It took a few minutes for the dogs next door to stop barking after the uniformed police officers left, but eventually, the small living room was silent and the older man was ready to speak.

“I never thought it would get to this point,” he said quietly, sitting on a wine-colored, brocade couch. The former firefighter briefly massaged his left temple with the tips of his rugged fingers, then cupped his jawline in his hands.

“What point are we talking about?” San Antonio Police Officer Roger Astin asked, matching the man’s hushed tone. He sat across from the man, jotting down details in his notebook. Astin was flanked by a mental health clinician and a paramedic, who leaned in on one knee to listen closely to the man’s story.

“Like, I’m losing my mind,” the man said shakily, just above a whisper. “All the burden has fallen on my wife.”

His wife looked on with tears in her eyes while she folded, unfolded and crumpled a napkin in her hands.

She had planned a long trip out of town, but he was afraid to stay home by himself. His memory had deteriorated since his stroke a few years ago. He said he has felt depressed but doesn’t want to go to a doctor out of fear he’ll be “put in a whole different category” and forced to leave his West Side home.

“They’re here to help us — me and you,” said his wife, who urged him to take the team’s advice to see a doctor that same day. A diagnosis could “help me to understand you more, what you’re going through.”

SA CORE team members work with individuals to assess their specific needs and help connect them to appropriate resources. Credit: Bria Woods / San Antonio Report

Their daughter had called 911 that Tuesday morning to request a welfare check on her father. The team declined to share with a reporter what specifically prompted the call. The San Antonio Report agreed not to publish the couple’s names or likeness to protect their privacy.

“Welfare check” is a routine call, but this multidisciplinary response is not yet routine in San Antonio.

SA CORE, which stands for Community Outreach and Resiliency Effort, launched just over a year ago as a pilot program to holistically respond to certain 911 calls. It may soon become an expanded and permanent fixture in San Antonio’s mental health ecosystem.

The team’s clinician spoke up. “There’s a lot of unknowns right now,” she told the man. “I think going to the doctor would be good — but I’m not trying to push anything on you.”

First of its kind in San Antonio

The need for a specialized mental health response emerged as part of the city’s police services review, which was sparked by the 2020 protests in the wake of the police killing of George Floyd in Minnesota.

Bexar County started a similar program that year, two months after a sheriff’s deputy killed a man experiencing a mental health episode. The city and county modeled their programs in part after the Dallas police department’s successful and growing program.

CORE sends a specially-trained police officer, a paramedic from the San Antonio Fire Department and a licensed mental health clinician from the Center for Health Care Services to 911 calls that don’t involve weapons but are — or could be — related to mental health.

The program’s clinicians are funded through the city’s partnership with Southwest Texas Regional Advisory Council, which also provides coordination support and data analysis. The SAPD officer receives additional training in mental health crisis intervention.

The goal of the program is to reduce arrests and increase access to mental health services while augmenting other public safety-related mental health initiatives such as SAPD’s Mental Health Unit, department-wide crisis intervention training, Program for Intensive Care Coordination and Mobile Integrated Healthcare.

911 dispatch can assign the team a call, a patrol officer can request the team as a secondary response to a call or, unlike typical patrol units, the team can pick up 911 calls in the system that appear to fit the parameters of the program.

If a weapon is removed from a scene, then the CORE team also can respond, Astin said.

Charlie Piñeda, SAFD paramedic with SA CORE, prepares to respond to a call for a welfare check Tuesday. Credit: Bria Woods / San Antonio Report

Currently, the team only responds to calls made within the central substation’s service area, which includes downtown, neighborhoods north of downtown and the near West Side. Now, the city is prepared to turn the pilot into a more permanent program and expand citywide with two additional response teams, which would cost an additional $750,000 in fiscal year 2023 and $2.7 million in 2024, officials have said.

Details will likely be discussed at City Council’s budget meeting Wednesday.

An expansion would be welcomed by the team.

“We have the whole city up on our [call scanners] and we see quite a few calls that we would like to go to,” said Chris Edwards, lead paramedic for CORE.

Nearly 1,500 calls. Six arrests.

The team typically wears matching polo shirts with slacks or jeans. Only the gun and badge secured to Astin’s hip indicate that he’s a police officer. The team travels in two white, unmarked SUVs that don’t have visible emergency lights.

The plain-clothed approach void of lights and sirens is intentional, as many people are intimidated by or don’t trust law enforcement.

The team carries a scaled-down version of medical supplies that an ambulance carries, plus snacks, blankets, water and even fidget toys that can help reduce anxiety.

CORE operates seven days a week from 7 a.m. to 11 p.m. It received 1,465 calls for service between April 2022 and March 2023.

More than a third of those calls, 512, were resolved on-site without an arrest, voluntary transportation or emergency detainment — when a person is involuntarily taken to a hospital. Less than a third of the calls resulted in an emergency detainment.

Six calls resulted in an arrest — which is unavoidable if someone has a warrant, Astin said. For the most part, if an arrest is needed, the team tries to have a patrol officer handle it.

“We want to make it very clear that we are here to assist in connecting with services,” he said, not to execute arrest warrants.

A key piece of the CORE program is follow-up care.

Generally, when a patrol officer has to emergency detain someone, the officer’s job ends after they drop the person off at the hospital. Through CORE, a CHCS clinician reaches out to every person the team responds to within three days, then again after 30, 60 and 90 days.

That follow-up care is much more difficult with unhoused individuals, Astin said.

“We can get that person into immediate crisis services,” he said, but once they’re discharged, it’s sometimes difficult to find them. To help, the team has built relationships with homeless service organizations and often makes calls to shelters and housing providers on behalf of clients.

More than a bodyguard

The program has been welcomed by SAPD’s rank and file, McManus told the San Antonio Report last month.

“Everybody seems to feel it’s working well,” McManus said. “I think the question now is: how much do we expand it? Not if, but how much?”

The CORE team is able to handle complex mental health situations, which frees up patrol officers for other calls, he said. And when calls are resolved on-scene, it’s “less taxing on the system and it allows for further follow up with these same individuals who may be high volume users,” — that is, people experiencing mental health issues who frequently interact with police.

Before the team launched last April, some mental health and police reform advocates called on city leaders to remove police officers from the team entirely.

They argued that a gun and a badge aren’t needed for all mental health calls and pointed to teams in Oregon and Colorado that call in armed police officers only as a secondary response.

So far, Astin said he has not once had to pull out his gun from its bulky retention holster while working on the CORE team, but he’s “glad I have it” in case of unexpected escalation.

Part of the police officer’s formal role on the team is to ensure civilian safety, he said. “I joke sometimes that, hey, I’m just their bodyguard.”

The clinician performs behavioral health assessments and the paramedic addresses physical health concerns. But in the field, those roles become less defined, Edwards said. Paramedics and police officers often participate in behavioral health assessments.

“We have set roles and responsibilities … but we don’t hold to that on the call,” he said. “On paper, we’re supposed to be a certain way, but you never know if the next person … may not like you or you may relate to someone more.”

SA CORE team members help a man get checked in to see a physician with the Geriatric Behavioral Health Unit at Baptist Medical Center downtown Tuesday. Credit: Bria Woods / San Antonio Report

Each member of the team uses their own lived experiences to connect with individuals who are struggling.

“We are able to, each one of us, kind of pick up those roles if need be,” Astin said. “So it is kind of like this … dance — this flow.”

Finding the right angle

Charlie Piñeda, a paramedic on the CORE team, pet the couple’s white cat while talking to the man on the couch.

Because the man had been a firefighter, the team had a clear path to connect with him and all members were engaged.

“There’s always an angle,” Piñeda told the San Antonio Report later. As part of that connection, team members try to diminish the cultural stigma associated with mental health.

Feelings of depression and anxiety are “pretty common,” Astin told the man. “In the past two years, I’ve had seven co-workers commit suicide. … I will fully admit to you that I’ve had those thoughts before [and] there is help. I don’t want you to feel like that’s something that you have to keep to yourself.”

It can be hard for first responders, who are used to being helpers, to ask for help, Piñeda told the man. “I know sometimes that firefighter mentality is there, I get it. … We’ve been there just like you have. It’s okay to let it down. It’s okay, brother.”

When he reached out to the man’s arm and squeezed, the man’s shoulders dropped with alleviation.

When the team first arrived, the man did not want to see a doctor. But after about an hour of calm discussion — and a little laughter — he changed into a button-up shirt and grabbed his wallet and keys from a tray in his living room.

After securing their cat and puppy, he and his wife stepped into one of the unmarked vehicles for a ride to Baptist Medical Center to visit doctors in the Geriatric Behavioral Health Unit.

The couple held hands as they walked up the stairs to the check-in window.

The man shook hands with each member of the team before they left.

“I appreciate it,” he told them.

If you or someone you know is experiencing a crisis, call or text 988 to reach the Suicide and Crisis Lifeline

Senior Reporter Iris Dimmick covers public policy pertaining to social issues, ranging from affordable housing and economic disparity to policing reform and mental health. Contact her at iris@sareport.org