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San Antonio police have radical approach to mental illness: Treat It

San Antonio and Bexar County have completely overhauled their mental health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years.
BY JENNY GOLD, Kaiser Health News Staff Writer Published: August 24, 2014

It’s almost 4 p.m., and officers Ernest Stevens and Ned Bandoske have been driving around town in their black, unmarked sport-utility vehicle since early this morning. The officers are part of San Antonio’s mental health squad – a six-person unit that answers the frequent emergency calls where mental illness may be an issue.

The officers spot a call for help on their laptop from a group home across town.

“A male individual put a blanket on fire this morning, he’s arguing with them, and is a danger to himself and others, he’s off his medications,” Stevens reads from the blotter.

A few minutes later, the SUV pulls up in front of the group home in a run-down part of the city. A thin 24-year-old sits on a wooden bench in a concrete lot out back, wearing a black hoodie. His bangs hang in damp curls over his forehead.

“You’re Mason?” asks Bandoske. “What happened to your blanket?” Eight years ago, a person like Mason would have been heading to the emergency room or jail next. But the jail in Bexar County, Texas, where San Antonio is located, was so overcrowded – largely with people with serious mental illnesses – that the state was getting ready to levy fines.

To deal with the problem, San Antonio and Bexar County have completely overhauled their mental health system into a program considered a model for the rest of the nation. Today, the jails are under capacity, and the city has saved $50 million over the past five years.

The effort has focused on an idea called “smart justice” – basically, diverting people with serious mental illness out of jail and into treatment instead. It is possible because all the players in the system that deal with mental illness — the police, the county jail, mental health department, criminal courts, hospitals and homeless programs — pooled their resources to take better care of people with mental illness.

In San Antonio and cities across the country, police officers often serve as de-facto mental health workers. When a family confronts an emergency with a loved one in a state of psychosis, they usually dial 9-1-1, and the police respond. Sometimes the resulting confrontations can have disastrous results, such as a case last year in North Carolina, where police shot and killed a teenager in his home after the family called for help during a schizophrenic episode.

More often, the person ends up in jail. Across the country, jails hold 10 times as many people with serious mental illnesses as state hospitals, according to a recent report from The Treatment Advocacy Center, a national nonprofit that lobbies for treatment options for people with mental illness.

San Antonio’s new approach starts with the kind of interaction Bandoske and Stevens are having with Mason. The troubled young man is hunched over, and his eyes dart back and forth between the two officers.

Kaiser Health News is using only his first name because he was in the middle of a mental-health crisis. He mumbles answers to their questions, sometimes stopping to stare at a spot in the distance. For outsiders, it’s hard to know what’s going on, but the officers can tell Mason is hallucinating. Bandoske kneels in front of him, trying to maintain eye contact and get Mason’s attention.

“Are you hearing some voices right now? You are, aren’t you? What are the voices telling you?” he asks. Mason is silent, but Bandoske persists. “Hey Mason, you’re seeing something that I’m not seeing. What is it?”

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Did you know?

Oklahoma has one of the highest rates of mental illness in the nation.

Although the state has the second highest rate of adults with serious mental illness in the U.S., Oklahoma spends among the least per capita on mental health.

This article highlights a community’s comprehensive efforts to help their residents struggling with mental illness, something leaders say Oklahoma hasn’t quite reached.

“Here in Oklahoma, while we had and have partial pieces of what that program has done and represents in San Antonio, we still lack in both metropolitan areas the needed integration, coordination, thinking and planning that is required to do something as innovative as what they’ve done there in that community,” said Mike Brose, executive director of Mental Health Association Oklahoma.

Join the conversation

If you would like to be a part of the conversation, join the Facebook group Oklahoma’s Addiction and Mental Health Community at The group was created and is moderated by The Oklahoman’s staff.


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