Did San Antonio choose the right combination in its response to mental health calls?

SAN ANTONIO – From a fire to a fall, we have been trained to dial 911 whenever trouble arises. But is 911 the right number to call during a mental health crisis?

“It’s evolving,” The Center for Health Care Services President and Chief Executive Officer Jelynne LeBlanc Jamison said. “We need to be positioned to meet them where they are and respond appropriately with all of the tools that we have.”

Right now, when dialing 911 in San Antonio, a caller is met with three options: police, fire and EMS.

Mental health advocates said those three options might not be enough.

“There’s room for growth,” Ernest Stevens, the deputy division director at the Council State Governments Justice Center, said.

Cities have created crisis intervention teams to better respond to these mental health cases like San Antonio did with SA CORE.

These are typically multidisciplinary programs comprised of law enforcement and health officials to bring the best resources to someone in need, but each program can look different from city to city.

There are two program models cities tend to choose from: a co-responder team or a community-civilian response team.

“They both have a very similar mission, but they also are different in the way that they are comprised,” Stevens said.

The Co-Responder Model

When SA CORE responds to a mental health call, the team comes in a trio.

Each unit has a San Antonio Police Department Mental Health officer, a San Antonio Fire Department paramedic and a Center for Health Care Services crisis response clinician.

SA CORE is considered a co-responder program because the team has a police officer working with a mental health official.

The benefits of the system are:

• Ensuring a secure scene with a police officer
• Making mental health services more accessible
• Improving public safety with direct resources

“They have great outcomes,” Stevens said. “They all have (an) attachment to case management.”

Having a law enforcement officer on the team also allows this unit to make an emergency detention, if needed.

At the same time, having a police officer in the program can be viewed as a point of criticism.

“Sometimes an officer showing up can be a barrier to communication, to building rapport and trying to really connect a person with empathy,” Stevens said.

The Community-Civilian Response Model

The main difference between a co-responder and a community response team is the law enforcement officer. In the community-civilian response model, staffing is more focused on behavioral clinicians and health professionals.

If a situation escalates, these teams would then call law enforcement.

The benefits of this system are:

• Reduced costs without needing a law enforcement officer on staff
• Improved access to mental health treatment
• Culturally-responsive interventions

“It is cheaper,” Stevens said. “They provide an excellent service, and they mitigate a lot of the calls that come into 911.”

The City of Denver has a program called STAR that replicates this model.

Which model did San Antonio choose?

“I don’t want to pick a winner or loser,” Jamison said. “We need an all-of-the-above strategy.”

There is no one-size-fits-all solution to this type of crisis response. Mental health advocates agree it’s up to each city to listen to its community to find the best-fitting program.

San Antonio city leaders chose the co-responder model for SA CORE when it launched in 2022. San Antonio Mayor Ron Nirenberg said it was a decision that came down to safety.

“We’re in Texas,” Nirenberg said. “There are many situations, like domestic violence situations and mental health crises, where a responder might walk in, and it becomes a very dangerous and volatile environment. Let’s do what we know will work — according to the experts in the room — but also let’s do some common sense.”

San Antonio Police Department Chief William McManus said he agreed.

“Our concern was safety for everybody,” McManus said. “We didn’t want to send people to a call where there could be violent behavior and possibly stand a chance that they might get hurt.”

Retiring SAPD assistant chief Karen Falks suggested that just because SA CORE is a co-responder team now doesn’t mean the city couldn’t add a community response unit in the future.

“We would have to really figure it out —and make sure that it’s safe — but I do think that there is a possibility that that could come to fruition,” Falks said.

As the city prioritizes programs like SA CORE, mental health advocates like Doug Beach of NAMI (National Alliance on Mental Illness) Greater San Antonio, said no model should be left unexplored.

“We can do a much better job in our community with coverage and answering calls,” Beach said. “What we need to do is learn along the way of how to make a better response and how to better utilize our resources.”

For mental health resources, click here.

“Crisis in Question: Measuring Mental Health in South Texas” will begin airing on Monday, Nov. 11 on The Nightbeat with a new episode each night at 10 p.m., culminating on Friday, Nov. 15 at 10 p.m. All episodes can be seen on KSAT, KSAT+, KSAT’s YouTube channel, and KSAT.com.

If you or someone you know is struggling with mental health or thoughts of suicide, call 988 or text TALK to 741-741.

You can also reach out to the American Foundation for Suicide Prevention (AFSP) or the National Alliance of Mental Illness (NAMI) at 210-223-7233 (SAFE) or 800-316-9241. You can also text NAMI to 741-741.

More Crisis in Question: Measuring Mental Health in South Texas coverage on KSAT:

• Introducing KSAT’s ‘Crisis in Question: Measuring San Antonio’s Mental Health Solution’ series