The Texas Department of Mental Health and Mental Retardation was established in 1965 by the Texas legislature, replacing the former Board for Texas State Hospitals and Special Schools. The department's mission is to offer an array of services responding to the needs of individuals with mental illness and mental retardation, enabling them to make choices resulting in lives of dignity and increased independence. With passage of the Texas Mental Health/Mental Retardation Act of 1965, the department's role was narrowed almost exclusively to mental health and mental retardation services. In its previous incarnation, the agency had provided services for Texans with tuberculosis, orphans, and individuals who were blind and deaf. TXMHMR has grown to Texas's largest state agency (in terms of employees) from its beginning in 1861 in Austin, where the first state mental hospital was opened. In 1992 the department was the umbrella organization for sixty-two facilities, including eight state hospitals, a special facility for emotionally disturbed youth, thirteen state schools, five state centers, and thirty-five community mental health and mental retardation centers. The department also included a Genetic Screening and Counseling Service and the Leander Rehabilitation Center, a recreation facility for the department's clients. More than 40,000 persons were employed by the agency and the thirty-five community centers. The department is governed by a nine-member board of directors, each appointed by the governor for a six-year term. The board sets policy for the agency and hires a commissioner, who is the administrative head of the department. In turn, the commissioner appoints a deputy commissioner for mental retardation services and a deputy commissioner for mental health services, with the appointments subject to board approval. The deputies are in charge of the state hospitals, state schools, and state centers, of the programming offered at those facilities, and of assuring that all rules, policies, and standards set by the department are implemented. They also oversee community services offered by the facilities and contract services provided by the community centers.
The fields of mental health and mental retardation have blossomed in complexity and sensitivity in the decades since Texas opened its first State Lunatic Asylum in Austin. In 1925 the legislature removed the words "lunatic" and "insane" from the names of state facilities. In 1957 the legislature enacted the Texas Mental Health Code, which eliminated such terms as "lunacy," "insanity" and "unsound mind" in the law books and replaced them with "mental illness." In 1992 the department was actively promoting greater sensitivity by referring to the people it serves as "individuals with mental illness" or "individuals with mental retardation." The mental health code was historic for other reasons. It stipulated that epilepsy, senility, alcoholism, and mental deficiency are not mental illnesses, but a person having one of these conditions can receive care in a state hospital if he is also mentally ill. The code also allowed for voluntary as well as court-ordered admissions. Previously, the state hospitals had been filled by individuals ordered there by the courts. In the late twentieth century most admissions remained court-ordered as the state moved its focus from institutional care to community-based treatment.
Texas began its move away from institutions in the late 1940s after the United States Public Health Service reported a critical need for mental health clinics. In the 1950s four adult mental health clinics were opened-in San Antonio, Harlingen, Fort Worth and Dallas. In 1963 President John Kennedy signed a bill providing federal matching funds for community mental health centers. Since then, thirty-five community mental health and mental retardation centers have sprung up throughout the state. TXMHMR allocates state general revenue and federal funds to the community centers through annual performance contracts. The community centers are governed by a local board and receive local tax support. The relationship between TXMHMR and the community centers is contractual as well as collaborative in an effort to provide a single state system for dealing with mental illness and mental retardation.
State hospitals and state schools have operated community service programs in counties not served by community centers. With a growing commitment to service outside institutional walls, TXMHMR has promoted the development of community programs in every county of the state. The department has a number of funding sources, drawing money from the state treasury, the federal government, grants, contracts with other state agencies, and fees collected from patients able to pay for services. In 1974 a class action lawsuit was filed against the department challenging conditions in state hospitals. Under this lawsuit, known as RAJ v. Jones, the state hospitals were placed under court monitoring. In 1992 a settlement was reached setting forth specific compliance criteria for each hospital to meet. The settlement called for the department to conduct self-monitoring of specific treatment issues, with each facility exiting the lawsuit once it meets the specified criteria.
In the field of mental retardation, Texas began greater emphasis on care and treatment options in the community in the 1980s. The state's first institution for individuals with mental retardation was opened in 1917 and was known as the State Colony for Feebleminded. The name was changed to Austin State School in 1925. By 1992 there were thirteen state schools housing about 7,000 individuals, down from the all-time high of 12,000 in 1974. In the 1980s, both through policy direction and through court rulings stemming from the Lelsz v. Kavanagh class action lawsuit, the department began downsizing its state school population. The lawsuit, filed in 1974, sought improved conditions at state schools and greater community placement of individuals with mental retardation. A settlement, the third in the long-running case, was reached in 1991. Under the agreement, the suit will be dismissed when the first of two state schools is closed and 600 individuals have been placed in community living arrangements. Governor Ann Richards in 1992 approved the closure of Fort Worth State School and Travis State School in Austin. Department officials said they expected to have both schools closed by 1998.
Because of a dearth of facilities and services along Texas borders and in lesser populated areas, state centers were established in Beaumont, Harlingen, Laredo, El Paso, and Amarillo. Two of the five offer only mental retardation services, while three offer both mental health and mental retardation services. The department's forensic psychiatric unit is at Vernon State Hospital, where individuals who are incompetent to stand trial or who have been found not guilty by reason of insanity receive treatment. Also key to the TXMHMR system is a clinical research unit at San Antonio State Hospital, where new medication regimes are tested in a collaborative effort with the University of Texas Health Science Center at San Antonio.
As the system becomes more refined and focused, the respective missions of state schools and hospitals are expected to change markedly. For example, a phaseout began in the early 1990s of substance abuse treatment facilities at state hospitals, with the services being transferred to the community centers. High on the priority list for the department are increased funding for child and adolescent services, supported housing, a program to enable families to care for a disabled person at home, increased physician and nurse recruiting, and improved capacities to address the needs of incarcerated persons with mental illness and mental retardation.