Hundreds of law enforcement professionals from across the U.S. raised their hands to answer a simple question on Monday:

“How many in this group (have) a story – either personal or (professional) – about confronting somebody with a mental health problem?” National Sheriff’s Association Director Jonathan Thompson asked.

Almost everyone in the ballroom at the Hyatt Regency Hill Country Resort had either a family member or an inmate that was struggling with a mental health issue. For that reason, the Annual Criminal Justice Conference and Training Institute has placed special emphasis on combatting the problem this year, as have medial, reentry, and diversion programs in sheriff’s departments around the country. The five-day conference aimed at finding sustainable solutions to the issue was coordinated by the National Organization of Hispanics in Criminal Justice and the Texas Criminal Justice Association.

“The No. 1 issue facing sheriffs in this country right now is mental health and mental health treatment, bar none,” Thompson said during a panel discussion with local and national law enforcement representatives.

Director of the National Sheriff's Association Jonathan Thompson raises his hand after he asked attendees if they have had to deal with mental illness during some point in their career. Photo by Scott Ball.
National Sheriff’s Association Director Jonathan Thompson raises his hand after asking attendees if they have had to deal with mental illness at some point in their career. Credit: Scott Ball

More than 90% of jails are overseen by sheriffs, and according to reports more than half of the inmates have mental health issues of some kind.

Texas’ 254 counties and thousands more across the U.S. are attempting to tackle the problem head-on by combining federal, state, and local funding, but not all solutions will look the same, he said. “One size doesn’t fit all in mental health. …What’s working here may not work in Wisconsin.”

Bexar County’s pre-trial jail diversion programming, which sends offenders with mental health issues to treatment facilities for counseling and medical care instead of jail, is looked to by sheriff’s departments around the country as a framework on which to base their own.

“I’ve been to 48 states, five foreign countries, and I’ve testified five times before Congress, and Bexar County is known as the gold standard,” said mental health advocate and journalist Pete Earley. “(Bexar County is the) leading county in America when it comes to jail diversion and stopping the inappropriate incarceration of people who have serious illness like schizophrenia and bipolar disorder.”

The County started a crisis center in the early 2000s to connect inmates with mental health services and trained thousands of law enforcement officers and other first responders on how to recognize and de-escalate situations involving psychiatric and emotional issues. The Mental Health Court/Initiative started its work in 2008. The County’s Mental Health Department was established in 2014 and a more robust pre-trail diversion program began in 2015.

“Some of the mental health issue is a high recidivism rate. A lot of times (inmates) are self medicating, they come back to jail, and our jail is becoming a de-facto state hospital and it’s just not right,” Bexar County District Attorney Nico LaHood said. “No. 1, from a moral standpoint, and No. 2, it’s not efficient financially. It’s irresponsible to handle people that way.”

Bexar County District Attorney Nico LaHood gives his experience with personal loss and how he was put down his path to become a District Attorney.
Bexar County District Attorney Nico LaHood explains his personal experience with anger management and mental health. Credit: Scott Ball

Diversion programming has saved the County $50 million over the past five years, Bexar County Sheriff Susan Pamerleau said. A lot of those savings come from incarceration and emergency room avoidance. Instead of spending up to 12 hours waiting for emergency room doctors to treat mental illness episodically, sheriffs can take inmates to a crisis center that specializes in mental health care. Instead of building more jails, the County achieved higher returns by investing in those initiatives as well as rehabilitation, housing, and employment assistance.

That doesn’t mean the problem is solved. Earlier this summer, the Bexar County Adult Detention Center saw four suicides in less than a four-week span. The Bexar County Health Collaborative hosted San Antonio’s first Pathways to Hope conference in August, a community-wide gathering that focuses on changing the conversation about mental illness and providing support and resources for those affected by it.

Closing the final gaps will mean getting creative in terms of outreach and support. Pamerleau suggested increased family involvement, meaning finding out critical information about an inmate before it’s too late.

But what convinces many agencies to adopt diversion programs are the cost savings, Earley said. “I’ve learned that the personal stories can only go so far. The thing that sells is money. If $1 will save $7 down the line, that really resonates.”

Bexar County has received funding from federal, state, and local sources to improve its screening and diversion programs, but Thompson credits Pamerleau specifically for her leadership in bringing all the parties to the table. Pamerleau faces three challengers in the General Election on Nov. 8.

Local faith organizations, parents, teachers, and the sheriffs department need to work together to tackle mental illness and tailor solutions for each region, Thompson said.

“We cannot expect our federal government to solve this for us,” he added. “If you’re looking to Washington to solve this problem, you aren’t looking in the right place.”

Dr. Tony Fabelo, director of reserach for the Council of State Governments, urged participants to reach out to the state and federal legislature for more aggressive funding for programs.

“If we’re going to turn this around,” Fabelo said, “we must fund our treatment and diversion programs on the front end.”

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Iris Dimmick

Senior Reporter Iris Dimmick covers public policy pertaining to social issues, ranging from affordable housing and economic disparity to policing reform and workforce development. Contact her at