The Southwest Texas Regional Advisory Council (STRAC) is improving how people in crisis in Bexar County receive services through a collaborative dedicated to mental health crisis response.
STRAC established the Southwest Texas Crisis Collaborative (STCC) after research conducted in 2016 indicated the need to develop services for the highest users of emergency rooms, jails, crisis, and inpatient services.
Led by Eric Epley, a tenured emergency management professional with decades of public safety response experience, the collaborative uses data to drive decision making and collaboration.
Analyses by the Meadows Mental Health Policy Institute and Bexar County drove the development of the STCC. The analyses uncovered a need for an integrated crisis system of care and called for funding to alleviate the burden on hospitals that were receiving people on emergency detentions. Analyses also showed the need for providing a safety net for people cycling between emergency rooms, jails, and crisis and inpatient services.
Methodist Healthcare Ministries provided the seed money to start the STCC and agreed to give $5 million per year for programming. But there was one catch: local hospitals were required to make a $5 million match. Once again, data validated the need for an integrated crisis system and showed value to hospital stakeholders. After the hospitals agreed to finance the project, the collaborative formed an organized health care arrangement allowing it and hospitals to participate in a joint initiative and share information.
Innovation
Today, there are many programs under the STCC that demonstrate the spirit of innovation in Bexar County’s emergency mental health response efforts.
Law Enforcement Navigation Programs
When a medical emergency happens, someone calls 911 and emergency response is dispatched to the scene. Depending on a person’s condition, they may be transported to a nearby hospital for additional care. If the hospital doesn’t have capacity in its emergency room, EMS personnel will direct people to another hospital.
Epley proposed the same process for mental health crisis. Without knowing the availability of a psychiatric bed for people under emergency detention orders, officers didn’t know which hospital could accept a person in crisis.
That is why the STCC adopted MEDCOM, an existing centralized communication and coordination hub for helicopter air traffic. MEDCOM is added to emergency calls for service on the police dispatch system when there is a mental health component. If the dispatcher confirms an emergency detention is needed, MEDCOM helps the police officer decide where to take the person in crisis when they don’t require medical attention.
After implementing coordination with MEDCOM, hospitals that serve Bexar County residents saved $3 million annually on ambulance costs alone. This approach also saved time for law enforcement who directly drop off a patient for psychiatric care and return to the field without waiting for medical clearance. Local judges now refer to MEDCOM for mental health warrant placements rather than assigning a specific hospital which may or may not have the capacity to serve a mental health patient.
Response Programs
Many STRAC analyses have focused on high utilizers of the community’s behavioral health and homeless services. The Program for Intensive Care Coordination (PICC) addresses the needs of these people within Bexar County.
PICC provides intensive case management to people who have had six or more emergency detention orders in one year. Service providers use universal release of information forms to allow for information sharing between organizations to identify and target a reduction of emergency detentions. In a study reviewing the program, nearly $4.5 million of cost efficiencies were provided back to the health care system because of the decreased use of emergency services by the target population.
The Specialized Multi-Disciplinary Alternative Response Team (SMART) is another STRAC program focused on responding to mental health-related 911 calls in Bexar County. This mental health co-responder program offers follow-up and first response by a team comprised of a licensed mental health professional, peer support specialist, qualified mental health law enforcement officer, and a paramedic.
Support Programs
Another initiative of the STCC is expanding the Psychiatric Emergency Services unit, an emergency room for psychiatric emergencies. The unit allows for promptly transferring a patient from an emergency room to a Psychiatric Emergency Services bed with access to a psychiatrist. These transfers are facilitated by MEDCOM. Previously, people would spend hours and potentially days waiting in emergency rooms before being transferred into inpatient psychiatric care.
For more information on Southwest Texas Crisis Collaborative programs, visit strac.org/stcc.
Additional Resources
Bexar County Mental Health Systems Assessment. Meadows Mental Health Policy Institute and Methodist Healthcare Ministries, 2016.
Case Study: Improving Outcomes through Coordinated Health and Justice Systems. National Association of Counties Familiar Faces Initiative, 2022.
Texas Regional Advisory Councils History and Overview. Department of State Health Services, 2008.
National Guidelines for Behavioral Health Crisis Care. Substance Abuse and Mental Health Services Administration, 2020.
In the News
Coordinated response to mental health emergencies ‘saves time, money, and lives’. San Antonio Report, 2018.
The Southwest Texas Crisis Collaborative is having a positive impact on our community. Methodist Healthcare Ministries News, 2019.