Designing for Mental Health

Dr. Steven Pliszka led a committee to overhaul the San Antonio State Hospital with an eye on modern design that addresses mental health.

Asset 11.png

By Ivy Ashe
Population Health Scholar
University of Texas System
PhD Student in Journalism
UT Austin Moody College of Communication

Dr. Steven Pliszka, professor and chair of the Department of Psychiatry at UT Health San Antonio

Dr. Steven Pliszka, professor and chair of the Department of Psychiatry at UT Health San Antonio

When it was built in the 1960s, the San Antonio State Hospital was envisioned as a state-of-the-art care facility for people needing inpatient psychiatric care.

Though that goal hasn’t changed in the ensuing decades, the SASH infrastructure is rapidly aging, making it difficult to offer the best care. Now, a more informed understanding of mental health care along with official recognition that Texas’ current care structure is far too strained has prompted an extensive overhaul of the state hospital system.

The San Antonio hospital is one of five Texas Health and Human Services facilities that are scheduled to be renovated in the coming years. The goal is to do more than just build new buildings; it’s to seize the opportunity to make the most of the state’s overall investment in behavioral health. Funding for the design of a new facility in San Antonio was allocated during the previous legislative session. Funding for the construction will need to be secured in the current session.

“This is quite unique,” said Dr. Steven Pliszka, professor and chair of the Department of Psychiatry at UT Health San Antonio, which is partnering with HHS for the replacement project. Dr. Pliszka was chair of a SASH Stakeholder Committee that spent one year studying the issues surrounding both the replacement of the hospital and provided suggestions for a redesign of the mental health system in South Texas. The committee’s recommendations can be found here.

“We focused on how we wanted to reform the delivery of services,” Dr. Pliszka said.

If funding is secured, construction on the new facility is expected to begin in 2020, with an estimated move-in date for patients in 2022.

The plan for the new hospital, which was developed by two Austin-based firms, HKS Architects and Architecture Plus, emphasizes the role of courtyards and green spaces as part of a broader effort to de-emphasize the institutional feel.

The new hospital design also shifts from having four beds per room to giving each patient his or her own bedroom. It’s a feature both design and clinically oriented.

“It’s not just for comfort,” Pliszka said. “Large group rooms result in more agitated behavior.”

Beyond the building of the new hospital, said Pliszka, stakeholders in the region are hoping to address broader issues of access to care, particularly in rural areas outside of San Antonio that are currently served by SASH.

Most rural areas in Texas suffer a shortage of psychiatrists, and while it may continue to make sense for some patients to travel to major facilities like SASH, there are other people who would be better served in their community. The stakeholder planning group thus recommended developing smaller inpatient units in areas where there are currently inadequate facilities.

HHS and UT Health San Antonio are also planning to expand collaboration with Local Mental Health Authorities (LMHAs) and nonprofits in the hospital’s service area in order to better integrate and triage care.

Working on the redesign committee made Dr. Pliszka all the more aware of how many gaps are in the current system. Replacing SASH is just one part of the overall puzzle, but one that will have a major impact.

“It’s definitely a big first step,” Pliszka said.