Southwest Texas Crisis Collaborative

The Psychiatric Emergency Services System of Care (PES) was created to provide a safe environment for adult mental health patients presenting to acute care emergency departments who require timely mental health evaluations. The purpose is to decompress the overcrowding of mental health patients in emergency departments. Patients at PES can stay up to 48 hours and the PES facility provides immediate psychiatric evaluations, clinical assessments, and linkage to the next appropriate level of care. The model not only creates the opportunity to provide PES beds at a facility within Bexar County but is intended to enhance access to outpatient services at the Local Mental Health Authority, the Center for Health Care Services (CHCS).

Combining the efforts of the PES System of Care and Law Enforcement Navigation, Southwest Texas Regional Advisory Council (STRAC) and The Center for Health Care Services (CHCS) have embedded licensed clinicians in MEDCOM 24/7 to assist in facilitating interfacility transfer requests to the identified contracted bed facilities. The MEDCOM Clinician can assist in determining whether the patient would benefit from PES, inpatient treatment, or potentially avoid admission all together and be connected back to an assigned treatment team for follow up. All Contract Beds in Bexar County are managed by the MEDCOM Clinician through a standardized process called Contract Bed Navigation. The goal of Contract Bed Navigation is to quickly and efficiently move patients to the best location for their stabilization and ongoing care.

The Program for Intensive Care Coordination (PICC) is a collaborative program with the San Antonio Police Department (SAPD) Mental Health Unit, San Antonio Fire Department (SAFD) Mobile Integrated Health and the Center for Health Care Services (CHCS) aimed at reducing Emergency Detention Orders (EDO’s). By focusing on persons identified as high utilizers (6 or more EDOs in a 12-month period) we aim to reduce the utilization and impact on 911 and hospital systems by addressing psychiatric and social needs through intensive case management and collaboration with the community thereby reducing the need for emergency services.

A multidisciplinary team comprised of the San Antonio Fire Department (SAFD), San Antonio Police Department (SAPD), and The Center for Healthcare Services (CHCS) that responds to mental health related 911 calls in the San Antonio Police Department Central service area. The goal of the response is to provide the least restrictive method of resolving the crisis. This team routinely provides resources and follow-up services to the community in lieu of transporting them to a facility, however the option of transportation is an option if a higher level of care if deemed necessary.

SMART multidisciplinary response team comprised of the Bexar County Sherriff’s Office (BCSO), multiple Bexar County EMS Providers and The Center for Healthcare Services (CHCS) that responds to mental health related 911 calls in Bexar County. The goal of the response is to provide the least restrictive method of resolving the crisis. This team routinely provides resources and follow-up services to the community in lieu of transporting them to a facility, however the option of transportation is an option if a higher level of care if deemed necessary.

An overnight medical clinic located on the Haven for Hope campus which is staffed by San Antonio Fire Department EMS Mobile Integrated Healthcare. The primary goal of this clinic is to provide medical support onsite, and when applicable, preventing the transport to a local hospital, and enhancing continuity of care by directly referring to CentroMed, San Antonio’s Federally Qualified Health Center which has a daytime clinic, located on the campus of Haven for Hope.

Since 1963 Crosspoint has been providing outpatient and residential services to primarily veteran and justice involved Bexar County residents. In 2018, Crosspoint opened a behavioral health program that provides transitional living support services for men and women with behavioral health and/or substance use disorders, in need of post-crisis stabilization. Residents residing at Crosspoint can receive up to 120 days of services and outpatient treatment services are provided onsite that include psychiatric care, employment services, group and individual counseling, and case management to residents.

The Southwest Texas Regional Advisory Council (STRAC) MEDCOM hosts the Domestic Violence Navigation service line 24/7 to ensure the correspondence from law enforcement to victim advocacy is established upon identification of a high-risk lethality case due to domestic violence. The navigation line increases the utilization of evidence-based lethality tools used by law enforcement and healthcare providers, and follow-up services are provided to victims of domestic violence by Bexar County Sheriff’s Office (BCSO) Crime Victim Advocates, the City of San Antonio (COSA) Violence Prevention Case Managers, and/or Family Violence Prevention Services (FVPS).

Through the Psychiatric Emergency Services System of Care (PES), the Southwest Texas Regional Advisory Council (STRAC) and The Center for Health Care Services (CHCS) have also embedded Hospital Liaisons at the PES facilities that provide aggressive referral, linkage, and transition to the next level of care, in partnership with PES facilities and MEDCOM Clinicians. Included is a Transitional Liaison who conducts post-discharge engagement services and provides interim case management until the patients’ first follow-up appointment post-discharge.