Spotlight: San Antonio’s Mental Health Care a National Model

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Albert Garcia sits alongside the bridge in which he was removed from prior to the cleanup. Garcia, a native San Antonian has been homeless for 7 years. Photo by Scott Ball.

Scott Ball / Rivard Report

Albert Garcia has been homeless for seven years as outreach coordinators and San Antonio Police Officers proceed with a citywide homeless camp cleanup to encourage individuals to seek shelter at Haven for Hope.

Media outlets traditionally offer readers a look back at the top stories and notable passings this time of year. I’d like to focus instead on a San Antonio story that was told elsewhere, a reminder that we don’t always appreciate what we stand for as a city.

In this case, it’s how much we care for some of our most vulnerable and neediest fellow citizens. I have long admired Haven for Hope, University Hospital, the Center for Health Care Services, and all the good people I have met at those institutions over the years.

Rivard Report articles published after the Nov. 8 elections noted that voters unseated 386th Juvenile District County Judge Laura Parker and Sheriff Susan Pamerleau, both synonymous with progressive programs and initiatives to deliver healthcare services to mentally ill adults and juveniles.

Bexar County Sheriff Susan Pamerleau. Photo by Scott Ball.

Scott Ball / Rivard Report

Outgoing Bexar County Sheriff Susan Pamerleau.

Yet many of our readers probably do not appreciate the breadth or depth of our system, or the role Bexar County, the City, the San Antonio Police Department, and others play in forming the safety net of healthcare services delivered to people whose afflictions are psychological.

That will change if you read the final article published Dec. 10 in a seven-part series titled, “The Desperate and the Dead,” by the Boston Globe and its Spotlight Team, best known, perhaps, for the 2003 Pulitzer Prize-winning reports that revealed the systemic cover-up of child abuse at the hands of predatory priests in Boston’s Catholic Church.

This latest series by the Spotlight Team focuses on Massachusetts’ broken mental healthcare system. As reporters delved deeper into the subject and how Boston and the state compared to other cities and states, they landed on San Antonio and Bexar County as a national model.

Given the wealth of the city of Boston, with its world-class universities and medical schools, and its concentration of intellectual capital, it should be a great source of pride to San Antonians to win such recognition.

Anyone who lives here, of course, knows that our city’s needs are many, and our resources are inadequate to meet those needs. Our county jail houses more than 3,700 people, many of whom need treatment rather than incarceration. Like Boston, our city struggles to fill the enormous gaps left by the state’s elected leadership. Child Protective Services remains broken and woefully underfunded. The state has refused to accept $100 billion in federal Medicaid funds over the next decade even as area hospitals spend tens of millions of dollars treating uninsured citizens whose only health care comes in emergency room visits. Politicians play politics and skirt federal law in denying family planning services to women.

And yet we do much with so little in San Antonio. On Christmas Day, that seems like a far more important gift to our city’s families than anything to be found under a Christmas tree.

The expansive, 5,500 word story was reported by five Globe reporters – Scott Helman, Maria Cramer, Jenna Russell, Michael Rezendes, and Todd Wallack – and was written by Helman. It’s worth your time to read the entire article, which begins, “San Antonio became a national leader in mental health care by working together as a community.”

That’s a familiar refrain to the 172,000 people who work in the health care, medical, and bioscience sector of our local economy. I have heard such praise echoed as frequently as two weeks ago at a BioMedSA meeting. San Antonians work together because we cannot afford the alternative. Bigger, richer cities can afford silos. San Antonio needs everyone pulling in the same direction to compete.

So this particular Bexar County story, one that puts us on a national map and deserves to be promoted locally with much greater investment and understanding, is no longer an untold story. Yet few in San Antonio can comprehend what we have accomplished together because too few stories are published locally about our public healthcare workers, programs, and institutions. That’s the fault of the local media, where crime news and “man bites dog” stories get more attention than the real news. Public health issues are woefully undercovered locally. There are no public health reporters at the San Antonio Express-News, other print publications, or at any of the broadcast outlets.

That will change early next year when the Rivard Report hires a full-time public health reporter, thanks to funding from Methodist Healthcare Ministries and the Baptist Health Foundation. We will search nationally for a skilled reporter with a passion for public health. It was a community-wide need we identified early in our first year as a nonprofit, and with generous local foundation support, our efforts will soon bear fruit.

Those who do read the entire Boston Globe story will learn about many of the individuals who have helped build what is now a nationally-recognized model.

“…the vanguard lies here in San Antonio, an oasis of creativity and dedication in a state not known for progressive social policy,” the article states.

There are philanthropists like Bill Greehey, the visionary who first imagined Haven for Hope and spent millions of his own dollars helping make it a reality, his giving often complemented by fellow philanthropist Harvey Najim, both men models for how highly successful business leaders can invest philanthropically to initiate transformative change in public policy and delivery of services.

Haven for Hope founder Bill Greehey speaks with a member of the homless population during the annual point in time search in January of 2016.

Scott Ball / Rivard Report

Haven for Hope Founder Bill Greehey speaks with a member of the homeless population during the annual point in time count in January of 2016.

There are the progressive policing policies of San Antonio Police Chief William McManus and his seven-person mental health unit. There was the decisions in 2001 by newly-appointed Bexar County Judge Nelson Wolff to support the transformation of county services and create what is now known as the Center for Health Care Services.

The story can’t be told without including Dr. Roberto Jimenez, a prominent psychiatrist who recruited Leon Evans to help rebuild the county’s broken mental healthcare system 16 years ago. Jimenez himself is the product of a Boston medical school and its hospitals and healthcare system before he returned home as a major change agent. Evans is a legend in his field and deserves to be better known at home.

One last person I will include here, knowing the many names I am leaving out, is Judge Oscar Kazen, who for 10 years directed the county’s Involuntary Outpatient Commitment program, which sent patients in need of mental health counseling and treatment into mandated programs. These patients are among those most in need and least willing to accept treatment.

Kazen, a Democrat, was summarily fired without explanation this past summer. The news came via an email sent by Probate Court No. 1 Judge Kelly Cross, a  Republican who then elevated a colleague and fellow Republican to replace Kazen. It was politics at its worst to the detriment of a system that otherwise is attracting national accolades.

I can’t wait for the day when the Rivard Report has its own dedicated reporter bringing these people and their stories to life for our readers. Our healthcare system is winning national attention and it is driving our economy and smart job growth.

Until then, thanks to the Boston Globe and its Spotlight Team.

3 thoughts on “Spotlight: San Antonio’s Mental Health Care a National Model

  1. I stayed at the Nix hospital downtown and was appalled with the treatment of patients. A Patient dug into a trash can to find food and was told, “If you get sick, don’t blame us.” Didn’t offer him a snack. Restrooms not cleaned for days. Patients made fun of by the staff. Staff falling asleep in patients rooms. They cleaned an area with a bedspread and left it on the ground for the patients to pick up. Medications are not handed out in a timely manner. Awful.

  2. I didn’t know Judge Kazen was fired. I was in my mental health student nursing rotation just 1 year ago and had an opportunity to see Judge Kazen in action. He blew our whole group away with his knowledge and insight into mental health issues and the the various options in helping to determine which was the best course of action to help mental ill people. Mental health isn’t my forte or most favorite subject, but I look forward to when you hire a full time public health reporter.

  3. Gilbert Gonzales and Leon Evans are heroes. The effort to change the way law enforcement and emergency responders approach people struggling with mental illness hardens back more than a decade, forged by a passionate advocacy and intelligent public health. Working with the others you mentioned, Gonzales and Evans have ushered in a humane, effective 21st century paradigm in mental health treatment for the most severely affected.

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