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Mental Health Meets 'Moneyball' In San Antonio

Posted: August 21, 2014

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The jails, hospitals, courts, police and mental health department in Bexar County, Texas, used to work separately. Since they started cooperating, psychiatric care has improved and costs are down.

Leon Evans, director of the community mental health system for Bexar County and San Antonio, broke through barriers that had hindered care.

Leon Evans, director of the community mental health system for Bexar County and San Antonio, broke through barriers that had hindered care. Jenny Gold

The jails aren't overflowing in San Antonio anymore. People with serious mental illnesses have a place to go for treatment and the city has saved $10 million a year on. How did it happen?

"You know Brad Pitt in the movie Moneyball?" asks Gilbert Gonzalez, Director for the Bexar County Mental Health Department. "Well, the success in that movie was based on the data and analytics. We needed to do the same thing."

Gonzalez's task was to look at all the money San Antonio was spending on mental health in one way or another.

Just eight years ago, the jails, hospitals, courts, police and mental health department in Bexar County all worked separately.

Each part of the system was encountering the same people with serious illnesses, but the people were just cycling through, not getting better. Gonzalez found that the city was spending enormous sums of money while taking care of people with mental illness poorly.

So Leon Evans, director of the community mental health system for Bexar County and San Antonio, got everyone talking. That turned out to be the most challenging piece of the puzzle.

"If you think law enforcement and mental health workers have anything in common, we don't," says Evans. "We speak a different language. We have different goals. There's not a lot of trust there."

But once the decision-makers saw what could be done if they pooled their resources, every sector chipped in and the county built a single, integrated system where people with mental illnesses could actually get better.

Among other things, the San Antonio center has a 48-hour inpatient psychiatric unit, outpatient primary care and psychiatric services, help with substance abuse, housing for people with mental illnesses and job training. More than 18,000 people pass through the Restoration Center each year.

"San Antonio is ahead of what's a growing trend across the country to try to build a non-hospital alternative for people who are experiencing a psychiatric emergency, often with co-occurring alcohol or other drug abuse," says Dr. Mark Munetz, a psychiatrist and professor at Northeast Ohio Medical University who toured the Restoration Center last year.

But he says the San Antonio model might not work everywhere. The Restoration Center and homeless shelter, he says, felt like "a psychiatric oasis, removing the people from the most central part of the city. It felt a little like segregating people in that part of the city, especially with the homeless shelter next door. I'm not sure how that would fly in other parts of the country."

Nonetheless, the rest of the country has started to notice. City officials say every state in the country has sent delegates to San Antonio to see if they can model their own mental health systems after this one.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

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