Mental Health Care Before It Becomes a Crisis

Central Health’s behavioral health director on why getting help early changes the outcome

In September, Central Health’s fiscal year 2027 tax rate and $650 million dollar budget was approved by the Travis County Commissioners Court, dedicating $127.5 million for mental health crisis and recovery care.

Central Health’s commitment to mental health care comes at a critical time when Travis County has no dedicated psychiatric emergency department. More than $54 million in new funding will support $33.1 million toward construction of an inpatient psychiatric emergency wing, the construction of a $16 million-dollar mental health crisis center, and $4.5 million for a host of crisis and recovery treatments.

And yet, even before that massive milestone, Central Health has been laying the groundwork for expanded mental health care access for Travis County residents. We sat down with Dr. Ashley Trust, Central Health’s director of behavioral health, to learn more about how the Central Health system is taking care of patients.

Let’s start with an easy question: Can you explain to me what mental health care is?

Dr. Ashley Trust: Mental health care is really about brain health and wellness. Our brain controls so much of what our body does—our movement, breathing, heart rate, memory, and how we process the world around us. That same brain plays a huge role in our emotions, our behaviors, and how we respond to stress, how we sleep, and how we function day-to-day. Mental health care helps when something in those areas isn’t working the way we want it or need it to. That could mean treating depression, anxiety, and trauma. It can also mean helping someone through a particular difficult time in their life.

That makes perfect sense. Mental health care can have an effect on everything we do. So, how important is it for us to make sure we’re taking care of it?

Dr. Ashley Trust: It’s important to care for our mental health because it affects everything else: our physical health, relationships, work, parenting, sleep, and ability to function day-to-day. We sometimes talk about mental and physical health as though they’re separate, but they’re deeply connected. We would never tell someone to ignore their diabetes or heart disease and just hope for it to get better. Mental health deserves that same attention. Getting help early can also help keep manageable things from becoming a crisis.

And yet, we sometimes forget to manage those very things. Does that mean mental health sometimes gets overlooked?

Dr. Ashley Trust: There’s stigma around saying ‘I’m struggling’ or ‘I need help.’ People may minimize symptoms for a long time because they think they should be able to handle it themselves, and sometimes our health care system contributes to that because we’ve historically treated behavioral health separately from physical health. Asking about someone’s mental health should feel just as routine as asking about their blood pressure.

OK, so say we’re at the point where we need some intervention. What role does a psychiatrist play for a patient who needs care?

Dr. Ashley Trust: We play different but very complementary roles. A counselor or therapist often helps someone understand what they are experiencing, developing coping skills, processing difficult experiences, and learning about change patterns that may be making life harder. A psychiatrist is a physician, so we look at both the medical and psychiatric pieces: diagnosis, medications, physical conditions that may be contributing like sleep, stress, and other factors. We are trying to understand what is happening in this person’s life, and what they need to get better. The best care is often collaborative: psychiatry, therapy, primary care, medical specialty, family, and community resources all working together.

If we’re talking about direct impact, what are ways a psychiatrist can impart change for a patient going through a difficult period in their life?

Dr. Ashley Trust: Sometimes, the first thing we provide is simply a place where someone can say, ‘This is what’s happening to me,’ and feel heard about their circumstances without judgement. We can help put language around what they are experiencing and help them understand that there are treatment options. Therapy can give someone tools to cope differently, think differently, communicate differently, or work through trauma or grief. Medication, when appropriate, can reduce symptoms enough that someone can sleep, function, work, parent, or engage in therapy again. We can also help identify practical barriers such as housing, food, safety, medical problems, family stress, and connect people with resources. Often it isn’t one dramatic intervention; it’s a series of small changes that eventually makes a very big difference.

Small steps are so important. Is there an average timeline of care when it comes to managing mental health? How long does it take to navigate a health crisis?

Dr. Ashley Trust: We make accurate diagnosis and try to understand the whole picture, rather than treating one symptom. We look at medical conditions, or medications that could be affecting someone’s mental health. We also determine when management isn’t needed or medication management isn’t the right answer. Assessing safety when someone is expressing suicidal thoughts or another mental health crisis is another important part of our work. We also connect patients to therapy, substance use treatment, higher levels of care, community services, or other specialties. We work to coordinate with primary care and other medical providers, and we continue to. We adjust the plans over time, because people’s needs change, and we understand that.

At the end of the journey, how should we look at progress? When should we begin to measure success?

Dr. Ashley Trust: Mental health is rarely a quick fix. Some people may feel significantly better after a relatively short period of treatment. For others, it may take months or even years. We may need to try different approaches, medications, or types of therapy before finding what works best for that individual. Recovery isn’t always a straight line. People can improve, have setbacks, and improve again. It’s important for patients to know that a setback doesn’t mean a treatment failed. My goal is to stay alongside them and keep adjusting the care as their life and needs change.

If you or someone you know needs help, call our community mental health crisis hotline at 512-472-4357.