The Grassroots Law Project holds a protest to pursue justice in the killing of combat veteran Damian Daniels outside of Paul Elizondo Tower. Credit: Bonnie Arbittier / San Antonio Report

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Daniel Prude. Angelo Quinto. Hannah Westall. Damian Daniels. Far too often, we are confronted with the names of the many people who have died at the hands of police because of an inadequate and fatal response to a mental health crisis and deep racial inequities in our justice system.

A staggering number of people experience tragedy and violence after calling the police for help with a mental health emergency. Those with mental illness are 16 times more likely to be killed during police encounters, with one in four deaths at the hands of police involving a mental health emergency. These interactions, which disproportionately impact Black, brown, and indigenous communities, create deeper inequalities in our health care and response systems.

As San Antonio and other cities and counties across the country continue to address the disproportional and harmful impacts of law enforcement responses, we have an obligation to respond to these crises with dignity and care. That means ensuring that trained peers and health professionals are first responders, with police and other law enforcement rarely required, and reserved for the uncommon instances where there is a clear and imminent safety risk.

At each level of government, leaders can disrupt this tragic pattern of violence toward people with mental illness, which is disproportionately harmful to Black people and other people of color, by allocating resources to support a health-first emergency response program that keeps everyone safe. 

This means acknowledging that the presence of armed officers often exacerbates the problem for those experiencing a mental health emergency, and paving the way for a multidisciplinary response to mental health emergencies that truly protects those with mental illness in San Antonio and across the country.

There is already growing recognition by the public and law enforcement of the misalignment of police-based interventions for people needing emergency mental health care. Police are being asked to do jobs they were never intended to do –responding to people who have mental health concerns or who are homeless. 

As the president and CEO of Fountain House, and a public health professional and mental health advocate working closely with people living with serious mental illness, I’ve seen firsthand the kinds of mental health emergencies that can elicit a wide range of traumatic emotions, paranoia, and other triggering reactions. We recognize the need for terminology and an approach that goes beyond law enforcement, one we like to call “care response.” 

Fountain House, based in New York City, pioneered a model of mental health recovery that supports the dignity, rights and choices of those living with serious mental illness. Our proven model has inspired 200 replications around the country, including the San Antonio Clubhouse. As part of our national policy and advocacy work, we are working closely with the San Antonio Clubhouse, and clubhouse affiliates throughout the country to advocate for and implement a community-led care response model. And we know that this works thanks to programs like the Crisis Assistance Helping Out on the Street (CAHOOTS) initiative in Eugene, Oregon. 

Police backup was requested in only 1% of the calls CAHOOTS responded to in 2020. In 2019, CAHOOTS helped save the city an estimated $14 million in ambulance and emergency room treatment costs, along with $8.5 million in public safety costs. This model has proven so effective that U.S. Senators Ron Wyden of Oregon and Catherine Cortez Masto of Nevada introduced the CAHOOTS Act in Congress, underscoring their interest in providing states and communities the funding required to take a health-first approach to re-imagining policing.

The City of Denver has also been among those leading on care response. A team from the City and nonprofits traveled to Eugene to learn more about the CAHOOTS program, and utilized this model to craft their own community response program, called Support Team Assisted Response (STAR). Prior to the development of STAR, mental health calls to Denver 911 were routed one of two ways: the criminal justice system or the hospital system. STAR created a third path that puts the needs of the person experiencing a mental health crisis first and redirects them away from a costly emergency department visit, jail, or worse. During the first six months of implementation, STAR responded to 748 mental health-related incidents, and none required police involvement. The program demonstrates how cities throughout the country are working to develop their own care response models that address this critical issue facing communities.

The City of San Antonio has already demonstrated leadership and support for innovation around public safety, particularly for compassionate emergency response, and is similarly positioned to learn from the CAHOOTS model to develop its own care response program. Last month, San Antonio was selected by What Works Cities (WWC) and White Bird Clinic to participate in a collaborative online learning opportunity led by practitioners of the CAHOOTS program on improving response models to behavioral health, addiction, poverty, and homelessness related public safety calls. The program, called Compassionate Emergency Response: Exploring Innovative Local Approaches to Public Safety, has brought together a small cohort of cities and stakeholders committed to advancing toward mobile crisis programs in their communities.

Staff from the San Antonio Clubhouse, the Mayor’s Office, and Council Districts 1, 4, and 7 are representing the City of San Antonio in this initiative. The Fountain House team presented to the group about the care response model, and our policy report From Harm to Health, advocating for centering racial equity and lived experience in developing a care response.

Additionally, we have seen how the people of San Antonio, on a bipartisan level, overwhelmingly support this model and approach to mental health crises. In recent polling, 64% of likely voters in the city support the use of non-police responders to mental health-related crises. And 71% of likely voters support community-based programs to prevent violence. 

This is an opportunity for San Antonio to be part of a vanguard that not only centers and collaborates with people living with serious mental illness, but grasps the urgent opportunity to invest in solutions that communities can tailor and customize to best respond to their needs. We must smash the stigma around serious mental illness and completely reimagine a mental health system that first addresses the intersectional systemic issues that disproportionately impact people living with serious mental illness.

It’s past time for San Antonio and other cities to invest funding and enact policies that create and implement health-first emergency response programs that limit law enforcement’s role in crisis response. As those of us in the clubhouse movement know, we must turn to people with lived experience as resources and leaders in this effort and harness the nationwide desire for change to create cities, counties, and countries where people are guaranteed safety and dignity. Anything less means more needless tragedies in the future.

Ashwin Vasan

Ashwin Vasan, MD, Ph.D., is the president and CEO of Fountain House, a national nonprofit fighting to improve health, increase opportunity and end social and economic isolation for people with serious...