Texas County Seeks $60 Million for Hospital Upgrades to Support Inmate Care

By Fay Harvey  

BEXAR COUNTY, Texas — Bexar County, Texas, officials have requested $60 million in state funding to renovate seven buildings within the San Antonio State Hospital complex. The renovations would allow the county to better meet the needs of jail inmates who require psychiatric services.  

Operated by the Texas Health and Human Services Commission, the San Antonio State Hospital (which opened in 1892) offers inpatient psychiatric care to more than 50 counties in the state’s southern region, including Bexar County—home to San Antonio and neighboring cities, with a combined population exceeding 2 million residents. 

Construction on a $357 million replacement facility at San Antonio State Hospital was completed in April 2024. The three-story, 454,000-square-foot addition included 300 beds in a non-maximum-security unit as well as trauma-informed features including recreational, music and social spaces. Additionally, the project added a gym, library, common areas, a chapel and outdoor environments. However, the expansion also shifted geriatric services to several existing facilities, leaving no space to provide inmate healthcare. Seven older buildings on the grounds that were built in the 1960s and 1970s and are in poor condition with sinking foundations were left unrenovated. If improvements to those facilities are funded, each could provide psychiatric care bed space for up to 48 inmates. The county is currently working with HKS Architects to determine a plan for the facilities. 

Daily, up to 200 inmates await admission to mental health facilities. Most of the state hospital’s population comes from the criminal justice system, including those deemed unfit to stand trial and in need of treatment before criminal trials can proceed.  

In December 2024, 129 inmates were waiting in the Bexar County’s Adult Detention Center for psychiatric unit bed openings. In 2024, 13 people died inside the jail, down slightly from 18 in 2023. In response, Bexar County Sheriff Javier Salazar implemented a medical screening process and created a policy to reject detainees who are detoxing from drugs or alcohol, who are diabetic and dependent on insulin, and who require dialysis. 

“Bexar County continues to experience an unprecedented and ever-increasing number of individuals found incompetent to stand trial, and whom are being held in the County’s Adult Detention Center because they are awaiting transfer to an HHS facility for competency restoration,” the county proposal mentions. 

The proposed facility renovations will additionally cut down the crowding at Bexar County’s Applewhite Recovery Center, which is currently undergoing renovations. The center’s $25 million expansion is set to add 39,000 square feet and 130 mental health beds to bring capacity from 240 to 370. Once open, the renovated space will aim to help reduce the jail population while expediting treatment for non-violent offenders waiting to officially enter the facility. 

The Texas legislature has until June 2 to approve the state budget.