Where the Police Are Part of Mental-Health Care

In San Antonio, law enforcement, courts, and medical clinics are working together to treat, rather than jail, people with psychological problems.

It’s almost 4 p.m., and officers Ernest Stevens and Ned Bandoske have been driving around town in their black unmarked SUV 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. This article uses 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?”

Bandoske, left, and Stevens are part of the San
Antonio Police Department's mental-health squad. 
(Jenny Gold/KHN)

Finally, Mason responds. “I’m seeing Jesus.”

“Jesus and what else? It’s OK, you can tell me.”

“My heart hurts,” says Mason.

Mason acknowledges that, yes, he’s hearing voices. And, yes, they’re telling him to do bad things to himself. Officer Bandoske also spots a dime-size scab on Mason’s face. “Hey Mason, is that on your face from a cigarette? What’s it from?”

“I cut it,” says Mason. “With my finger.”

“Do you ever feel like something is crawling on you?” asks Bandoske. The answer is yes—a sign of tactile hallucinations.

These officers seem more like social workers. Stevens says that’s a huge change from his early days on the police force.

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Jenny Gold writes for Kaiser Health News. Her work has also appeared on NPR and in the Washington Post.

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