Policing with Velvet Gloves


Joe Smarro, right, and Ernie Stevens of the San Antonio Police Department’s Mental Health unit.

By Anne Snyder

“We’ve got a lady that’s cut­ting her­self with a knife right now.”

Of­ficer Ernie Stevens looks at the laptop that’s blink­ing with this shift’s first call. His part­ner in the driver’s seat, Of­ficer Joe Smarro, punches the ad­dress in­to the GPS.

“Hold her down un­til we get there. Then we’ll take over re­spons­ib­il­ity,” Ernie says in­to the phone.

Joe and Ernie are two of the six qual­i­fied of­ficers that San Ant­o­nio’s po­lice de­part­ment de­ploys from its spe­cial­ized men­tal-health unit. They go out in pairs, dress in plain­clothes, and re­spond to crises that might be rooted in men­tal ill­ness.

It’s easy to see they’ve bon­ded, hav­ing tag-teamed in the midst of high emo­tion­al in­tens­ity for over five years.

Four patrol cars are already parked at the scene, their strobe lights rov­ing. “Yup, you can see how they’re responding,” Ernie says, ex­as­per­a­tion lat­ent in his tone. “Just be­cause there was men­tion of a knife.”

The of­ficers speak re­spect­fully of their fel­low patrol­men—jobs they once held—but it’s clear the pair op­er­ates from a broad­er defin­i­tion of “dis­turb­ance.”

“All patrol sees in this call right here is ‘knife,’” Joe says. “So they’re im­me­di­ately think­ing in terms of tac­tics. It’s ‘I might have to get my gun out,’ or ‘I might have to shoot some­body.’

“But when I see this call, I see that this is someone who’s really hav­ing a bad day. This is someone who is really upset. Something’s happened in the last 24-48 hours that’s caused her to get to this point, to where she’s cut­ting herself. And chances are this is not the first time this has happened. We’re deal­ing with a cycle here, and something’s caused this cycle to re­sur­face. We need to fig­ure out what’s go­ing on.”

This type of psy­cho­lo­gic­al in­sight in­to a volat­ile situ­ation is the end res­ult of a dec­ade of re­train­ing by San Antonio’s po­lice force.

As the rest of the coun­try re­mains em­broiled in a heated de­bate on crim­in­al justice, the city of 1.4 mil­lion has quietly reached the fore­front of po­lice re­form by pri­or­it­iz­ing men­tal-health-centered ap­proaches and gain­ing the trust of its res­id­ents and pub­lic-ser­vice pro­viders.

Since 2005, San Ant­o­nio has re­quired its en­tire po­lice force to en­roll in a weeklong pro­gram called Crisis Intervention Train­ing (CIT), which helps of­ficers bet­ter un­der­stand and re­spond to the nu­ances of men­tal ill­ness. It’s also helped spon­sor a 37-acre treat­ment cen­ter to handle ci­vil­ians in vari­ous stages of men­tal ill­ness and sub­stance ab­use, giv­ing those be­ing di­ver­ted away from jail sup­port in man­aging their chal­lenges.

On this par­tic­u­lar call, Joe and Ernie enter the house and move past the armed of­ficers. There’s a wo­man on a couch, cry­ing. A man shifts awk­wardly in the kit­chen. Joe walks up to him as Ernie goes to­ward the wo­man.

“OK,” Ernie says as he sits down catty-corner from her. “You’re Jes­sica? What’s go­ing on? My name is Ernie.”

She struggles to catch her breath, look­ing wary and spent.

 Officer Ernie Stevens looks as a woman reveals the marks where she cut herself, in her home in San Antonio, Texas. Stevens sat and spoke with the woman about what had motivated her to injure herself and her possible suicidal thoughts before asking the woman if she wanted to receive further treatment at a mental-health facility built to temporarily treat the mentally ill outside of jail and outside of the ER. MATTHEW BUSCH

Officer Ernie Stevens looks as a woman reveals the marks where she cut herself, in her home in San Antonio, Texas. Stevens sat and spoke with the woman about what motivated her to injure herself and her possible suicidal thoughts before asking the woman if she wanted to receive further treatment at a mental-health facility built to temporarily treat the mentally ill outside of jail and outside of the ER. MATTHEW BUSCH

Jes­sica of­fers Ernie an agit­ated list of ex­plet­ive-laced com­plaints about her boy­friend’s trans­gres­sions dur­ing an eight-year re­la­tion­ship. She un­leashes an­ger and ex­haus­tion in equal meas­ure. Ernie stays calm, fo­cused on her.

“I can see you’re up­set,” he says. “Let me ask you something. One piece of in­form­a­tion we re­ceived was that you were cut­ting your­self. Was that—…”

“I told you be­fore that I did,” Jes­sica cuts him off with de­fi­ance, lump­ing Ernie in with the patrol of­ficers who first reached her house.

“I’m sorry,” Ernie says softly. “Did you try to cut your­self today?”

“No.” She swal­lows con­vuls­ively.

“OK. Have you ever re­ceived any kind of coun­sel­ing or ther­apy in the past?”

“I used to,” Jes­sica says. She says she was raped at age 18 and be­came preg­nant. Her foster par­ents took her off meds to pro­tect the baby, and the only thing she’s tried since is marijuana.

“So you feel over­whelmed?” Ernie asks. “Would that be fair to say?”

Jes­sica nods.

“OK” Ernie says. “Would you agree with me if I said, hon­estly, you don’t want to kill your­self, you just want this pain to go away?”

Jes­sica nods, gulp­ing. She ex­plains that she used to cut her legs, “just so I could feel bet­ter.” She openly ac­cuses her boy­friend of sleep­ing with an­oth­er wo­man when she is out of the house and of mak­ing her and the kids stay away from morn­ing un­til 6 p.m.

She’s a gush­ing faucet of pain, but Ernie keeps his fo­cus.

“OK, all right,” he says. “I can see that point of view. What I’m wor­ried about is the way that you handle these types of stressors in your life. When you’re up against a crisis like this, and something hap­pens, how are you equipped to deal with it?”

Jes­sica ex­plains that she usu­ally leaves and goes to a friend’s house, that she could nev­er af­ford coun­sel­ing and is afraid of its con­di­tions.

“They tell me that if I’m go­ing to harm my­self…” her voice dwindles off. And then, “I don’t want them to take my kids away.”

Ernie re­sponds swiftly.

“Let me put that fear at ease, OK? Hear me: There’s no way at all that I’m go­ing to even con­sider tak­ing your chil­dren away from you. All I want to do is get you help so you’re equipped to deal with life when it comes at you like this.”

The con­vic­tion in Ernie’s prom­ise seems to break through to Jes­sica.

“Well, then, if someone’s go­ing to check me, can I be hon­est with you and show you what I did?”

Ernie nods, hav­ing waited, it seems, for this break­through. Jes­sica stands up, takes off her out­er shirt and lifts the cam­isole un­der­neath. Ernie sighs heav­ily. Her chest is covered by a jig­saw puzzle of 50 bleed­ing gashes, some of them deep.

“Did you show the patrol of­ficers this?”

“No,” Jes­sica says.

Ernie’s eyes nar­row as he leans closer. “Let me see this for a second. They may want to su­ture these and put a couple of stitches in there. We need to get help. This is something we don’t want you to do. They can take care of this at the crisis cen­ter.”

Then he looks in­to her eyes.

“Listen to me, Jes­sica. I’m heart­broken. If you were my wife, my sis­ter, I’d be heart­broken.”

Her eyes well up, hear­ing a truth about her value that’s been bur­ied. And then…

“This is nor­mal for me,” she says limply.

“Ori­gin­ally, I didn’t want to get in­to this line of work,” Ernie says back in the patrol car, after Jes­sica has been checked in to the crisis cen­ter, called Res­tor­a­tion.

“Deal­ing with a men­tally un­stable con­sumer was my biggest fear. I’d been a patrol of­ficer for 13 years when a buddy signed me up for this train­ing, called CIT. I just said yes be­cause to do it would mean I’d get a week­end off.”

CIT was at that time new to San Ant­o­nio, hav­ing been in­tro­duced in 2005 as part of an ini­ti­at­ive Bex­ar County was under­tak­ing to stave off fines from an over­crowded jail.

A con­stel­la­tion of fresh mu­ni­cip­al lead­ers came on the scene in the early 2000s—in­clud­ing the dir­ect­or of men­tal-health com­munity ser­vices, a new po­lice chief, and a new county judge (who had pre­vi­ously been San Ant­o­nio’s mayor)—and put their heads and polit­ic­al skills to­geth­er to launch a deep listen­ing ef­fort between law en­force­ment officers and men­tal-health pro­fes­sion­als. The idea was to get these two cul­tures to bet­ter un­der­stand one an­oth­er and then hone in on what could be done to stop the cycle of in­car­cer­a­tion for men­tally ill per­sons.

With the help of what is now a six-per­son men­tal-health squad, San Ant­o­nio has di­ver­ted more than 100,000 people away from jail or emer­gency rooms in­to ap­pro­pri­ate treat­ment—all without the use of force. MATTHEW BUSCH

With the help of a six-per­son men­tal-health squad, San Ant­o­nio has di­ver­ted more than 100,000 people away from jail or emer­gency rooms into ap­pro­pri­ate treat­ment—all without the use of force. MATTHEW BUSCH

Some time in­to these con­ver­sa­tions, it be­came clear that the needs of the first re­spon­ders—e.g. patrol­men and women—had to be pri­or­it­ized. Men­tal-health and law en­force­ment lead­ers ori­gin­ally thought they could build men­tal-health ser­vices in­side the jail. This proved in­ef­fect­ive: Too few in­mates were be­ing re­moved. So in­stead they tar­geted the most com­mon trans­ition vehicle for those with men­tal ill­ness: squad cars.

Up to that point, po­lice academies were not of­fer­ing courses in how to deal with men­tal-health crises. Though of­ficers of­ten ex­per­i­enced an av­er­age of one such crisis per day while on duty, most settled for fum­bling their way through the “cra­zies,” pre­fer­ring a quick jail book­ing to the murk­i­ness of a men­tally ill per­son’s world.

“As soon as I got [to CIT], I did not want to be there,” Ernie re­mem­bers as we drive to the next crisis call, this one from a moth­er who says her 17-year-old son is threat­en­ing to harm him­self and her. “I didn’t feel com­fort­able.”

Be­sides un­ease when faced with un­pre­dict­able psychoses, there was also the fear of be­ing labeled a “hug-a-thug” or “social work­er.” Ernie had been trained to be tough, to com­mand and con­trol. But on the fourth day of the train­ing, he was in­tro­duced to an older wo­man named Jean­ine who de­scribed what it was like to live with a schizo­phren­ic son. Her testi­mony was riv­et­ing.

“‘One day, one of you of­ficers will have to come to my house and you might have to shoot and kill my son,’” Ernie recalls her say­ing, still shak­ing his head at her resig­na­tion. “‘And I want you to know that if that hap­pens, that’s OK. Be­cause I want you to go home safe to your fam­il­ies. You don’t know what it’s like to live with this.’

“At that mo­ment, everything changed for me,” Ernie re­mem­bers. “To see her re­solved to the fact that her son would eventu­ally be killed by a po­lice of­ficer, and to know she couldn’t pos­sibly be alone … I just thought, there’s no way that this can be.”

For Joe, re­morse also set in quickly after join­ing.

Night­mares haunted him for the first couple of months; tak­ing on sev­en or eight men­tal-health calls per day dis­turbed his sense of real­ity. But per­spect­ive gradu­ally re­turned as he and fel­low of­ficers re­cog­nized pat­terns in their calls and their dis­cre­tion in man­euv­er­ing crises grew in deft­ness and sens­it­iv­ity.

With the help of Joe, Ernie, and the rest of what is now a six-per­son men­tal-health squad, San Ant­o­nio has di­ver­ted more than 100,000 people away from jail or emer­gency rooms in­to ap­pro­pri­ate treat­ment—all without the use of force.

We get out of the car, about 10 minutes after leav­ing Jes­sica safe at the crisis unit. An­oth­er wo­man is cry­ing, this one in a dilap­id­ated park­ing lot, dart­ing her eyes to find her hooded son who is schizo­phren­ic and al­legedly threatening vi­ol­ence. Joe walks up to get more in­form­a­tion from her as Ernie rounds the corner and care­fully approaches the cli­ent.

“Hi, Vic­tor? What’s go­ing on? My name is Ernie.”

The suc­cess of San Ant­o­nio’s jail-di­ver­sion pro­gram has at­trac­ted na­tion­al at­ten­tion, and those who vis­it from oth­er jur­is­dic­tions of­ten walk away think­ing Crisis In­ter­ven­tion Train­ing is a ma­gic lever to be im­ple­men­ted every­where. There’s a strik­ing hu­mane­ness to these of­ficers, a nu­ance to their abil­ity to build trust with those in the throes of crisis that makes this out­side im­pulse un­der­stand­able, es­pe­cially in the cur­rent cli­mate of an­ger to­wards po­lice behavi­or.

Without ro­bust treat­ment ser­vices also avail­able, however, even a CIT-trained po­lice force will have no choice but to wait 8-14 hours in an emer­gency room, or to book the per­son in the loc­al jail.

When Ernie and Joe dropped off Jes­sica at the Res­tor­a­tion crisis unit, they knew they were ush­er­ing her in­to an ar­ray of re­sources, wheth­er or not she ul­ti­mately de­cided to pur­sue treat­ment. Loc­ated just north­w­est of down­town, Restoration is a fully out­fit­ted crisis-care and re­cov­ery cen­ter run by San Ant­o­nio’s Cen­ter for Health Care Ser­vices (a quasi-gov­ern­ment agency fo­cused on men­tal-health and sub­stance-ab­use solu­tions), ad­ja­cent to a 37-acre cam­pus called Haven for Hope that provides longer-term res­id­ence and med­ic­al and be­ha­vi­or­al care for the home­less, ad­dicts, and the men­tally ill.

When someone like Jes­sica is brought in by law en­force­ment, her case-man­age­ment needs are as­sessed. Is men­tal ill­ness co-oc­cur­ring with sub­stance ab­use? Will she need to see a psy­chi­at­rist right away? What are all the chal­lenges to her get­ting and main­tain­ing ac­cess to treat­ment? Is it child care for her chil­dren? Is it food stamps? What is her relation­ship with her peers, cowork­ers, and fam­ily?

“We don’t want to be the end-all and be-all for every­body,” says Kath­leen Dor­ia, a con­tract em­ploy­ee at the Cen­ter for Health Care Ser­vices. “But what re­sources can we be the li­ais­on for to keep this fra­gile case man­age­ment to­geth­er?”

Jes­sica looked both nervous and re­lieved as she waited for the ver­dict on her case. Journ­al­ists are not al­lowed to inter­view cli­ents once ad­mit­ted, but Ernie says it’s likely she was placed in the Josephine Re­cov­ery Cen­ter, Restoration’s 16-bed crisis res­id­en­tial and res­pite fa­cil­ity for men and wo­men, which is fo­cused on provid­ing crit­ic­al cop­ing skills to sus­tain func­tion­ing and re­in­teg­rate in­to the com­munity. What she does after that is up to her.

“I fear she’s go­ing to go back to that same situ­ation be­cause she feels like she’s trapped in it,” says Ernie, as he re­lives the 15-20 minutes he and Joe spent de-es­cal­at­ing her crisis at home. “This may be a Band-Aid on an open wound for her. There are re­sources in place to help her, but she’s got to be will­ing to up and leave [her cur­rent situ­ation].”

This struggle to achieve prop­er agency is what the rest of the Cen­ter’s wrap­around ser­vices are de­signed to sup­port. From its crisis-care unit and re­cov­ery cen­ter, to its Mom­mies Pro­gram that treats preg­nant and par­ent­ing wo­men who use or ab­use sub­stances, to its sober­ing and de­tox­i­fic­a­tion pro­grams and an in­teg­rated primary-care clin­ic com­plete with coun­sel­ing and ther­apy ser­vices, all of the pro­grams are in one loc­a­tion. Many staff mem­bers are “peers” who once found them­selves in sim­il­ar straits, and at­tend along­side pa­tients to of­fer le­git­im­ate em­pathy and a glimpse of what’s pos­sible.

The com­mon thread that binds all the avail­able tracks—in­clud­ing Haven for Hope’s more in­tens­ive 90-day treat­ment for home­less and men­tally-ill pa­tients—is an ori­ent­a­tion to­ward em­power­ing the pa­tient, to get her in the driver’s seat of her re­cov­ery.

Scott Ack­er­son dir­ects Haven for Hope, across the street from Res­tor­a­tion Ser­vices, and he’s con­vinced that this person-cent­ric ap­proach needs to pre­cede tac­tic­al check­lists. “I’ll ask a pa­tient, ‘What do you live for?’” Ack­er­son says. “A com­mon re­sponse is, ‘I want to get my kids back.’ OK, then that’s your goal. Your goal is not medication com­pli­ance. If you have is­sues with men­tal ill­ness or ad­dic­tion, do those need to be ad­dressed? Ab­so­lutely. But that’s not your goal. Your goal is to get your kid back…. The only way a per­son can re­cov­er is if they’re want­ing and will­ing to re­cov­er.”

Bags of medication hang in Haven for Hope's medical-storage room. MATTHEW BUSCH

Bags of medication hang in Haven for Hope’s medical-storage room. MATTHEW BUSCH

This drilling-down in­to the needs and iden­tit­ies of people who have been stripped of their scaf­fold­ing is the philosoph­ic­al and cul­tur­al strain that seems to run through every piece of San Ant­o­nio’s learned-in­ter­ven­tion and treat­ment strategies. There’s a strik­ing con­sist­ency to the way Joe and Ernie listen and speak when they’re on a call, to the way the nurses and dir­ect­ors of Res­tor­a­tion’s crisis unit listen and speak, to the way Scott in longer-term care listens and speaks. They fo­cus on re­la­tion­ships, listen­ing deeply, and want to help each per­son re­cov­er a sense of his or her true self.

San Ant­o­nio is not slow­ing down in lever­aging what’s worked in cre­at­ing an un­usu­al con­tinuum of care from po­lice interven­tion to treat­ment and re­cov­ery. This next year, the city plans to per­man­ently re­move 400 jail beds in or­der to cre­ate an­oth­er 400 beds for the Cen­ter for Health Care Ser­vices’s treat­ment pro­grams. So far, the Bex­ar County jail has emp­tied 500 beds since the di­ver­sion pro­gram began. In the last year alone, from Dec. 21, 2014 through Nov. 30, 2015, the Cen­ter for Health Care Ser­vices es­tim­ates that 9,270 in­di­vidu­als have been di­ver­ted from jail.

The push for on­go­ing im­prove­ments is rooted in a con­fid­ence that the unique col­lab­or­at­ive cul­ture de­veloped across San Ant­o­nio’s pub­lic-ser­vice sec­tor will con­tin­ue to bear fruit. Lead­er­ship has been sig­ni­fic­ant—mo­tiv­ated doers see­ing the same prob­lem at the same time—but a city eth­os of non-ter­rit­ori­al­ity and cross-sec­tor ap­pre­ci­ation has been the mor­tar al­low­ing for on­go­ing gains.

Most not­ably, a po­lice force is ex­per­i­en­cing a very real sea change in mind-set and dis­pos­i­tion. The quiet pas­sion of Joe and Ernie has not only earned the re­spect of their fel­low of­ficers, it’s provided a needed safety valve for mentally un­stable po­lice­men and wo­men with­in the de­part­ment. In a year of heightened na­tion­al scru­tiny on the powers and pre­pared­ness of law en­force­ment, the pair once ri­diculed for their “hug-a-thug” skills are now leaned upon for their abil­ity to listen and provide coun­sel for the psychoses that may be bur­den­ing their col­leagues on patrol. Lives have ar­gu­ably been saved as job posts are now at­tached to a peer-to-peer web of psy­cho­lo­gic­al sup­port.

Wheth­er oth­er cit­ies will suc­cess­fully ad­opt San Ant­o­nio’s ap­proach de­pends some­what on those loc­al cul­tur­al entrenchments that pre­cede the ex­tent of the in­car­cer­a­tion prob­lem. Ra­cial dy­nam­ics, a city’s size, the pre­ced­ence of cross-sec­tor col­lab­or­a­tion, and the will to in­vest in wrap­around treat­ment ser­vices are all vari­ables that can af­fect each jur­is­dic­tion’s chance of empty­ing jail beds and re­du­cing deaths. But for now, San Ant­o­nio’s les­sons are worth study­ing. In a ra­cial and crim­in­al-justice de­bate defined by heat, this grow­ing Lone Star city provides some light.

Up­date: This story has been ed­ited to re­flect that Kath­leen Dor­ia is a con­tract em­ploy­ee of CHCS, not a spokesperson.

This article was originally published by the National Journal on 1/21/2016