Since the last death by suicide in October 2022 — one of an unprecedented eight deaths in under two years — the San Antonio Police Department hasn’t reported any current or former officers taking their lives.
Initiatives launched over the past two years appear to be working.
While proving a negative is often a futile endeavor, investments in mental health resources and staff over the past two years have improved access and removed barriers for police and other first responders seeking this care, police officials and mental health experts told the San Antonio Report in recent interviews.
Prior to 2022, suicide wasn’t talked about much in the department, explained Sgt. Tina Baron, who oversees SAPD’s new Wellness Unit, formed in 2023 in response to the spate of suicides.
“In law enforcement, you just didn’t say the word ‘suicide,'” Baron said. “But we were at a point in that time when it was imperative that we would say the word.”
The total number of SAPD suicides spiked in 2022, while national totals flattened out after a 2019 spike — meaning SAPD was an outlier that year. “We had never been through anything like that,” she said.
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Before that, the last reported SAPD suicide was in 2016.
The Wellness Unit provides comprehensive support for police officers’ mental, physical and financial wellbeing. Over the past two years, more first responders — including firefighters and paramedics — are getting mental health training to support their peers and the list of providers who specialize in first responder mental health treatment is slowly growing.
This year, the 100 Club of San Antonio, which offers financial and social support for first responders and their families, will receive a total of $80,000 in grants from the City of San Antonio and Bexar County to cover the out-of-pocket costs of therapy and counseling. The funds include a $50,000 federal Law Enforcement Mental Health and Wellness Act grant and $30,000 of the county’s federal coronavirus relief funds.
The 100 Club of SA has a list of several mental health providers and clinics it has vetted and recommends to first responders, said Bartholomew “Bart” Vasquez, a retired SAPD sergeant who now leads the nonprofit. It has referred hundreds of officers in recent years to places like Battling Minds, Salient Clinical Services, My Choice Counseling and Wellness, Warriors Heart, and the San Antonio Counseling and Behavioral Center.
First responders have specific mental health needs, including specialized treatment and therapies for the dangerous and traumatic work they do, Vasquez said.
“They see things that they can never unsee and they’re gonna have to see them again, and again, and again,” he said. “We know that it has an impact on them and their families.”
And the two biggest barriers are confidentiality and cost. “Hopefully we’re removing most of those barriers and the first responders are willing to go get the treatment.”
Ultimately, these efforts benefit the entire community, he said.
“If I have to call 911, I want the best physically fit officer, the best mentally well officer responding to my emergency,” Vasquez said. “Because I want them concentrating 100% on whatever emergency I have that I’m calling about.”
Wellness unit
After the suicides that spanned from February 2021 to October 2022, clinicians and first responders started looking for ways to double down on prevention measures. Two examples of the result are SAPD’s Wellness Unit and UT Health San Antonio’s expansion into therapies tailor-made for first responders.
“We had so many pieces of great programs, but all these programs were very siloed,” Baron said of SAPD. “We weren’t necessarily pulling in the same direction.”
The Wellness Unit was established to combine and expand existing psychiatric, financial, family, peer support, chaplain and physical fitness services into a centralized unit for all things wellness, Baron said.
This unit is called in after critical, traumatic incidents happen on the force, but is active year-round.
“Having that ability to have those different layers and different access [points for] just having a conversation makes a huge impact if we’re all pulling in that same direction,” she said. “I have seven wellness officers, and that’s all they do. They don’t do anything else. They just take care of other officers.”
And that investment helps address the stigma associated with asking for help.
The goal is to get officers to add mental health conversations to their regular routine so it doesn’t feel alien when they need to reach out, Baron said. “We want to normalize the fact that we’re here and that we’re available to have a conversation with you and move forward from there.”
And judging from how busy the Wellness Unit and psychologists are, it’s starting to normalize, said Dr. Brandi Burque, one of three staff psychologists within SAPD.
Across the country, we’ve done “such a good job of reducing stigma that there now is not enough psychologists to address the mental health need,” Burque said. “I see that in general for law enforcement as well.”
The staff psychologist position at the Bexar County Sheriff’s Office has been vacant for several months after the previous doctor found a better-paying job, Deputy Johnny Garcia said.
It’s been difficult to attract a psychologist who has the “special skill set” required to care for law enforcement, he said.
With this position vacant, the department leaned heavily on its own peer support network when recently graduated deputy Meredith Portillo, 20, was killed in a vehicle crash in July. Her classmates from the academy were given time off together and connected to services as needed, Garcia said.
“Luckily, they had each other to lean on and they were able to get through that situation,” he said.
Therapy for first responders
While the Wellness Unit was getting off the ground, UT Health San Antonio’s New Opportunities for Wellness (NOW) Adult Behavioral Health Clinic added specialized therapy for first responders in November last year.
The NOW Clinic, funded by a three-year nearly $5.4 million grant from University Health, started in 2020 in response to the growing need for “timely, appropriate outpatient behavioral health care before an individual experiences a crisis,” said Shelley Kofler, senior public relations manager for University Health.
The clinic takes insurance, but can also cover the cost for uninsured individuals for up to six months.
The clinic started looking into expanding its specialties after the rash of suicides, said Megan Fredrick, director of programs.
“We started talking about what the need is,” Fredrick said, and they started working with UT Health physicians, University Health and the local police union to see what was needed. “We knew that this population sort of suffers silently. … They have a huge responsibility, they see a lot of really difficult things and there isn’t always a built-in outlet for that.”
The clinic hired Dr. Austin Lemke, a clinical psychologist who specializes in treating first responders and post-traumatic stress disorder, to complement its offerings.
“The benefit of being in a clinic like this that has all these other specialty programs — marriage and family therapists, psychiatrists, social workers — is anything that I don’t specifically do, I can get them connected for mental health needs across the board,” Lemke said.
Typically the clinic can schedule an appointment for a first responder within two days, he said. “I am usually able to keep at least one emergency appointment available same-day or next-day.”
First responders who would like more privacy when seeking treatment are given the doctor’s phone number so they can wait in their vehicles until they are ready to open a side door to the clinic for them to avoid the waiting room, Lemke said.
The more resources available, the better, said Danny Diaz, president of the San Antonio Police Officers Association. “I just wanted to bring another option to the table.”
And the NOW Clinic is one more option first responders have that is not directly associated with their employer, he said.
Fear of penalty, need for anonymity
One of the biggest barriers police officers, firefighters and paramedics face when seeking help with their mental health is the fear that what they say will get them in trouble with their bosses, lead to reassignment or ultimately getting fired.
That may have been true decades ago, but not anymore, Diaz said.
Just like at any other doctor’s office in the city, there are narrow exceptions for doctor-patient confidentiality with staff psychologists, Burque said. Generally, doctors can only share information if they have the patient’s permission or if there is a reasonable probability that the patient will seriously harm themselves or someone else.
And doctors have a vested interest in maintaining confidentiality, Burque said. “If I violate somebody’s confidentiality, I lose my license. If I lose my license, I can’t work here or anywhere else and that’s how I feed my family. So I take that … very seriously.”
The perceived connection to leadership remains pervasive, but she said the police department has tried to build trust.
“Part of it is being embedded everywhere,” Burque said of the psychologists and wellness officers that are spread out across the department. “They’re just part of the fabric.”
External psychologists are welcome and needed, Baron said. “Probably 90% of the people that we’re navigating to services are using services outside of our department.”
The San Antonio Fire Department does not have a centralized wellness unit, but has many of the same offerings SAPD does and a growing number of volunteers for its peer support program, said Lt. Ryan Westerhoff, the San Antonio Fire Department’s mental health and resilience coordinator.
About 60 SAFD peer-support volunteers are trained for how to connect a firefighter or paramedic to resources inside or out of the department, he said. They wear green silicone bracelets, the color that represents mental health awareness, to signal to their colleagues that they’d welcome a tap on the shoulder to talk.
The firefighters’ union also has a mental health peer support team.
“There’s a lot of options,” Westerhoff said. “And part of my job is to make sure people know how to use them.”
It’s unclear how frequently uniformed SAFD employees have died by suicide in recent years, he said. The department does not currently track suicides, but nationally firefighters are more likely to die by suicide than on duty, he noted.
“It could be by a larger margin than we even know because there’s not really a good tracking system,” Westerhoff said.
Westerhoff himself came dangerously close to becoming a statistic several years ago.
One year after local firefighter Scott Deem died while battling a large fire in 2017, Westerhoff’s mother was diagnosed with cancer and died, he injured his shoulder the next year, then he was diagnosed with cancer the following year. All this, combined with other personal issues, led to depression and anxiety.
“I was on the edge,” he said, but he got help. “I take pride in the fact that I made it through it and I have much more clarity on what’s important.”
His experience inspired him to be more involved in peer support, which is one of the best ways to spread awareness and prevent tragedies, he said.
“People think when you’re faced with these things: I can’t do it, there’s no way out,” he said. “I’m living proof that there is.”
