Shots - Health News
Tue August 19, 2014
Mental Health Cops Help Reweave Social Safety Net In San Antonio
Originally published on Thu August 21, 2014 12:08 pm
It's almost 4 p.m., and police officers Ernest Stevens and Ned Bandoske have been driving around town in their unmarked black 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," Stevens reads from the blotter. "He's arguing ... and is a danger to himself and others. He's off his medications."
A few minutes later, the SUV pulls up in front of the group home. A thin 24-year-old sits on a wooden bench out back, wearing a black hoodie.
"You're Mason?" asks Bandoske. "What happened to your blanket?" Eight years ago, the next stop for someone like Mason would have been a hospital emergency room or jail. (Because of his condition, NPR is not using Mason's last name.) But the Bexar County jail, in San Antonio, was so overcrowded — largely with people with serious mental illnesses — that the state was getting ready to levy fines.
This sort of situation is not unusual: Across the country, jails hold 10 times as many people with serious mental illness as state hospitals do, according to a recent report from the Treatment Advocacy Center, a national nonprofit that lobbies for better treatment options for people with mental illness.
To deal with the problem, San Antonio and Bexar County have transformed their mental health system into a program considered a model for the rest of the nation. Today, the jails aren't full, and the city and county have 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.
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. He mumbles answers to the officers' 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 say they 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?" Bandoske asks. "You are, aren't you? What are the voices telling you?" Mason is silent, but Bandoske persists. "Hey Mason, you're seeing something that I'm not seeing. What is it?"
These officers seem more like social workers than law enforcers. Stevens says that's a huge change from his early days on the police force.
"We had absolutely no training 20 years ago in the police academy on how to deal with mental health disturbances," recalls Stevens.
Back then, the police were repeatedly arresting the same people; many not only had a serious mental illness but were also addicted to drugs or alcohol, and were often homeless. And whether they went to the jail or the ER, it was expensive for everyone — the jails, the hospitals and the police department that had to pay for overtime while cops waited at the hospital.
San Antonio's response was to require all officers to take a 40-hour course called Crisis Intervention Training, to learn how to handle mental health crises.
But even with strong programs, there's only so much that training alone can do; there's still the problem of where to take patients like Mason.
San Antonio tackled that problem, too.
People who commit a felony still go to jail, regardless of their mental status. And those who need extensive medical care are taken to the hospital.
But for patients like Mason, San Antonio built another option: the Restoration Center, a separate facility with a full array of mental and physical health services.
The center was the brainchild of Leon Evans, director of San Antonio's mental health department.
When he took over the department 14 years ago, Evans says not one of the county or city agencies and nonprofits that deal with mental illness was talking to another. The jails, hospitals, courts, police and mental health department all worked in separate silos.
"People who fund these services only look at their little, small piece of the pie and whether there is a return on investment," says Evans.
So, with the help of a county judge, Evans worked to get the funders together to talk about the money they were all spending on mental health. Once they stopped looking at mental health as an isolated expense, the groups realized they were spending enormous sums of money and offering poor care. Pooling their resources instead, they found, could offer significant savings.
Everyone contributed funding to create the Restoration Center. It offers a 48-hour inpatient psychiatric unit; outpatient services for psychiatric and primary care; centers for drug or alcohol detox; a 90-day recovery program for substance abuse; plus housing for people with mental illnesses, and even job training.
More than 18,000 people pass through the Restoration Center each year, and officials say the coordinated approach has saved the city more than $10 million annually.
When Mason arrives at the center, nurse Catherine Riojas checks him in immediately. She gives Mason a physical and helps him get settled in an inpatient psychiatric unit that keeps patients for 48 hours.
And then, about 15 minutes after the police officers walked through the door of the center, they're heading out again, ready to get back on the street.
"OK, Mason, good luck," Stevens calls to the young man, and waves. "OK, buddy? Hope you feel better."
KELLY MCEVERS, HOST:
In many cities across the U.S., the mentally ill have no safety net. Ten times as many people with serious mental illness are in jail as in state hospitals. But in San Antonio, Texas they're trying to change that. And there've been some interesting results. Eight years ago, the state was going to levy fines because the county jail was so overcrowded largely with people suffering from serious mental illnesses. Today the jails are under capacity and the city has saved $50 million in five years. Reporter Jenny Gold explains that the safety net in San Antonio begins with the police.
JENNY GOLD, BYLINE: Officers Ernest Stevens and Ned Bandoske are part of San Antonio's mental health squad - a six person plainclothes unit that answers the frequent calls where mental illness may be an issue.
ERNEST STEVENS: 2749.
GOLD: They've been in the car since early this morning. They're letting me ride along with them today. And we've already taken several calls. Their shift is almost over when Stevens spots a call for help on their laptop.
STEVENS: 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.
GOLD: You know this guy?
NED BANDOSKE: I know his caseworker. I've dealt with him several times.
GOLD: It's a typical call for Stevens and Bandoske. We head for a group home in a rundown part of town in an unmarked SUV. There we find a young man, Mason, sitting on a wooden bench in an empty concrete yard. He's wearing a black hoodie and his damp bangs hang in curls over his forehead.
STEVENS: You're Mason?
GOLD: They walk over to him casually.
STEVENS: What happened with your blanket?
GOLD: Mason's hunched over. His eyes dart back and forth between the two officers. We're not using his last name because of his condition.
BANDOSKE: Are you hearing some voices right now? You are, aren't you? What are the voices telling you?
GOLD: Most of the time, Mason doesn't answer the officers' questions and tilts his head to stare at a spot in the distance. To me it just looks like Mason is spacing out. But officer Bandoske, who's had special training in handling people with mental illness, says Mason is hallucinating.
BANDOSKE: You're seeing something that I'm not seeing, right? Hey, Mason? You're seeing something that I'm not seeing, aren't you? What are you seeing?
BANDOSKE: You're seeing Jesus and what else? Go ahead, you can tell me.
MASON: My heart hurts.
BANDOSKE: Your heart hurts? Hey, Mason? Mason? Can you concentrate on me for just a second?
GOLD: He spots a dime-sized scab on Mason's face.
BANDOSKE: Hey, Mason, how did you get that burn? Is that a burn mark on your face from a cigarette?
BANDOSKE: What's that from?
MASON: I cut it.
BANDOSKE: With what?
MASON: With my finger.
BANDOSKE: You just picked at it?
BANDOSKE: Do you ever feel like things are crawling on you?
GOLD: As I am watching these officers work, they seem more like social workers than cops. In the past, Stevens says the police would have responded to Mason with the same tough-guy command voice they use with criminals. And they often took people like Mason to jail.
STEVENS: They would be arresting him for just minor misdemeanor offenses such as trespassing or criminal mischief or, you know, basically you're-disturbing-the-peace type calls.
GOLD: Or the police could take them to an emergency room. But the officers might end up waiting in the hospital for 12 hours or more until the person could be triaged. Bandoske says that made the jail seem like a much more appealing option for cops.
BANDOSKE: You can book somebody in the jail within 20, 30, 45 minutes tops, especially if you have a partner to help, you know, share the paperwork load. And then you're back out on the streets.
GOLD: Another problem - they were arresting the same people over and over again - people who not only had a serious mental illness but were often also addicted to drugs and alcohol. Many were homeless. And whether they would to jail or the ER, it was expensive for everyone - the jail that accepted them, the hospital, the police department that had to pay for overtime while cops waited. So the police chief decided to require all cops to take a 40-hour crisis-intervention course to learn how to handle mental health crises the way Officer Stevens is today with Mason.
STEVENS: Mason, we're here to get you some help buddy, OK? You don't want to tell Ned what the voices were telling you?
MASON: They're not my friends.
STEVENS: The voices aren't your friends. Are they telling you bad things to do to yourself?
BANDOSKE: They are. OK. But we don't want you to do anything bad to yourself, OK? We want to help you and we want those voices to stop.
GOLD: And they want to keep people like Mason out of jail and off the streets. But that raised the question where should they take people like Mason? So the city of San Antonio did something new. They created a totally separate facility called the Restoration Center with a 16-bed psychiatric unit. There's also a place where police can drop off people who are intoxicated called a sobering unit. And there's a medical clinic.
BANDOSKE: I'll be honest with you, when it first came out, I was very skeptical.
GOLD: Officer Bandoske.
BANDOSKE: I thought well, this is ridiculous. If somebody is, you know, breaking the law - if they're public intoxication - they should go to jail.
GOLD: People who commit a felony still go to jail regardless of their mental status. And those who need extensive medical care are still taken to the hospital. But for patients like Mason, this gives the officers another option. Back in the courtyard, Bandoske makes a call to the Restoration Center.
BANDOSKE: I'd like to bring you a patient. He's experiencing auditory, visual and tactile hallucinations. He's set his blanket on fire in his room. And he's seeing Jesus.
GOLD: We all get back in the car and head to the center. Thirty minutes later, nurse Catherine Riojas is checking Mason in.
CATHERINE RIOJAS: Can we have your necklaces to lock up? And you can keep your hoodie, but I need the string from the hoodie.
GOLD: Mason seems more settled now as she collects all of his property - cigarettes, jewelry and a folded piece of construction paper with a poem.
RIOJAS: You like to write poetry in your spare time?
MASON: Well, that one -
RIOJAS: What is this?
MASON: - That one was just me being sweet.
RIOJAS: OK. I like this heart you drew. It's a nice one.
MASON: Yeah. Can you give that to my mother?
GOLD: And so just 15 minutes after walking into the center with Mason, Officer Stevens and Bandoske are ready to get back on the street.
BANDOSKE: OK, Mason, good luck. OK, buddy? Hope you feel better.
GOLD: The Restoration Center is saving the police department about $600,000 a year in overtime pay and perhaps more importantly it's keeping people like Mason out of jail. For NPR News, I'm Jenny Gold.
(SOUNDBITE OF MUSIC)
MCEVERS: Jenny Gold's story comes as part of our partnership with Kaiser Health News, a nonprofit news service. And tomorrow we'll spend some time finding out what happens to patients like Mason at the Restoration Center and how San Antonio offers them a chance to heal. Transcript provided by NPR, Copyright NPR.