San Antonio’s Major Rethink On Handling Mental Health

San Antonio (courtesy Wikimedia Commons)
San Antonio (courtesy Wikimedia Commons)

As most of us know, even with Obamacare there’s still a gaping hole in our health care system–mental health. But San Antonio may have put together a model for how to patch it. Social workers, health care professionals and the criminal justice system have pooled their resources to make sure mentally ill people in the nation’s seventh largest city can get the treatment they need. Kaiser Health News’ Jenny Gold spent a few days in San Antonio to see how this reconfigured system worked. The result was a two-part story that aired on NPR’s Morning Edition; part 1 aired on Tuesday and part 2 aired on Wednesday.

This effort is the brainchild of Lee Evans, the director of the community mental health system for San Antonio and surrounding Bexar County since 2001. It began more or less out of necessity. In 2006, the state was threatening to impose stiff fines on Bexar County because its jail was badly overcrowded. It turned out that part of the problem was that a significant number of people in the jail had serious mental illnesses.

Evans quickly discovered that part of the problem was that while the police, courts, jails, hospitals and mental health department were dealing with the same people, they weren’t talking with each other. With some effort, he managed to get the various agencies to sit and talk about how much they were spending on mental health. He then asked Gilbert Gonzalez to crunch the numbers. The results? Between them, the various agencies dealing with mental health were spending massive sums of money–and for the most part, people were just cycling through the system. Evans and Gonzalez convinced the police, courts, jails, hospitals and the mental health department to pool their resources so they could build a system that helps the mentally ill get better. The results speak for themselves–San Antonio and Bexar County have saved $50 million over the last five years.

The centerpiece of the system is the Restoration Center, located across the street from the city’s main homeless shelter. Besides inpatient care and drug treatment, it provides primary medical care and psychiatric services, job training, and a host of other programs. More than 18,000 people utilize its services each year. One of the many people applauding the Restoration Center is Laura Usher, a program manager at the National Alliance on Mental Illness. Usher, who helps mental health departments and law enforcement pool their efforts in ways similar to how San Antonio has done, says that Evans and his colleagues realize that “most people have overlapping needs,” and can benefit from the integrated services the Restoration Center provides.

The police play a very important role in this new system. Evans has long believed that nonviolent offenders with mental illnesses don’t belong in jail. Not only do they make bad find it hard to follow the rules, he says, but they take up spaces that could be used for violent offenders. And yet, rather than spend 12 hours or more waiting in the emergency room, until 2006 most officers found it easier to book them into the jail. Now all San Antonio police officers must take a 40-hour course on how to handle people with mental health problems. The department also formed a dedicated six-man mental health squad that answers emergency calls where mental illness may be an issue. Gold followed two of the squad’s members, Ned Banoske and Ernest Stevens, on a call about “Mason,” a man in a group home who had set his blanket ablaze and was arguing with workers. Eight years ago, Mason would have been on his way to jail. However, Banoske and Stevens quickly realized Mason was hallucinating. They made a call to the Restoration Center, and within half an hour, he was being checked in.

One of the program’s success stories is Samuel Lott. He was downsized out of his job with Burlington Northern Santa Fe in 2006, and soon lost his home as well. For the next four years, he lived on the streets and had numerous stays in jail. He’d long suffered from depression, but quickly began spiraling into psychosis fueled by alcoholism. During that time, he also caught hepatitis. Part of the problem, he said, was that he found it hard to get treatment. He had to go to one side of town to get a referral, and to another in order to have any prospect of getting help. He found his way to the Restoration Center in 2010, where he was cured of his hepatitis and alcoholism and received medication for his depression. He now works at the Restoration Center helping others make the same turnaround he did–one that still moves him to tears four years later.

It should surprise no one that delegates from every other state have come to San Antonio to see if they can implement something similar. If more states do take this approach, it can only be a good thing–for everyone.

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Darrell Lucus.jpg Darrell Lucus is a radical-lefty Jesus-lover who has been blogging for change for a decade. Follow him on Twitter @DarrellLucus or connect with him on Facebook.

Darrell is a 30-something graduate of the University of North Carolina who considers himself a journalist of the old school. An attempt to turn him into a member of the religious right in college only succeeded in turning him into the religious right's worst nightmare--a charismatic Christian who is an unapologetic liberal. His desire to stand up for those who have been scared into silence only increased when he survived an abusive three-year marriage. You may know him on Daily Kos as Christian Dem in NC. Follow him on Twitter @DarrellLucus or connect with him on Facebook. Click here to buy Darrell a Mello Yello.