Why Sedgwick County turns its eyes to San Antonio for mental health solutions
A Texas county of 2 million earns national praise for driving down homelessness and jail booking rates over the past two decades with the help of robust collaboration across agencies and a 37-acre one-stop shop.
But even a Sedgwick County-scaled version of such a project would be financially challenging and would require consensus across a diverse array of stakeholders.
SAN ANTONIO – Every weekday at San Antonio Public Safety Headquarters, people line up at windows to report crimes, seek advice, maybe challenge a parking ticket.
But not everyone is here to conduct typical police business. Some are unsheltered and have heard the police can help them get or recover an ID, removing a huge barrier to receiving services.
The ID program is the brainchild of the department's homeless outreach team, and it represents one small piece of a puzzle that San Antonio and Bexar County (population 2 million) have been putting together since the early 2000s. Its purpose: to reduce the number of people living on the streets and to try to help those with mental illness and addiction issues who often end up in courts and jails.
Other pieces include a hospital system prepared for mental health emergencies; a crisis center for mental health, addiction and medical issues; a behavioral health navigator who directs first responders to emergency rooms with available beds; homeless shelters with more than 1,000 beds across the county; a police force with a mental health unit; and specialty courts that focus on diversion.
Often dubbed the San Antonio model, this array of services and programs has earned a reputation for reducing homeless and jail populations. And it has caught the attention of mental health and criminal justice professionals across the country, with many trying to tailor the model to their communities.
That includes Wichita and Sedgwick County, along with other Kansas cities and counties. Although many Kansas communities have begun to adopt some of San Antonio’s novel approaches to decriminalizing mental illness, homelessness and substance abuse, none has invested as much money or has as much experience.
In recent months, Sedgwick County Commissioner David Dennis and other leaders have spoken with San Antonio officials, invited some to Wichita and even traveled to the city. "We're trying to figure out how to build a smaller version of San Antonio here in Wichita," says Dennis. "It's going to take a lot of money, and it's going to take a lot of people being involved in it.”
The stakes couldn’t be higher, Dennis says: "Our largest mental health facility in the state of Kansas is the Sedgwick County Jail. And that's absolutely wrong."
It isn’t necessarily the programs but the data that makes the San Antonio model compelling to people like Dennis. Bexar County, for example, has seen its rate of homelessness drop 23% over the last decade, from 19.1 to 14.6 individuals per 10,000. The rates in Sedgwick County are lower, 10.7 per 10,000 in 2020, but its decline from 12.7 per 10,000 in 2011 trails Bexar County’s. Plus, the rate of Bexar County’s jail bookings per 10,000 people has plummeted by 72% since the early 2000s; Sedgwick County’s have dropped just 42% over the same period, and the county books at a significantly higher rate than Bexar County, 359 bookings to just 120 per 10,000.
The Texas community’s numbers not only bring cost savings from reduced incarceration and services to the homeless, but they also show the path to providing thousands of people with enough support to live productive lives.
One of those people is Kevin Langehennig. A decade ago, Langehennig’s best friend died. He started drinking heavily. A cocaine habit came next, followed by a drug conviction, revoked probation and a suicide attempt. “When I woke up in ICU, I said, ‘It’s time to just get sober,’” he says.
But first he had to complete his sentence. Upon his release, he had no job to return to, no roof to protect him. He lived on the streets of San Antonio.
Fortunately for Langehennig, a new state-of-the-art shelter had opened, Haven for Hope. There he found a case manager who believed in him and, in time, helped him rebuild his life. Today, he’s a peer support specialist, helping people overcome challenges like his. “I've had suicide attempts. I have a state jail felony. I've been locked up. Been in mental health wards,” Langehennig says. “I don't feel like I'm any different than you guys are.”
A one-stop shop
In the early 2000s, Bexar County faced a problem familiar to counties across the United States: Its jail was chronically overcrowded. Pressure was mounting to expand it by 1,000 beds. But unlike many other governing bodies, the county’s Commissioners Court,equivalent to a county commission in Kansas, resisted expansion. Instead, led by County Judge Nelson Wolff, the court’s presiding officer, it created a system that would give nonviolent offenders – many experiencing mental health and substance use challenges – a path toward treatment rather than incarceration.
Wolff did not chart this course alone. He had partners in the judicial system, law enforcement and social services. Among them: Leon Evans, then CEO of the largest behavioral health system in the county, the Center for Health Care Services. (Full disclosure: One of the reporters of this article, Mark Wiebe, is the son of the late David Wiebe, executive director of the Johnson County Mental Health Center, who worked with Evans on a national board in the mid-2000s.) Evans had established similar diversion programs in other Texas communities, earning a reputation as an innovator.
But he knew that San Antonio and Bexar County faced several daunting questions: How could they stop people from entering the criminal justice system in the first place? What services should be available to people in jail and after they’re released? And most important: How could they coordinate the many organizations needed to pull all this off?
For answers, Wolff formed a task force that studied how other communities addressed the problem. They looked at training that helps police de-escalate incidents involving people with a serious mental illness. They learned about drug and mental health courts that divert offenders from jail. And they learned from Evans himself. “I figured out early on, working with law enforcement and these judges, that really this is a community problem, and if you actually want to improve the public safety net and make sure taxpayer dollars are spent in the right way, then you have to work together, you know, because people are siloed,” Evans says.
One major piece that Evans oversaw was the creation of The Restoration Center, which had its origins as a mental health crisis facility. After adding sobering and detox units, the center opened in 2008 to provide psychiatric care, substance abuse services and general health care. Police as well as the public now had a place to bring people in crisis – whether they were suicidal, experiencing psychosis or intoxicated. Previously many would have been jailed, then thrust into a court system with deadlines and conditions that many people with mental illness often fail to meet.
As of this year, more than 50,000 people have received help at The Restoration Center. Over the same period, jail bookings dropped by more than half. Many connect with services, fulfilling a principle that has guided Evans throughout his career: “People shouldn’t have to go to jail because they’re ill.”
Nor should they be consigned to the streets. Evans bristles at the notion that anyone “chooses” an unsheltered life. “Can you imagine living on the streets here in Bexar County when it's 110 degrees outside? Or Kansas when it's freezing in the park? No, they don't want it. It's just they are so addicted that they can't make good decisions.”
Yet for a long time, San Antonio did not have a central place for its homeless population to go. A number of shelters existed, but their criteria for entry varied. Some operated on shoestring budgets. Others offered substandard facilities.
In the mid-2000s, San Antonio took big steps to address this problem. Noting that some 4,000 people lived in Bexar County without a home – many near the city’s downtown River Walk attraction – a group of community leaders examined the practices of shelters across the United States. Joining them was Bill Greehey, then-CEO of Valero Energy Corp., a fuel and petrochemical company. A grand vision emerged from this research: create a one-stop campus where people experiencing homelessness can access whatever resources they need to begin leading self-sufficient lives.
In 2010, after Greehey led and helped fund a $100 million campaign, the Haven for Hope campus opened just west of downtown. Located on 37 acres across the street from The Restoration Center, Haven for Hope offers services designed to help those emerging from homelessness forge a path toward independence. Some of those services are provided by more than 70 organizations that occupy space on the campus, others by Haven for Hope itself. They include transitional housing, legal assistance, job skill development, mental health and substance use treatment. There’s even a kennel for those who’ve shared their journeys with a pet.
"Everyone deserves to get to a better place,” says Molly Biglari, Haven for Hope interim president and CEO. “We believe that housing is not something you earn; it's a right for everyone."
The campus also features a courtyard where unsheltered people can come anytime and stay for as long as they want. The courtyard averages 600 people a day. Large blue awnings provide shade and protection from rain while breakfast, lunch and dinner are served to all who stay there. No questions are asked, no conditions are made other than to not disrupt fellow courtyard residents or take drugs. Showers, places to sleep, medical and mental health care are available to all. Although staff work with residents to see if they’re ready for services that can help them find permanent housing, they don’t push too hard, adopting an approach that is personalized and sensitive to individual trauma.
Those who opt for more extensive services at Haven for Hope’s transitional campus must agree to enter a 90-day treatment program to address the root causes of their homelessness. While there, they can benefit from many services, including job training, case management, substance use programs and day care.
Recognizing Haven for Hope’s crucial role, San Antonio’s Department of Human Services allocates $5 million a year to the organization from an $18 million budget devoted to homelessness. Altogether, Haven for Hope is funded with roughly 50% public and 50% private dollars.
The reality is that no single institution or organization or philanthropist can address a problem as complex as homelessness. In fact, even with Haven for Hope, the need for shelter and services for the homeless in San Antonio remains high.
“People who are experiencing homelessness touch virtually every social service that a city has,” Biglari says. “And so everyone's a stakeholder, whether it's the hospitals or the fire department or the museums or the libraries, or the city hall and every service there, and all the nonprofit agencies and your food bank. It's really this incredible opportunity to collaborate.”
The view from Sedgwick County
Wichita and Sedgwick County have no one-stop shop like Haven for Hope, even though local officials identified the need for one back in 2006. As a result, the city still finds itself without a coherent strategy when crises involving the homeless erupt. Its police recently made headlines when the city took measures to prevent the unsheltered from setting up camps downtown, and then faced criticism for making the move without having anywhere to house the people it displaced. “The idea that we just shuffle people who are experiencing homelessness out of sight and out of mind is not human, like, at all,” Mayor Brandon Whipple told The Wichita Eagle. “We’re better than that as a city.”
Multiple agencies have been dealing with the same concerns for years but found themselves too often pointing fingers rather than cooperating. A Mental Health and Substance Abuse Coalition involving the sheriff’s office, police department, the city and county, nonprofits, hospitals and businesses was created in 2019 to foster collaboration.
With Bexar County being four times the size of Sedgwick County, community leaders say they wouldn't try to mirror the scale of a Texas-sized campus. But the scope of the project would still be daunting.
“Just the campus itself will probably cost us $12 to $15 million,” says Dennis, the Sedgwick County commissioner. “That’s just for property. That doesn’t count any buildings.”
Dennis longs for a philanthropic shot in the arm along the lines of what Greehey, the Texas oilman, brought to Bexar County by donating some of his own money, roping in others to donate, and lobbying agencies to offer their support. “We need that individual here in Sedgwick County,” Dennis says.
Such a venture would require not only private sector donations but state, federal and local financial support. But before the question of long-term financial sustainability can be answered, local officials and other stakeholders would need to agree that a campus should be a priority.
And it’s not clear that they would. At a September joint city-county meeting, officials took initial steps to collaborate with the mental health coalition to draft a plan that addresses mental health and substance issues. But there are still questions about what should be at the top of the list.
“What is our No. 1 priority?” Sedgwick County Commissioner Jim Howell asked. “It can’t be all of the above. I think we need to prioritize. Is it the campus, or is it mobile mental health? I think they're competing for the same dollars, in my opinion.”
Still room for improvement
As proud as San Antonio is of its accomplishments, those involved see limitations too.
Growing numbers of encampments, a dearth of outreach workers and unsheltered people with poor access to health and mental health care are evidence that homelessness is still a major problem. And while coordination is seen as a key to San Antonio’s success, a lack of it continues to be a problem. Resources abound to address homelessness, a recent report says, but “knowledge of these resources was often not shared among all relevant stakeholders including clients and the public.”
Another critique comes from former police officer Joe Smarro. A combat veteran who saw action in Afghanistan and Iraq, Smarro was among the first officers to request assignment to the San Antonio Police Department’s mental health unit. In 2008, the department piloted a mental health response team that later became a full-fledged unit. Composed of officers and behavioral health co-responders, the unit aims to get people with behavioral health challenges into treatment to avert an arrest or the use of force.
“I think the reason I was so drawn to it was because I was it,” Smarro says, revealing that he himself has lived a trauma-ridden life. “By the time I was 33 years old and going on my third divorce, my soon-to-be ex-wife at the time said, ‘Hey, something's really wrong with you.’” So he sought help at a Veterans Affairs hospital. “I started to really shift my perspective,” he says. “It's not that I'm a cop and they're a citizen. It's that I'm Joe. I'm just having a bad day, and so are the people that are calling the police.”
Smarro resigned from the department in 2019 and today is CEO and co-founder of SolutionPoint Plus, a national training and consulting firm focusing on crisis intervention, de-escalation and employee wellness in both the public and private sectors. As a part of the training, he shares lessons he learned in his 15 years as a San Antonio police officer, 11 on the mental health unit.
One especially critical lesson: Police must learn how to distinguish a mental health crisis from criminal activity. Smarro learned this both on the job and through Crisis Intervention Team training, which relies heavily on role playing to teach police how to recognize mental health and substance use disorders, and how to de-escalate tense situations. The 40-hour course is taught in departments across the country, including in Wichita and parts of Kansas.
“When you talk to someone in crisis, you should communicate low and slow, clear and brief,” Smarro says. “They're already experiencing sensory overload. Their mind is racing. … We become one more thing that is overwhelming them.”
Smarro advises officers to manage the tone and cadence of their voice, to avoid shouting commands, to keep requests simple. “What we're looking for is voluntary compliance, and you're never going to get voluntary compliance … if you do not have rapport established.”
Despite the growing popularity of CIT training, Smarro says that its lessons don’t come easy. That’s because much of an officer’s training is often at odds with CIT principles. “We have to look at how we're training our cadets,” he says. “We're training people to essentially fear our community. We're showing them video after video after video of officers being ambushed and killed from the last several decades, and then we're telling them, ‘Now go serve the community and do it well. …’ We can't scare the hell out of our cadets and probationary officers and then expect them to want to be neighbors with their community.”
Instead, Smarro urges police departments to focus on helping officers build empathy for the communities they serve, and to pay attention to their own mental health. “Every cop in this country has to qualify with their firearm for liability reasons and for proficiency, and yet more than 90-plus percent of them will never pull their trigger in their two- or three-decade career,” Smarro says. “Why do we do that? When the reality is we know for a fact every single police officer in this country will respond to traumatic events. They will see dead children. They will see murders. They will see suicides.”
Yet, Smarro says, there are few if any opportunities for police to process this trauma. “We don't have cultures of wellness. We don't provide the opportunities for officers to feel supported or celebrated in coming forward to say, ‘Hey I'm really struggling. … I'm going to need some time.’”
So teaching de-escalation tactics is a good start. But, Smarro says, “true de-escalation starts with your own self awareness. How are you showing up? What are your own triggers? How much sleep did you get last night? What's your relationship at home looking like?”
Smarro gives the San Antonio Police Department due credit for embracing CIT and creating the mental health unit. He’s seen firsthand how these efforts have helped Bexar County winnow non-violent offenders from the criminal justice system. But he questions whether the mental health unit’s growth is limiting its effectiveness. “When we were at four and six officers, it was incredible,” he says. ``We met every day. There were zero use-of-force incidents. We never took anyone to jail.”
Now the unit has 10 officers, two detectives, a sergeant, and three co-responders. “With the detectives, the whole purpose is warrants,” he says. “I never understood why that became a role” of the police department’s mental health unit.
Smarro also worries that recent changes at the department’s CIT program limit time spent on officer wellness and opportunities for role play. “It’s a drastic reduction in quality,” he says. “Are we emphasizing behavior change? Or are we checking a box to say we have CIT training?”
San Antonio police don't share Smarro’s assessment. In a written statement, the department reiterated its pride in the unit and its effectiveness. The statement noted that in 2020 the mental health unit provided outreach to 100 of the “highest mental health utilizers in the community,” reducing police contact with this group by 70%. The department also plans to add nine officers to the unit as well as more clinicians serving as co-responders.
Collaboration ‘the key’
The ID recovery is one highly visible example of how many San Antonio officers, as Smarro says, work hard to find services for the unsheltered or those in crisis. The program is overseen by members of the department’s HOPE Team, an acronym for Homeless Outreach and Positive Encounter.
On a hot San Antonio day in August, Francisco Olveda entered the police lobby to start the process of recovering his ID with help from Officer Joe Farris, a member of the HOPE Team. Olveda had been injured in an auto accident four years earlier and made his way from Chicago to San Antonio, staying with friends while recovering from surgery on both legs. He’d been able to get work here and there, but for the most part he was unemployed and unsheltered.
“I’m just trying to wait it out,” he says.
That wait wasn’t always easy. The Texas Department of Transportation had removed a camp he was staying at and he was unable to find a shelter. Securing an ID, he hoped, would unlock a door to services, a job and perhaps even a home. (Homeless people in Wichita can reportedly also obtain IDs, but the process isn’t clearly detailed in public pronouncements and KSN is currently investigating how it works.)
Such services represent a simple way to begin building bridges. Throughout his ordeal in San Antonio, Olveda says most people had treated him well. That includes the police. “I really haven’t had any problems with them,” he says.
Farris considers that a win. “Historically police and the homeless have not had a great relationship,” he says. The HOPE Team was created in 2015 to change that dynamic. “And so the idea was, hey, we have homeless people, a lot of them have mental illness. Let's get some guys to address that.”
At first, the team focused on getting unsheltered people into treatment or a program to help with job skills or transitional housing. But Farris says it soon realized that many services required identification – and that the department was uniquely positioned to help with fingerprinting and other tools it uses to verify identities. With those tools, the police were able to fill a niche better, perhaps, than others doing similar work. But there were still fears about redundancy.
“Probably the hardest thing is getting everyone organized so that you're not overlapping,” Farris says. “We have a couple ID recovery efforts. We reached out to them and (said), ‘You know, we can work on this and how about y'all work on that so we're not doing the same job.’ We can do more people if we split the load right.”
The relationships that the HOPE Team had with the community made all the difference in centralizing the ID recovery program. Those relationships pave the way for working together, making it easier to identify the challenges a community faces, and easier to address them.
“I just feel like the collaboration and probably the organization is key to what we have here in San Antonio,” Farris says.
This is the first of two articles that The Journal and KSN-TV are publishing through the Wichita Journalism Collaborative about Sedgwick County’s efforts to reduce its homeless population and keep people with mental illness out of jail. Next up: the county’s plans for accomplishing that and how recent changes in state policies, some inspired by San Antonio and Bexar County, could help.