Four numbers
If you read nothing else on this page.
1,242
Deputy hours spent in FY2025 driving people in crisis out of Starr County — about sixty percent of a full-time deputy position, spent on transport.
134,372
Transport miles across three years. The average psychiatric round trip is 98 miles, because there is no psychiatric bed on this side of it.
734
Behavioral health emergency department encounters a year, annualized from the most recent six months. Two a day, in a hospital with no psychiatric bed to admit them to.
$582k–$942k
Estimated annual cost to the County and its hospital district of having no local crisis capacity — and it buys no treatment at all.
Every figure on this page is sourced, and every estimate states its assumptions. Where the underlying data does not reconcile, we say so — see what we're unsure of.
I. What the records show
Three agencies, three separate systems, one direction.
The hospital's emergency department records. The Sheriff's transport logs and jail bookings. The federal shortage designations. None of it was contested. It had simply never been put next to itself.
Figure 1 · Emergency department
More and more people leave in a vehicle instead of going home.
Of 1,094 behavioral health encounters across three reporting periods, the share leaving in police custody or on a transfer out of the county rose in every single period — from 28.3% to 37.9%. Both lines move the same direction every time. That consistency is the finding; the totals are just the size of it.
See this figure as a table
| Fiscal year | Encounters | Insured | Uninsured | Home | To law enf. | Psych transfer | AMA / eloped |
|---|---|---|---|---|---|---|---|
| 2023–2024 | 487 | 329 | 158 | 326 | 58 | 80 | 23 |
| 2024–2025 | 240 | 171 | 69 | 143 | 32 | 41 | 24 |
| 2025–Apr 2026 (6 mo.) | 367 | 251 | 116 | 213 | 64 | 75 | 15 |
| Total | 1,094 | 751 | 343 | 682 | 154 | 196 | 62 |
Source: Starr County Memorial Hospital, provided to Starr County Behavioral Health Center — the full record is here. Percentages calculated by SCBHC from the encounter counts shown. Roughly a third of all encounters were uninsured. Annualized from the most recent six months, that is about 734 behavioral health encounters a year — two a day — in a hospital with no psychiatric bed to admit them to.
Figure 2 · Sheriff's Office
Transport time has more than tripled in three years.
This is the cleanest trend in the entire dataset, and it moves in only one direction. Measured against a full-time position of 2,080 hours a year, the FY2025 figure is about sixty percent of a deputy — spent driving, not patrolling.
See this figure as a table
| Measure | FY2023 | FY2024 | FY2025 | Total |
|---|---|---|---|---|
| Mental health evaluations | 135 | 265 | 316 | 716 |
| Emergency detentions | 47 | 121 | 33 | 201 |
| Deputy hours on transports | 380 | 997 | 1,242 | 2,619 |
| Transport miles | 16,964 | 75,896 | 41,512 | 134,372 |
| Jail bookings, mental health a factor | 343 | 219 | 259 | 821 |
| Inmates flagged | 278 | 185 | 205 | 668 |
| Average length of stay (days) | 89 | 58 | 71 | — |
| Inmates on psychotropic medication | 259 | 171 | 187 | 617 |
| Suicide watches / behavioral crisis incidents | 28 | 185 | 55 | 268 |
Source: Starr County Sheriff's Office, provided to Starr County Behavioral Health Center — the full record is here. Percentages calculated by SCBHC against a 2,080-hour full-time year. Note that the FY2024 mileage figure does not reconcile with the FY2024 hours figure — see what we're unsure of.
Figure 3 · Distance
134,372 miles is five and a half times around the Earth.
Across three years, the Sheriff's Office drove residents this far to reach psychiatric beds that do not exist here. The average round trip is 98 miles. Every one of those miles is a deputy off patrol and a person in crisis carried further from home, their family, and their language.
Source: Starr County Sheriff's Office (transport miles and hours). Earth's equatorial circumference, 24,901 miles, is a standard geodetic constant; the comparison is ours.
Figure 4 · Detention
The jail is already operating as a behavioral health facility.
It was not built for it, is not staffed for it, and is not paid for it. These are four separate three-year measures, not stages of one funnel — a person can appear in more than one.
Source: Starr County Sheriff's Office, FY2023–FY2025 combined. The FY2024 suicide-watch count equals the FY2024 flagged-inmate count exactly, which is very likely a transcription error in one of the two fields — see what we're unsure of.
Figure 5 · Federal designation
The shortage is not our characterization. It is measured, by the federal government.
HRSA scores Health Professional Shortage Areas from 0 to 25; a higher score means a greater shortage. Starr County carries three designations at once.
Mental Health
MHCA 6, Border Region (Jim Hogg, Starr, Webb, Zapata). High Needs Geographic. 18.21 full-time-equivalent clinicians short.
HPSA ID 7482490230
Primary Care
Starr County. High Needs Geographic. 16.01 FTE short.
HPSA ID 1487553424
Dental Health
Starr County. High Needs Geographic. 7.38 FTE short.
HPSA ID 6482510358
Source: HRSA HPSA Find, data.hrsa.gov. Note that the mental health designation covers four counties together, not Starr County alone. HRSA revises shortage scores periodically; the score published on The Need carries its own verification date.
II. What the current arrangement costs
Converting those records into dollars — with the assumptions in the open.
The estimates below are ours, not the agencies'. Every input is printed so any reader can substitute their own figures and recalculate. Move the scenario and watch what changes: the honest answer is a range, not a number.
Figure 6 · Interactive
What one year of having nowhere to go costs.
- Deputy time $33/hour fully loaded
- Vehicle operation $0.65/mile
- Jail housing $22.58/day
- Average length of stay 71 days
- Uninsured ED encounters 232/year
See all three scenarios as a table
| Scenario | Transport | Jail housing | Uncompensated ED | Annual total |
|---|---|---|---|---|
| Conservative | $67,969 | $328,652 | $185,600 | $582,221 |
| Midpoint | $67,969 | $415,224 | $278,400 | $761,592 |
| Higher | $108,955 | $415,224 | $417,600 | $941,778 |
Calculated by SCBHC from Sheriff's Office and hospital figures. A fully loaded deputy cost of $33/hour corresponds to roughly a $48,000 base salary plus benefits; $0.65/mile is below the current federal standard mileage rate. Whether psychiatric transports require one officer or two should be confirmed with the Sheriff's Office — it materially changes the total.
These are estimates, not findings
The jail figures multiply bookings by the reported average length of stay, which assumes every such booking stayed the average. They exclude psychotropic medication for 617 inmates, medical and mental health screening, and the staffing cost of 268 suicide watches — all of which the County also bears and none of which is counted here. Treat this as an order of magnitude, well over a million dollars across three years, rather than as precise cost accounting.
What the hospital has not yet provided
The hospital gave us volume and payer mix, but not cost. The emergency department column above is a sensitivity range — $800, $1,200, or $1,800 per behavioral health encounter — pending actual figures from the District. At 232 uninsured encounters a year that range spans $185,600 to $417,600. We would rather show you the range than pick a number.
III. What it costs if nothing changes
The snapshot is not the problem. The slope is.
Deputy transport hours have more than tripled in three years, and the share of hospital patients leaving in custody or on a transport has risen in every period. Zero percent growth is included below as a deliberately unrealistic floor, because every measured trend in this dataset is rising.
Figure 7 · Interactive
Cumulative public spending, at three growth assumptions.
The scenario you chose above carries through here. Drag the year to see what this region will have spent by then — on transport and detention, having purchased no treatment capacity with any of it.
Over 10 years, growing 5% a year, this region spends about $9,579,000 on transport and detention — and buys no treatment capacity with it.
See the projection as a table
| Scenario | Flat (0%) | 5% growth | 10% growth |
|---|---|---|---|
| Conservative — five years | $2,911,000 | $3,217,000 | $3,555,000 |
| Midpoint — five years | $3,808,000 | $4,208,000 | $4,650,000 |
| Higher — five years | $4,709,000 | $5,204,000 | $5,750,000 |
| Midpoint — ten years | $7,616,000 | $9,579,000 | $12,138,000 |
| Higher — ten years | $9,418,000 | $11,846,000 | $15,010,000 |
Calculated by SCBHC. Year one is spent at today's rate; each later year grows by the selected rate. The arithmetic runs in your browser from the scenario totals above — the same formula that produced the printed table in the stakeholder letter.
Between now and 2036, on midpoint assumptions and modest growth, this region will spend somewhere between seven and twelve million dollars transporting and detaining people in psychiatric crisis — and will have purchased no treatment capacity whatsoever with it.
IV. What the alternative costs
A Phase 1 program costs less than half of what the gap costs.
Outpatient and crisis foundation services with law enforcement drop-off, staffed on the licensed-clinician plus QMHP-CS plus peer-support model that makes rural crisis services affordable. Here is the indicative operating cost — and, immediately after it, the reason you should not read it as savings.
Indicative Phase 1 operating cost
| Component | Annual |
|---|---|
| Personnel — Executive Director, one to two QMHP-CS, peer support specialist, bilingual intake coordinator | $165,000–$215,000 |
| Employer payroll taxes and benefits (~22%) | $36,300–$47,300 |
| Occupancy, insurance, administration, contracted bookkeeping and billing | ~25% of the above |
| Indicative Phase 1 total | $252,000–$328,000 |
Be careful with this comparison — it is not a claim of savings
A crisis center does not eliminate transport and detention costs. It reduces them, by an amount that depends on the diversion rate actually achieved. That is an ambitious target for a first year and we will not promise it.
What the comparison does establish is the order of magnitude: this region is already spending more than twice a Phase 1 budget on an arrangement that produces no treatment.
Figure 8 · Interactive
How much would a Center have to divert to cover its own cost?
Drag the diversion rate. The bar on top is the public cost avoided at that rate; the bar below it is what Phase 1 costs to run at the high end of its range. Where they meet is break-even in avoided public expenditure alone — before a single dollar of Medicaid or commercial reimbursement.
At 25% diversion, a Phase 1 program avoids $190,398 of public cost — $137,477 short of the $327,875 it costs to run. It would have to reach 43% to cover itself on avoided public expenditure alone.
Calculated by SCBHC in your browser: avoided cost is the selected scenario's annual total multiplied by the diversion rate; Phase 1 cost is the high end of the indicative range, $327,875. This deliberately ignores Medicaid and commercial reimbursement, which is the actual operating foundation — see how it sustains itself.
The unit economics — the numbers that scale
A city or county deciding whether to sign a drop-off agreement is not evaluating a regional total. It is asking what it gets back per event.
$1,603 per jail booking avoided
71-day average length of stay at $22.58 a day, housing only. Diverting 10% of 259 annual bookings is 26 bookings and about $41,522 a year; 25% is 65 bookings and about $103,806.
3.5 deputy hours returned to patrol
Per event, converting a four-hour out-of-county transport into a thirty-minute local handoff. Diverting 25% of 734 annual emergency department encounters is worth roughly $146,800 to $220,200 a year at $800 to $1,200 per encounter.
At $1,603 per avoided booking and 3.5 deputy hours returned per avoided transport, the arithmetic works at small volumes. That is the basis on which a jurisdiction can justify paying for access — not charity, but the recovery of officer hours and bed-days it is already spending.
V. Why Rio Grande City
A point on U.S. 83 where several jurisdictions without capacity converge.
Rio Grande City is the county seat of the most populous county in this mental health catchment area outside Webb County.
Figure 9 · Geography
Who is near, and how near.
Diagram is schematic — it shows relationships and approximate road distances, not a surveyed map. County population from the U.S. Census Bureau.
Verify before claiming a regional footprint
Actual drive times from each jurisdiction to Rio Grande City have to be measured against drive times to the facilities those agencies use today. If the comparison does not favor Rio Grande City for a given community, that community should not appear in a service-area claim — and we will remove it.
Note also that western Hidalgo County falls under a different Local Mental Health Authority than Starr, Zapata, Webb, and Jim Hogg. Serving those residents is a coordination question to be worked out with both authorities, not something to be assumed.
VI. How it sustains itself
Grants start organizations. They do not keep them open.
The question every serious partner asks is what happens in year four, and it deserves a direct answer. Open each pathway for our honest assessment of it — including where it is weak.
Foundation Medicaid and commercial reimbursement
This is the foundation, and it follows the patient regardless of county of origin. It requires credentialing, licensure, and a payer mix that supports operations.
Where it's weak: roughly a third of hospital behavioral health encounters are uninsured. That constrains this line, and it is exactly why reimbursement cannot stand alone.
Contract County services contracts
A county may purchase defined services for a public purpose. A proposed scope of work is under discussion with Starr County, and the same structure is available to other counties.
To be precise: under discussion is not agreed. Nothing has been signed, and no county has committed any money.
Statute Hospital district partnership
Section 1076.110 of the Starr County Hospital District's enabling act permits the board to contract for facilities and services. Section 1076.113 permits the District to create and sponsor a nonprofit corporation and to solicit money for it.
To be precise: citing what the law permits is not a statement that the District, its board, or any official has agreed to anything. The statutory detail has its own page, with a link to the chapter itself so you can check us.
Interlocal Law enforcement access agreements
Interlocal agreements for drop-off, with an access fee or per-encounter rate justified by the officer hours and bed-days recovered.
Where it's weak: this is realistic with larger jurisdictions. Small municipalities have limited budgets and may contribute more as commitment and data than as revenue. We would rather say that now than discover it later.
Allocated Opioid settlement funds
Counties, municipalities, and hospital districts hold direct allocations restricted to opioid remediation. Crisis stabilization and diversion for people with opioid use disorder are abatement uses.
Why this one matters: the money is already allocated. It is not a competitive grant round.
Bridge Grants and philanthropy
Startup and capacity funding — a bridge to operating revenue, never the operating model. Any plan that puts grants in the year-four column is a plan that closes in year four.
VII. Where this data is not yet reliable
We would rather correct these ourselves than have a reviewer find them.
Every discrepancy we have found in our own dataset is listed here, and each is being reconciled with the agency that produced it. We expect to find more. If you find one first, we want to hear about it.
Reconciling FY2024 miles do not reconcile with FY2024 hours
75,896 miles in 997 hours implies a sustained average of 76 miles per hour. The comparable figures are 45 mph in FY2023 and 33 mph in FY2025. One of the two FY2024 fields is very likely wrong.
Reconciling Mileage does not reconcile with emergency detentions in any year
At a 98-mile average round trip, the reported mileage implies roughly 173, 774, and 424 transports against 47, 121, and 33 reported emergency detentions.
The likely explanation is that most transports are not emergency detentions, which is entirely plausible — but it should be stated explicitly rather than left for a reviewer to work out.
Reconciling Emergency detentions swing from 47 to 121 to 33
That is not a credible reflection of community need over three years. The counting method most likely changed, and we need to know when and how before this figure can carry any weight.
Likely error FY2024 suicide watches equal FY2024 flagged inmates exactly
Both are 185. Two independent measures landing on the identical number is very likely a transcription error in one of the two fields.
Reconciling The FY2024–2025 hospital encounter count
240 encounters sits between the 487 of the prior year and an annualized 734 for the current period. The same question applies: did the counting method change?
Open question The two agencies' fiscal years may not align
Start and end dates need to be confirmed before the two datasets are presented side by side. Until then, treat cross-agency comparisons in this briefing as indicative.
Data still outstanding
These agencies hold records that would materially sharpen this picture. The public record of the requests we have actually sent, with their dates, is on The Need.
| Agency | Jurisdiction |
|---|---|
| Rio Grande City Police Department | Starr County — county seat |
| Roma Police Department | Starr County — western end |
| Sullivan City Police Department | Hidalgo County — Starr County line |
| Peñitas Police Department | Hidalgo County — Starr County line |
| Zapata County Sheriff's Office | Zapata County — same catchment area |
| County of Starr — county records | Commitment proceedings, indigent care |
| Juvenile probation | Starr County — youth diversion |
| Rio Grande City Grulla ISD | Starr County — student behavioral health |
| Border Region Behavioral Health Center | Local Mental Health Authority for the four-county area |
Listing an agency here means only that its records would strengthen this analysis. It is not a partnership, not an endorsement, and says nothing about whether that agency supports, has joined, or funds the Center.
On the Local Mental Health Authority: Border Region Behavioral Health Center serves this four-county catchment area. Our purpose is to add capacity that does not exist in Starr County today — not to duplicate or displace services the Authority already provides.
VIII. Where things stand
Without inflation, in two columns.
Real
- A Texas nonprofit corporation, formed July 14, 2026.
- A Resolution of Support adopted by the Starr County Commissioners' Court on July 27, 2026 — a statement of support that appropriates nothing, and says so on its face.
- An independent Board of Directors.
- Adopted governance documents.
- The data in this briefing.
Not real
- No facility.
- No funding.
- No staff.
- Not a 501(c)(3): we have not applied for federal tax-exempt status, and no application is pending with the IRS. We plan to apply once the Center is serving patients.
- No signed agreement with any agency.
- No grant writer.
IX. What we are asking
Five things, none of which commits you to anything.
Data
De-identified, aggregate counts of what your agency already absorbs. No individual records, no names, no case numbers.
Cost figures
Specifically from the Hospital District: emergency department boarding hours, sitter and staffing requirements, and reimbursement collected against cost. We will do the analysis at no charge and provide the work product regardless of what it shows.
A letter of support
Nearly free to provide, and it materially strengthens state and federal applications. We can send a template.
Design input
Operating hours, intake criteria, acceptance and exclusion criteria, handoff time. A facility designed without input from the people who would use it at two in the morning is a facility that sits empty.
A conversation about a future agreement
Interlocal drop-off arrangements, services contracts, or partnership structures — none binding today, all worth scoping early.
Where to send it
Start on the partners page, or write to the team directly. We answer everything.
What we are not claiming
- We do not claim these figures are final. Section VII lists every discrepancy we have found, and we expect to find more.
- We do not claim a crisis center eliminates these costs. It reduces them by an amount that depends on diversion rates we cannot yet promise.
- We do not claim the County is a partner or funder. It adopted a resolution of support, which appropriates nothing and says so on its face.
- We do not claim a signed agreement with any agency.
- We do not claim a psychiatric hospital is straightforward. Physician recruitment in a designated shortage area, state licensure, and federal Medicaid payment rules for larger psychiatric facilities are real constraints any honest plan must address.
The one thing we do claim
That money is being spent today. It buys transport and detention. It buys no treatment at all.
On any set of assumptions a reasonable person would accept, this region is already spending more than half a million dollars a year — and probably closer to a million — on the consequences of having nowhere to send a person in crisis.
We would welcome the chance to walk through any of this with you, and to be corrected wherever we are wrong.
Prepared by
Johnny Gonzalez, MBA
Co-Founder & Organizer, Starr County Behavioral Health Center USA, RetiredAshley Gonzalez, M.A., LPC
Executive Director, Starr County Behavioral Health Center Doctoral Candidate in Psychology, Walden University Rio Grande City, TexasSources: emergency department data provided by Starr County Memorial Hospital; law enforcement and detention data provided by the Starr County Sheriff's Office; shortage designations from HRSA HPSA Find at data.hrsa.gov; statutory citations from Chapter 1076, Texas Special District Local Laws Code. All percentages, totals, annualized projections, cost estimates, and forward projections are calculated by Starr County Behavioral Health Center, Inc. from the underlying figures and are indicative rather than audited. Assumptions are stated wherever an estimate appears. This briefing is informational and is not legal, financial, medical, or accounting advice. It is not a crisis service — if you need help now, here is help right now.