For four years, a team of paramedics, clinicians and mental health officers have been responding to mental health crisis calls around Bexar County – keeping people out of jail and emergency rooms and instead getting them the help they need.
But the team had a problem. It didn’t work from 10 p.m. and 5 a.m., so if a mental health call came in overnight, regular sheriff patrol units had to respond. It wasn’t ideal, so this fall, the service added another shift and is now available 24 hours a day, 7 days a week.
“The decision to do that was really because there were calls being missed,” said Kellie Burnam said. the director for the committee at the Southwest Texas Crisis Collaborative, the team in charge of planning crisis and emergency medical response in the region.
She said expanded staffing means better crisis response.
The county’s Specialized Multidisciplinary Alternate Response Team, called SMART, is a collaboration between the sheriff’s department and several mental and physical wellness organizations. The SMART team was developed in 2020 to address a gap in the county’s mental health resources.
According to Burnam, the goal of expanding staffing overnight was for the team to respond to as many mental health calls as possible, freeing up patrol units to respond to other types of calls in the community.
Emily Kidd, the Texas medical director at Acadian Ambulance Service, said diverting people with mental illness from emergency rooms and jails is the main goal of the SMART program.
“They meet people where they are, assess what their needs are and what’s causing them to have manifestations of a mental health crisis,” Kidd said.
The need for an alternative response was highlighted by the death of Damian Daniels in August 2020. Daniels, an Army veteran, was shot and killed by a Bexar County sheriff’s deputy who was dispatched to his home during a mental health call.
Greg Hansch, the executive director of National Alliance on Mental Illness of Texas, said interactions between law enforcement and persons with mental illnesses can escalate quickly due to lack of experience and training for different types of mental health conditions.
“We’ve seen, too many, far too many examples of dramatically negative consequences resulting from law enforcement officers being there on the scene kind of quarterbacking a response to a mental health crisis,” Hansch said.
Rather than taking someone straight to an emergency room or jail cell during a mental health crisis, the SMART team focuses on getting people what they need, whether that’s connecting them to mental health providers, taking them to an appointment or scheduling a follow-up with SMART team members.
Utilizing a co-responder model, a certified mental health officer, paramedic, and clinician from the Center for Health Care Services, are dispatched to the scene. To aid in de-escalation, the teams arrive in two unmarked vehicles, everyone dressed in polos. Mental health officers don’t display weapons or badges, something Burnam said adds to a “softer,” more approachable look.
“Their goal is to respond to 911 mental health calls and use the least restrictive approach to effectively treat a patient,” Burnam said.
The SMART team responds to calls outside of the San Antonio city limits, from Fair Oaks Ranch to Lytle. Some of these areas are in more rural parts of the county, making access to preventative treatment limited.
Texas ranks last when it comes to access to mental health care in the U.S., according to Mental Health America, a national nonprofit dedicated to the promotion of mental health, wellbeing and illness prevention.
Across the state of Texas, a shortage of licensed mental health workers has led to a lack of access to preventative care and long waits for treatment. Cost, distance to treatment and stigma all contribute to a person’s ability to seek preventative care. Due to these factors, intervention and treatment often don’t happen until individuals are already in a crisis, leaving law enforcement officers to respond to mental health crisis situations, according to the Treatment Advocacy Center.
When stressing the need for alternative response programs like SMART, Hansch said that in addition to ensuring the safety of those with mental illnesses and peace officers, addressing disproportionate rates of incarceration is vital. Jail diversion is especially important in Texas, where people with mental illnesses are more likely to be jailed than sent to a treatment facility. Experts agree that investing in mental health care rather than allowing people to enter the criminal justice system is a better solution.
Not only is jail an ineffective placement for those experiencing a mental health crisis, it’s also expensive. A 2019 Treatment Advocacy Center report found that an average of 10% of law enforcement agencies’ total budgets was used to respond to and transport those with mental illnesses.
By state law, all peace officers must complete 40 hours of mental health training, but certified mental health officers receive at least 24 hours of additional de-escalation training provided by the Texas Commission on Law Enforcement. As of July, there were 271 certified mental health officers in Bexar County, making up 6.6% of peace officers in the county.
While Hansch said that mental health officers are integral to a city’s mental health resources, he said they’re only part of an effective response.
“Co-responder models are kind of the gold standard in responding to mental health crisis situations because you have the different capabilities, tools and skillsets,” Hansch said.
While each component of the team is important, Burnam also emphasized the role of law enforcement officers in crisis response.
“In the state of Texas, if you need to perform an emergency detention, only law enforcement officers can do that,” Burnam said.
However, many SMART calls end with all parties co-operating. Burnam said that sometimes people who are struggling with a mental health issue will call for help getting connected to services or asking for a ride to an inpatient facility.
Kidd said the lack of accessibility to care and scarce mental health resources are some of the main barriers to people getting help in Bexar County.
“A lot of times, people just don’t even know how to get plugged into the system and get help,” Kidd said.
The SMART collaborative was always aware of the need for an overnight response team, Burnam said, and while they had the resources to expand, staffing proved a major barrier.
“We’ve known that, from the beginning, a mental health crisis can happen at any time of day, any day of the week.”
In October, training new hires from all three agencies allowed them to make SMART teams available 24/7.
“Whether it’s 3 a.m. or 3 p.m., you’re going to receive the exact same response,” Burnam said.
For more information, visit the SMART website. If you or someone you know is struggling with mental health or thoughts of suicide, call 988 or text TALK to 741-741.
If you are experiencing a crisis, call (210) 223-7233 to reach the Center for Healthcare Service’s mental health and substance use crisis helpline.
Oli De Los Santos recently graduated with a journalism degree from Texas State University and is a contributor to Texas Community Health News, a collaboration between the School of Journalism and Mass Communication. and the university’s Translational Health Research Center. She grew up in and around San Antonio and strives to eventually become a journalist in the city. TCHN stories, reports and data visualizations are provided free to Texas newsrooms.
