incompetent to stand trial are required to undergo competency restoration in an HHSC state hospital. In some circumstances, they can go to a supervised, outpatient facility overseen by the state. While incompetent, their cases are essentially paused.
Disability Rights Texas is a nonprofit protection and advocacy agency that helps people with disabilities exercise their rights. Mitchell is the leading attorney for the organization and one of several lawyers handling a federal class-action lawsuit against HHSC over the constitutionality of forcing defendants to wait months in jail for a state hospital bed. The lawsuit has been ongoing for more than nine years and is set for a bench trial in December, according to federal court records.
A bed at the Austin State Hospital (KXAN Photo/Todd Bailey)“This situation is not new,” according to Disability Rights’ federal lawsuit. “Incompetent detainees and insanity acquittees suffer needless deterioration of their mental health as they wait in jails, frequently in prolonged isolation, for weeks or months before they receive the services HHSC is responsible for providing.”
KXAN has reported for years on the ripple effects of the waitlist, including thousands of individuals languishing in lockups, some dying, and the strain and costs passed through to county jails.
KXAN's Mental Competency ConsequencesIn November 2024, the State Auditor’s Office released a detailed review of competency restoration services in the state. Among numerous problems, auditors identified at least 54 people had died while on the waitlist since 2018.
Mitchell said the length of time people are waiting is a more pressing issue than the number of people waiting.
The waitlist could have triple the number of people on it, Mitchell said, but if the state were able to move them to a hospital in a timely manner there wouldn’t be an issue. Disability Rights’ lawsuit suggests 21 days as a benchmark for getting people to a hospital.
With the Texas’ population and demand for hospital space growing, the state is grappling with a capacity problem.
State officials and HHSC’s leaders have worked for years and invested substantial sums to reverse the problem.
Rebuilding, replacing, expanding
Gov. Greg Abbott and the Legislature have appropriated over $2.5 billion since 2017 to rebuild, replace and expand state hospitals across Texas. Projects are underway in Amarillo, Dallas, Harlingen, San Antonio, Terrell and Wichita Falls. When finished, the work will add over 680 state-owned beds, including 300 maximum-security ones, according to HHSC.
“We expanded our inpatient psychiatric bed capacity in Mental Health Community Hospitals by maintaining the existing capacity and adding 193 state purchased inpatient psychiatric beds, including 70 beds in rural communities and 123 beds in urban communities,” HHSC said in a statement.
Those efforts help, but Mitchell said she’s concerned the state still won’t meet future demand.
She referenced the 2014 so-called “Cannon Report,” which was a state-funded assessment of hospital demand that projected population changes and how many beds the state would need in the coming ten years.
Now, just over a decade later, Texas isn’t close to having the number of beds recommended in that, Mitchell said.
“Not to discount” all the efforts the state has made to improve state hospitals, she said. “They all may help, and they're necessary, but they still need to do more.”
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