Like the enchanting Riverwalk which unites the San Antonio community, surrounding Bexar (pronounced “bear”) County has successfully united its mental health and substance use services for children and adults. This very important work has overcome the chronic problems of service fragmentation and lack of access that plague our public mental health and substance use care systems everywhere.
It also has positioned Bexar County well for National Health Reform. Others continue to take note of these developments. More than 49 states and many foreign countries have visited to observe these successful programs in operation. What has led to this broad level of interest in the programs of the Bexar County Center for Mental Health Services? In my mind, three principal features stand in strong relief:
- A successful criminal justice-behavioral healthcare interface. Through a nationally recognized program of Crisis Intervention Training (CIT), more than 1,000 city and county police officers have been trained in successful diversion strategies for persons with mental illness or substance use conditions. These strategies are used successfully everyday to divert hundreds of persons per month into behavioral healthcare programs. Mental health, substance abuse, and veterans courts are available to support these diversions and to identify additional persons from the incarcerated population who can benefit from effective behavioral healthcare.
- A continuum of mental health and substance use care services that works well as a system. From crisis intervention and detox to longer term residential and ambulatory care, community-based programs are available to address different service needs and support configurations. A person can enter this system by walking in off of the street, by referral from the police or the courts, by referral from another facility or provider, or by referral from Haven for Hope, the local program for homeless persons. Very important to note is the fact that all persons receiving care through these programs have medical assessments, and medical problems are addressed with behavioral healthcare conditions.
- A very sophisticated and creative program for homeless persons. The Haven has novel features to engage homeless persons and to provide employment support and housing so that a person or family can return to a productive life in the community. Of great interest is the Prospects Courtyard, where homeless persons can remain outside, yet have a place to sleep under an overhang to prevent exposure to rain. Once trust is established, consumers can then move inside for food and more suitable short and long-term housing arrangements, while also being assessed for behavioral health and other social service needs.
Why does all of this work so well? Leon Evans, the Bexar County Director of the Center for Mental Health Services, recognized almost 10 years ago that traditional, unconnected mental health and substance use care services were dramatically inadequate to meet the pressing service needs being confronted every day. Persons with serious mental health and substance use conditions were being incarcerated inappropriately, they represented a large segment of the homeless population, and they were filling local emergency rooms each day. A carefully organized system was called for with a continuum of services appropriate for the levels of need of each person being served. Leon organized a Community Medical Director’s Roundtable representing the leadership of key community hospitals, programs, and providers to create the necessary organizational glue to foster the needed care integration and an appropriate service continuum. He cajoled the state of Texas to provide necessary flexibility in funding and organizational arrangements to make the desired changes possible.
The new service arrangements do work very, very well. Consumers are pleased with the services and the outcomes achieved, and providers are enthusiastic about their work. In visiting these programs, I was repeatedly impressed by the commitment of program staff and their dedication to the consumers they are serving.
As an added benefit, Bexar County is very well positioned to implement the Affordable Care Act. Many of the features called for in this Act are already evident in county programs. These include the Medical/Health Home, Accountable Care Organizations, and even a Hospital District health insurance program that is very similar to the planned Medicaid expansion.
Finally, I must note that these integrated services save Bexar County several million dollars each year. Although obvious to all of you, it is worthwhile to note that good care is much less costly than incarceration, and good integrated care is much less costly than fragmented care. Bexar County has the required data; good effectiveness studies must be undertaken to document the successes being observed there every day.
Our hats are off to Leon Evans, a super leader with a heart of gold, to his Communications and Diversion Director, Gilbert Gonzales, and to the entire staff of the Center, who see that this creative system continues to operate extremely well even in these most difficult economic times. This is truly a Riverwalk of behavioral healthcare services for which San Antonio can be proud!