San Antonio, Texas: Addressing Mental Health Crises with a Specialized Mental Health Detail Embedded in the Police Department San Antonio, Texas: ADDRESSING MENTAL HEALTH CRISES WITH A SPECIALIZED MENTAL HEALTH DETAIL EMBEDDED IN THE POLICE DEPARTMENT OVERVIEW other cities considering similar cross-systems approaches. San Antonio, Texas is the second-most populous city in Texas and home to nearly 1.5 million individuals, representing approximately PROGRAM DESCRIPTION five percent of the state’s population.1,2 SAPD Mental Health Detail Nineteen percent of individuals in San Originally a team of two officers who received Antonio live below the federal poverty level.3 training through a crisis intervention team Statewide, Texas’ overdose death rate is 10.5 (CIT) program, the MHD has subsequently per 100,000 population.4 expanded to include ten officers, two In response to an increasing number of detectives, and several social service and emergency behavioral health calls, the health care providers contracted to the city San Antonio Police Department (SAPD) by Baptist Healthcare System. All members of developed the Mental Health Detail (MHD).5 the MHD receive CIT training which teaches Launched in 2008, the SAPD MHD responds members of the detail to effectively respond to calls related to mental health issues, to calls from people experiencing a mental deescalates mental health emergencies, and health crisis, de-escalate mental health connects individuals living with mental illness emergencies, and coordinate treatment with to appropriate care. local behavioral health providers. In addition, local community behavioral health providers San Antonio has developed a number are brought in to educate the detail about of innovative programs that target the serious mental illness. Within the greater challenges of SUD, homelessness, and mental police department, 96 percent of officers are health issues. This case study focuses on CIT trained, and all cadets receive CIT training the MHD and presents key takeaways for in the police academy. NATIONAL LEAGUE OF CITIES 1 San Antonio, Texas: Addressing Mental Health Crises with a Specialized Mental Health Detail Embedded in the Police Department The MHD’s work typically begins when 911 untreated or unmanaged mental illness. If the dispatchers send patrol officers to respond to Group confirms an individual making a threat calls. All dispatchers take a 16-hour telephonic is suffering from mental illness, the individual CIT course to help identify and recognize an undergoes threat mitigation where he or individual with a mental health related issue. she is connected to treatment within CCSI When a call comes into 911, patrol officers are and his or her weapons may be confiscated. initially dispatched. If a situation appears to Clinicians lead treatment, however the Group/ involve an individual experiencing a mental CCSI continues to monitor progress of the health crisis, the responding officer will hand individual and follows up with him or her off the case to the MHD. MHD responders consistently for 90 days. Individuals who are arrive in plain clothes and unmarked cars, treatment compliant for 90 days can receive assess the individual, and transport the additional follow-ups quarterly, biannually, or individual to an appropriate facility. Once an annually. individual has been transported to a facility, MHD officers will stay with the individual for Rather than solely part of the justice system, as long as necessary to ensure that they are members of the MHD see themselves as part connected to treatment. of a comprehensive behavioral health care system, partnering with neighboring hospitals, Over the course of the MHD’s work, team psychiatric facilities and other community members recognized a need for enhanced support systems to meet the needs of case management and follow-up for high- individuals in crisis. need individuals. In January 2018, the MHD launched the chronic crisis stabilization initiative (CCSI), which helps remove RESULTS barriers to treatment for individuals who The SAPD found that over the course of have been detained on an emergency one year, the police department had nearly basis three or more times in a month. MHD 700 contacts with 43 individuals with high officers participate in the discharge process, utilization rates of police services (i.e. multiple and escort newly released individuals to 911 calls for police services; three or more pharmacies to ensure that they receive any emergency detentions in a one-month time prescribed medications. The MHD officers period; or use of violence, threats of violence also follow up for 90 days to confirm that the or weapons at the time of police encounter). clinicians are in contact with the individuals Within one year of implementing CCSI, police and are addressing housing, employment, contacts decreased by approximately 68 and other issues that may negatively impact percent. Further, more than half of the 43 mental health. individuals identified as high utilizers had no police contact in the final quarter of 2018, Finally, the MHD runs a Threat Assessment including one individual with substance use Group (the Group). The Group began in March disorder who, in the previous quarter, had 86 2018 and investigates threats of violence police encounters. made by individuals, some of whom may have mental illness. Detectives investigate violent The Group has completed 160 threat threats, assessing whether the individual investigations since its inception in March making them has the means to carry them out 2018. MHD officers have found that and explore whether the individual may have emergency detainment and admission to a NATIONAL LEAGUE OF CITIES 2 San Antonio, Texas: Addressing Mental Health Crises with a Specialized Mental Health Detail Embedded in the Police Department hospital for individuals experiencing mental Integrated Mobile Partners Action illness who may pose a danger to themselves Care Team (IMPACT) is preferable to admission to jail. Individuals IMPACT is a cross-systems partnership may be in and out of jail in a matter of between the SAPD MHD, the San Antonio Fire weeks and lost to follow-up but connecting Department/Mobile Integrated Healthcare individuals to treatment enables the Group to Team, and local behavioral health and monitor treatment for 90 days or longer. social service providers. The program uses multi-agency teams to offer individuals FINANCING AND experiencing homelessness medical treatment SUSTAINABILITY or navigation through the city’s social services network. This initiative removes barriers to The MHD is funded through local taxes that treatment by ensuring that case management are allocated by the San Antonio City Council. is available from emergency response to The size of the unit is determined by the chief crisis stabilization to treatment. Upon coming of police and is based on the city’s population into contact with the team, individuals and overall police force size. Additionally, San experiencing homelessness who are willing to Antonio’s Department of Human Services accept help are transported and connected awarded a contract to cover the costs to social services and health care treatment.6 associated with three clinicians from Baptist Of the 3,030 contacts the IMPACT program Healthcare System to staff the MHD. Funding made from October 2015 through February is provided every one to two years based on 2018, over half were referred to behavioral the city council’s legislative calendar. At its health or social services providers. inception, the police chief requested that the unit be funded as a budget line item separate The South Alamo Regional Alliance and apart from general police funding – this for the Homeless (SARAH) has allowed the unit flexibility in hiring non- SAPD (or MHD) works closely with the South police counseling staff and contributes to its Alamo Regional Alliance for the Homeless sustainability. (SARAH) across San Antonio and Bexar The SAPD MHD also receives indirect research Counties to support individuals experiencing support from the Meadows Mental Health homelessness. As the local Continuum of Care Policy Institute, which provides independent, Lead Agency, SARAH is charged with creating data-driven and policy and program guidance an improved social services system that to improve mental health services in Texas. effectively provides support, coordination, and housing to homeless populations in this area. COLLABORATION ACROSS SYSTEMS Center for Health Care Services The city of San Antonio has invested (CHCS) significantly in initiatives and organizations CHCS provides integrated care to children that assist people experiencing homelessness, and adults with mental health conditions, SUD, and/or mental illness. The SAPD substance use challenges and intellectual or MHD collaborates with a number of public developmental disabilities in and around the and private agencies, ensuring integrated, 19 offices it operates throughout San Antonio. responsive care. Examples include: CHCS is a key referral site for the MHD. The NATIONAL LEAGUE OF CITIES 3 San Antonio, Texas: Addressing Mental Health Crises with a Specialized Mental Health Detail Embedded in the Police Department organization offers a wide range of programs This is not only because these individuals to assist people who are experiencing may be resistant to such treatment, but homelessness, including outreach, residential also because the system creates a number shelter, mental health and SUD treatment, of barriers to accessing