San Antonio lacks services for people needing behavioral health treatment and medication before they experience a mental health crisis, an analysis of the city’s mental health system found.

That gap in services can result in potentially unnecessary trips to local emergency rooms and a lack of continuity of care.

Edward Gonzales, assistant director of the City of San Antonio’s Human Services department, told a City Council committee Monday that an analysis of 25 mental health services studies found that the “primary way that people who are suffering from mental illness access services [is] during a crisis.”

The analysis, completed with consulting firm Ladder Logik, recommended six ways for San Antonio to address the behavioral health of some of its most vulnerable residents. They include expanding services that focus on crisis prevention and increasing coordination efforts with the Southwest Texas Crisis Collaborative, which focuses on identifying people who often use emergency rooms to get treatment.

“We need to make a pre-crisis clinic a reality, so we have to identify existing funds to see how we can fund this moving forward,” Gonzales told the five-member Community Health and Equity Committee, which requested the analysis. “As of now, we don’t have an idea as to how much it would cost, so we will continue to work with the consultants to determine that.”

From January to June 2019, the consultants reviewed reports from local behavioral health services to determine what could be done at the City or County level to address the problem and how a newly created City/County work group on mental health should direct its efforts. 

Gonzales said pre-crisis treatment would likely come in the form of outpatient treatment programs for medication management and the creation of behavioral health urgent care centers dispersed throughout the city so that people won’t need to go to hospital emergency rooms. 

As City and County officials look at potential funding sources for program creation and expansion, Gonzales said they will do so while keeping in mind “that the majority of people without private-pay insurance likely don’t have means to pay for public transportation.” 

San Antonio needs an expansion of services for adults and children with serious mental illness, substance use disorders, autism spectrum disorders, and people with intellectual developmental disabilities, Gonzales said. He noted that most of the people needing behavioral and mental health treatment and cannot afford it are likely in need of other low-income assistance programs.

“There are not enough services for the number of people who need them, and there are a number of unfunded people without health insurance who strain the system, and we have to explore ways to address that,” Gonzales said.

Councilwoman Adriana Rocha-Garcia (D4) said that expanding housing options for those needing long-term mental health services and increasing the number of inpatient treatment centers for drug and substance abuse will help reduce the influx of emergency room visits by people seeking treatment. 

The City will work with Ladder Logik to determine how much a preventive behavioral health network would cost.

“We still have a lot of work to do,” Gonzales said. “But we understand the importance of having a continuity of care for people with mental illness that extends past stabilization. We need to connect these people to services and keep them connected. And that’s what we will be working on creating going forward.”

Roseanna Garza reports on health and bioscience for the San Antonio Report.