Inside Texas’ Hidden Mental Health Crisis—Told by the People Living It

Texas is living through a mental health emergency—one that touches families, teachers, veterans, caregivers, and young people in every corner of the state. 

One in 5 adults in Texas experiences a mental health condition each year. And in 2023, 18.3% of Texas high school students said they made a plan about how they would attempt suicide—that’s up about 5% since 2001. These numbers are signals of a system buckling under its own weight. Texas is frequently ranked the worst state for mental healthcare. And 61% of children with depression receive no treatment. 

Behind every one of these statistics is a family navigating waitlists, a teacher acting as an ad-hoc counselor, a veteran pushed into crisis, or a caregiver searching for help that simply isn’t there. What follows are the stories Texans have shared: stories that reveal why the system is struggling, where it’s failing the people who need it most, and the steps we’re taking to build something better.

Patients and Caretakers on the Brink

Parents across Texas are navigating lengthy waitlists for child mental health programs. Families like Nidia Heston’s show what those delays really mean. 

When her son Quin was barred from starting eighth grade until he received a full psychiatric evaluation, doctors warned he needed intensive inpatient care—treatment that would have required Nidia to give up custody. Not wanting to give up her son, she spent a month waiting for him to be approved for the YES program, a home-based program that helped stabilize his bipolar disorder, autism, and ADHD. During that month, Heston says she had to sleep on the couch with Quin to make sure he didn’t hurt himself. 

The program now has nearly 900 children waiting, shrinking provider networks, and months-long delays that put families in crisis. Today, Quin is thriving, but he and his mother both say thousands of Texas families are still stuck in the gap where help exists—just not in time.

The Rural Healthcare Desert 

For rural Texans, the problem is geography. Some residents must drive 2–3 hours to reach a psychiatrist. Terry Scoggin, CEO of the Titus Regional Medical Center (TRMC), told the Texas Tribune: “We have one psychiatrist in the five counties that we support. So that gives you an idea of the lack of opportunities.” Most of the time, a rural Texan experiencing a mental health emergency is sent to the nearest ER, which is less than ideal.

“The emergency department is a very hectic, chaotic, life-and-death area. It’s not the best environment for a mental health person or person with drug overdose,” Scoggin said.

Because mental health centers are so limited and prohibitively expensive, teachers, pastors, and school counselors—often without training—have become de facto first responders. These roles weren’t meant to fall on them. But in the absence of a robust mental health system, they do.

The Structural Problems Behind the Pain

Texas has one of the largest mental health provider shortages in the country. 246 of Texas’ 254 counties are wholly or partially designated as “mental health professional shortage areas. This absence cascades into long waitlists for therapy, psychiatry, detox beds, and inpatient care.

Even when care is available, many Texans can’t afford it. The average cost of an out-of-pocket therapy session in Texas, according to a national state-by-state report, can be more than $160.

With nowhere else to go, Texans often end up in emergency rooms, jails, or schools—places never designed to function as mental health hubs.

Building a Better Future

There are real reasons to feel hopeful about where Texas is headed. 

Nonprofit organizations like the Meadows Mental Health Policy Institute help the state improve mental health policies and programs so more people can get effective, affordable care. 

Lawmakers came into the 2025 session with a clear goal of strengthening the state’s mental health system. Their focus this year was simple: get people help faster, update outdated rules around emergency treatment, and put more money into services for kids, rural communities, first responders, and anyone in crisis.

Several bills push this work forward. SB 1164 updates how courts decide whether someone is at risk of harming themselves or others and whether they can safely make decisions about their care. The goal is to make sure these tough calls are based on medical evidence, not guesswork. SB 188 adds new funding for crisis centers, mobile crisis teams, and the 988 Suicide & Crisis Lifeline so people can get support immediately instead of waiting hours or days. HB 1747 creates a statewide council and trust fund to better coordinate mental health, substance-use, and public-health services—so families don’t fall through the cracks just because agencies aren’t talking to each other.

Rural areas should see big improvements, too. Roughly $239 million will go toward building and expanding inpatient mental health facilities, cutting down long ER wait times and hours-long drives just to find a bed.

Schools and first responders aren’t being left behind. More telehealth options will connect students to licensed therapists, and a new statewide peer-support network will give firefighters and EMS workers a safe, confidential place to get help when they need it most.

Texas still has a long road ahead, but this session marks a meaningful shift. And with sustained focus, community input, and smarter policy, Texas can build a future where getting help isn’t a privilege or a fight—it’s simply possible.

—Alex Buscemi (abuscemi@buildersmovement.org)

Art by Matthew Lewis