Layoffs at County’s Largest Mental Health Provider Approved by Board of Trustees

Integral Care budgets over time (Data via Integral Care)

The Integral Care Board of Trustees voted unanimously, Aug. 31, to adopt a $131 million budget that will result in a 5% reduction in the agency’s workforce, including layoffs for 48 employees, amid a budget shortfall stemming from inadequate delivery of services.

Integral Care is the largest provider of mental health care services in Travis County and it plays a vital role in the social safety net of people who cannot afford private care. But it is also a flawed public agency that has suffered from staffing issues in recent years and perceived mismanagement – both factors that contributed to the agency failing to meet benchmarks for service delivery tied to funding. Partly as a result of the underperformance, Integral Care had a roughly $9 million hole to plug in the budget for fiscal year 2023-2024.

The staff-proposed budget will close that deficit through about 6% of spending cuts from the agency’s operations budget. That equates to about $8.6 million worth of cuts, including 48 layoffs and the elimination of funding for 67 vacant positions. Employees affected by layoffs will be given a 12-week notice period, during which they can try to transfer into one of the agency’s open positions, without needing to submit a formal application. Initially, agency management intended to offer a six-week notification period, but the board amended the budget to double the notification time.

And help is on the way. In his newsletter, Mayor Kirk Watson suggested a stopgap solution intended to prevent the layoffs: funding assistance from Central Health, Travis County’s hospital district. As the Chronicle went to press Sept. 6, the Central Health Board of Managers was set to approve the agency’s budget for FY 2023-24, which includes a $400 million reserve fund.

A draft budget amendment from Board Manager Ann Kitchen would transfer $7 million from the reserve fund to increase the contract Central Health already has in place with Integral Care. The contract increase is likely enough to prevent the 48 layoffs approved by the Integral Care Board last week.

Before Integral Care’s budget meeting, past and current employees implored the board to reconsider the proposed layoffs, arguing that increasing the caseload of already overworked nurses and mental health clinicians would only further erode service delivery and quality of care. (Agency management actually projects serving more clients in the next fiscal year, which would improve their state funding.)

Cynthia Lewis, an advanced practice nurse who works in residential crisis care at Integral Care, cited poor management as central to the problems at Integral Care. “I first spoke to the board in March when I called to your attention the resignation of our our supervisors and director of medical analytics,” Lewis said of alarming resignations within the residential crisis program, which offers care to people who are suicidal, homicidal, psychotic, hallucinating and delusional, or withdrawing from substances. “Orders from the top down have been sloppy and dysfunctional,” Lewis continued. “There is a huge disconnect between the leadership … and front-line staff who provide care to our community.”

Lewis described troubling changes to how care was provided in her program, like a decision made “abruptly and without forewarning” to reduce the number of nurses per shift at crisis centers to one. Earlier this month, Lewis said, nursing staff working at Integral Care’s respite care center on East 15th were instructed, with three hours’ notice, to evacuate clients and equipment to the agency’s Next Step respite center, located on North Lamar. “This exodus was chaotic, disorganized, and unsettling,” Lewis said.

United Workers of Integral Care, the union representing front-line employees at the agency, said the additional weeks of notification were “not an all-out win,” but doubling the notification period should be seen as an important victory for affected employees. “We have power in our numbers,” UWIC co-President Carly Melancon told the Chronicle. Now, UWIC is calling on the city of Austin and Travis County elected leaders to “urgently work” with Integral Care management over the next 12 weeks to “to secure additional funding to prevent any employee layoffs and cuts to services.”

Before the budget vote, Integral Care CEO David Evans noted that the budget was a “living document” and that staff routinely bring budget amendments to the board every month. “We're continuing to work on opportunities to continue to build and fund and meet the gaps that we have within this community,” the CEO concluded.