Texas has the second-largest population in the country and a public mental-health system shaped by limited Medicaid expansion, a network of regional authorities, and a strong but uneven set of academic centres. This guide explains how schizophrenia care is structured and how families can navigate it.
In Texas, public schizophrenia care is delivered by 39 Local Mental Health Authorities (LMHAs), paid for largely through STAR+PLUS Medicaid managed care for adults with disabilities, and governed by the civil commitment provisions of the Texas Health and Safety Code.
Medicaid in Texas
Texas has not expanded Medicaid under the Affordable Care Act, so adults without children, without disability, and without pregnancy generally do not qualify regardless of income. Adults with schizophrenia who receive SSI typically qualify and are enrolled in STAR+PLUS, the Medicaid managed-care program for people with disabilities and adults age 65 and over. Information is on hhs.texas.gov.
STAR+PLUS plans contract with managed-care organisations such as Amerigroup, Molina, Superior, and UnitedHealthcare. They cover antipsychotic medications, outpatient and inpatient psychiatry, and case management. Behavioural-health carve-outs and pharmacy benefits are unified into the plan.
The LMHA system
Texas divides the state into 39 Local Mental Health Authorities (LMHAs) and two Local Behavioural Health Authorities (LBHAs). Each is a public or non-profit entity contracted by the Texas Health and Human Services Commission (HHSC) to deliver crisis services, outpatient mental-health care, and case management for adults with serious mental illness, regardless of insurance status. A directory is at hhs.texas.gov.
Examples include:
- The Harris Center for Mental Health and IDD (Houston)
- Integral Care (Travis County / Austin)
- Metrocare Services (Dallas)
- The Center for Health Care Services (Bexar County / San Antonio)
The historical "NorthSTAR" carve-out, which once delivered behavioural health care across seven North Texas counties through a single managed-care plan, was discontinued in 2017; that region is now served by Metrocare and other LMHAs.
Leading academic centres
- UT Southwestern (Dallas) — the Altshuler Center for Education and Research and the early-psychosis CEDAR Clinic.
- Baylor College of Medicine (Houston) — the Menninger Department of Psychiatry.
- UTHealth Houston — the Schizophrenia Genetics Lab and a busy outpatient psychiatric programme.
- UT Health San Antonio — early-psychosis services and clozapine clinic.
- Dell Medical School at UT Austin — partners with Integral Care on the EPINET-affiliated CARE Center for Early Psychosis.
Advocacy organisations
NAMI Texas (namitexas.org) coordinates more than 20 local affiliates. Mental Health America of Texas, Disability Rights Texas, and the Hogg Foundation for Mental Health are major statewide players. The Meadows Mental Health Policy Institute publishes data and policy reports on Texas care.
Civil commitment in Texas
Texas civil commitment is governed by Chapter 573 (emergency detention) and Chapter 574 (court-ordered mental health services) of the Texas Health and Safety Code. Key elements:
- Emergency detention — a peace officer (or, by warrant, a clinician) can detain someone with mental illness who poses a substantial risk of serious harm to self or others, or who will deteriorate without intervention. The hold lasts up to 48 hours.
- Order of protective custody — bridges from emergency detention to a hearing.
- Court-ordered mental health services — temporary (up to 90 days) or extended (up to 12 months) inpatient or outpatient commitment, requiring clear and convincing evidence of mental illness plus danger or distress.
Texas allows court-ordered outpatient mental health services, the state's version of assisted outpatient treatment. A judge can require participation in treatment, including medication, as a condition of remaining in the community.
Crisis services
Every LMHA operates a 24/7 crisis hotline and many run Crisis Intervention Teams in partnership with police. Texas also operates the statewide 988 Suicide and Crisis Lifeline. Mobile Crisis Outreach Teams (MCOTs) are the LMHA-based response that can come to a home and de-escalate.
Your loved one is voicing thoughts of suicide, threatening violence, or unable to maintain basic safety — call 988, the LMHA crisis line, or 911. If you call 911, you can request a Mental Health Officer or CIT-trained responder.
Practical first steps
- Find your LMHA on the HHSC directory and call its access line.
- If on Medicaid, call your STAR+PLUS plan's behavioural-health line for a list of in-network psychiatrists.
- If uninsured, the LMHA will assess for indigent care eligibility regardless of immigration or income status.
- Contact your local NAMI affiliate for Family-to-Family classes and peer support.
- If a court order may be needed, talk to Disability Rights Texas or a local legal-aid attorney.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.