8 minute read
The Specialized Multidisciplinary Alternate Response Team
A Group Effort for Treating Individuals Struggling with Mental Health Emergencies
By Lauren M. Miller
On August 25, 2020, the family of thirty-one-year-old combat veteran, Damian Daniels, desperately called 911 dispatchers to assist Daniels as he struggled through a mental health crisis. Daniels was fatally shot by the sheriff deputy who responded to the call.1 Upon arrival to the scene, the sheriff deputy attempted to de-escalate the situation, but failed to do so and instead shot and killed Daniels. Daniels suffered from severe PTSD and trauma, which likely developed as a result of his service in the military, and he died as a result of his mental illness.2 Daniels is one of countless individuals who struggle to understand and obey law enforcement commands due to mental illness. In many cases, an individual struggling with a mental health emergency is arrested because of his or her inability to comply with commands and ends up stuck in the criminal justice system. In other cases, such as Daniels’, the individual’s mental illness, left untreated, results in his or her death. Several programs in our community—including the Bexar County Office of Criminal Justice and the Department of Behavioral Health—recognized that there would likely be a drastically different outcome if first responders had appropriate training in mental health, as well as the ability to recognize signs of mental illness, and proposed a solution to the problem: The Specialized Multidisciplinary Alternate Response Team (“SMART”).
About six weeks after Daniels was fatally shot, the Bexar County Commissioners Court considered funding for SMART—a proposed resource designed to respond to and treat individuals who are experiencing a mental health emergency, in an effort to keep them out of our criminal justice system while also maximizing the efficiency and effectiveness of county resources. Despite the fact that one in five adults in the United States lives with mental illness, and one in twentyfive adults in the United States lives with serious mental illness (e.g., schizophrenia, bipolar disorder, major depression), mental health has historically been overlooked and brushed aside.3 Until fairly recently, the discussion of mental health and treatment of mental health disorders has arguably been stigmatized in our community. In October 2020, that changed for the San Antonio community when the Commissioners Court allotted $1.5 million to SMART.
While the SMART program is the first of its kind in Bexar County, it was created and developed using information and best practices from similar programs throughout the country.4 One of the many keys to success in the similar programs was a collaborative approach to treating individuals experiencing a mental health emergency. Similar programs in Oregon and Colorado introduced the idea of creating a team of individuals, rather than just law enforcement officers, to respond to mental-health-related calls, and the idea proved effective when put into action. As a result, the SMART program uses a similar approach and incorporates individuals from different backgrounds to respond to, de-escalate, and resolve mental health emergencies using a least restrictive approach.
Consisting of a licensed mental health professional, a peer support specialist, a qualified mental health specialist, a specially trained mental health law enforcement officer, and a paramedic, the SMART team responds to dispatch calls that are flagged as mental-health-related emergencies.5 While the mental health professional and qualified mental health specialist work together to identify and treat mental illness, the peer support specialist contributes first-hand knowledge of what the person being treated might be going through and offers moral support to that person. These team members are complemented by a paramedic, who is available to treat the individual’s physical injuries, as well as a specially trained mental health law enforcement officer, who assists with de-escalating the situation and is also available to step in and protect the individual or team, if needed. Although each member of the team brings a unique set of skills and perspective to the situation, members working alone may not be able to fully resolve the mental health emergency; but the team, working as a group, is able to identify, treat, and offer compassion and moral support to the person struggling through a mental health crisis.
In the past, 911 dispatchers had three options when they received a call: (1) to dispatch law enforcement to the scene; (2) to dispatch the fire department to the scene; and/or (3) to dispatch paramedics to the scene. The introduction of the SMART unit to Bexar County provides a fourth option that dispatchers can use to respond to calls similar to the call made by Damian Daniels’ family. The introduction of the SMART unit to our community allows individuals experiencing a mental health emergency to receive the attention and treatment they need from a team that will address and resolve the problem efficiently and effectively. At the same time, the SMART unit relieves other first responders from having to spend time and effort responding to mental health emergency calls.
In an effort to better understand mentalhealth-related calls and the response to these calls, the Meadows Mental Health Policy Institute analyzed the circumstances surrounding mental-health-emergency calls. In the report, Meadows Mental Health Policy Institute characterized three types of mental-health-related calls: (1) Mental Health Routine calls; (2) Mental Health Disturbance calls; and (3) Mental Health in Progress calls.6 The report provides that if a subject is reported to be mentally unstable and/or has a history of mental illness, then the call is characterized as a Mental Health Routine call.7 However, if the same circumstances apply—but the subject is also uncooperative, loud, and/ or argumentative, or the reporting person requests police attention—then the call is characterized as a Mental Health Disturbance call.8 The third category, Mental Health in Progress calls, include calls that report a subject with a history of mental illness who is posing an imminent threat to himself or herself, or to others.9
In an effort to better understand mental-health-related calls and the response to these calls, the Meadows Mental Health Policy Institute analyzed the circumstances surrounding mental-health-emergency calls. In the report, Meadows Mental Health Policy Institute characterized three types of mental-health-related calls: (1) Mental Health Routine calls; (2) Mental Health Disturbance calls; and (3) Mental Health in Progress calls.
The Meadows Mental Health Policy Institute report goes on to state the frequency of each type of call and provides that the most frequent calls are categorized as Mental Health Routine calls or Mental Health Disturbance calls. More specifically, from January 2019 through April 2021, the Meadows Mental Health Policy Institute reported 21,961 Mental Health Routine calls, 23,217 Mental Health Disturbance calls, and 9,754 Mental Health in Progress calls, totaling 54,932 mental-health-related calls during that time period.10 It is important to note that before the SMART program was developed, first responders were taking a significant amount of time responding to these calls because of their lack of training in mental health. For example, a mental-health-related call that might take a mental health professional one hour to address and resolve might take law enforcement officers two or three times as long, simply because the latter do not have the same knowledge and experience when it comes to dealing with mental health issues. Thus, the introduction of the SMART unit has resulted in more efficiency for all groups of first responders by allowing them to respond to calls that they are best trained to address.
The Southwest Texas Regional Advisory Council used the information provided by the Meadows Mental Health Policy Institute to develop the SMART program, as well as to expand on and improve the program. Each aspect of the program was thoughtfully developed to ensure that an individual struggling with a mental health emergency is treated in every way necessary. Less than a year after the pilot program was introduced in Bexar County, Sheriff Javier Salazar stated that it “just fell together” and “surpassed expectations.”11 As the program continues to grow and expand, those living with mental illness and their family members can find hope that the tragic story of Damian Daniels will not repeat itself. No doubt, one life lost is one too many.
ENDNOTES
Tiffany Huertas, Family calls for Bexar County sheriff’s resignation after viewing body cam footage of Damian Daniels’ death, KSAT, June 14, 2021, https://www.ksat. com/news/local/2021/06/14/family-of-damian-daniels-holds-news-conferenceabout-his-death/
Justice for Damian Daniels, Justice for Damien Daniels, Mar. 19, 2020, https:// www.justicefordamian.com/.
About Mental Health, https://www.cdc.gov/mentalhealth/learn/.
Sep 10, 2020 Commissioners Court Budget Work Session, Bexar County, TX, https://bexarcountytx.new.swagit.com/videos/197101
About S.M.A.R.T., Official Website https://www.bexar.org/3459/About-SMART.
City of San Antonio First Response System Final Review Draft 2021-07-31, Aug. 1, 2021, https://www.sanantonio.gov/Portals/47/Files/meadows-report.pdf
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Max Massey, Bexar County sheriff says mental health pilot program has ‘surpassed expectations’, KSAT, July 26, 2021, https://www.ksat.com/news/local/2021/07/26/ bexar-county-sheriff-says-mental-health-pilot-program-has-surpassed-expectations/
