There were 1,626 people waiting for forensic state hospital beds at the end of fiscal year 2026, down from 1,734 in the first quarter, according to a November report from the Texas Health and Human Services Commission.
The forensic waitlist covers people found incompetent to stand trial or not guilty by reason of insanity. At the close of the fourth quarter, 1,149 people were awaiting non-maximum-security beds and 477 were awaiting maximum-security beds. Average waits were 163 days for non-maximum-security admissions and 213 days for maximum-security admissions.
HHSC said patients who no longer need inpatient psychiatric care but lack community placement options continue to occupy beds, slowing admissions. Unscheduled walk-ins also compete for capacity: Terrell (Texas) State Hospital logged 323 walk-ins in the fourth quarter and admitted 251 of them, according to the report.
Aging infrastructure compounds the strain. State hospitals carry about $650 million in deferred maintenance needs, compared with $98 million lawmakers appropriated in 2025 for repairs at state hospitals and state supported living centers. Beds go offline when anti-ligature remediation or other maintenance is required.
A small group of patients cycles through the system repeatedly. An April study from the Texas Institute on Excellence in Mental Health found 623 of 2,998 people examined had three or more waitlist entries.
The commission’s Forensic Support Team pilot in Dallas and Travis counties has removed 239 people from the waitlists since launching in April 2025. The report attributed the removals to active waitlist monitoring, re-evalutions, diversion efforts and court collaboration.
On the community side, 128 adults were on the waitlist for community mental health services and receiving none at the end of the fiscal year, and 1,133 underserved adults were waiting for additional services.
HHSC currently contracts for 478 competency restoration beds, and more capacity is coming: replacement hospitals in Terrell and Wichita Falls, with 275 and 225 beds, are expected to be completed in fall 2027 and winter 2027, respectively.
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