In Galveston, a New First Response to Mental Health Crises

After a neighbor called 911 on her, Melissa Perez explained to two responding police officers that she had cut the fire alarm wires to her southwest San Antonio apartment building because the FBI was using the system to spy on her. The cops asked her to walk over to their patrol cars, but instead she hurried back into her first-floor apartment and locked the door. “Hey, lady, get over here,” one of them yelled.

The 46-year-old grandmother, who, it later emerged, had been diagnosed with schizophrenia, was exhibiting telltale symptoms of the disorder. Someone undergoing a schizophrenic crisis often can’t distinguish between reality and what they’re imagining. Mental health professionals know to handle such cases with care, seeking to avoid further isolating or frightening the patient. But the police who arrived at Perez’s home a little after midnight on that occasion last June didn’t employ such an approach.

One officer hopped the railing enclosing Perez’s back patio, tried to open her locked back door, and then began to remove the screen from an open window leading into Perez’s living room. In response, she moved toward her back door with a hammer, at which point the officer drew his gun.

“You’re going to get shot!” he yelled.

“Shoot me,” Perez replied.

“Open the door,” he said. “No,” she answered before throwing a glass candlestick through the window that struck him and shattered on the concrete patio. He withdrew and, along with other officers soon dispatched to the scene, continued to talk to Perez through the window for about twenty minutes.

Then Sergeant Alfred Flores and Officer Nathaniel Villalobos attempted to enter the apartment. As they stepped into the patio area, Officer Eleazar Alejandro saw Perez charge toward her back door with the hammer. He drew his gun and fired several rounds at her through the open window. Perez, apparently unscathed, initially retreated but then moved toward the door a second time, at which point all three officers opened fire, killing her.

Seventeen hours later, Alejandro, Flores, and Villalobos were charged with murder. The arrest affidavit stated that Perez, armed with only a hammer, “did not pose an imminent threat of serious bodily injury or death when she was shot because [officers] had a wall, a window blocked by a television, and a locked door between them.” San Antonio police chief William McManus told Texas Public Radio in July, “We have no gap in our training or our policies that would have allowed for this to happen.”

San Antonio officers receive more than eighty hours of mental health crisis-intervention training, including their initial cadet classes, refresher courses every few years, and other supplemental instruction. The department’s mental health unit—a team of about twenty officers whose sole responsibility is mental health calls—has been celebrated as a model. And in 2022 the City of San Antonio launched its Community Outreach and Resiliency Effort program, which dispatches a team, including a police officer, a paramedic, and a mental health clinician, to 911 calls that may require mental health expertise. CORE, as it’s known, wasn’t available to respond to Perez’s apartment because, at the time, the team operated only between 7 a.m. and 11 p.m. The city has since approved funds to expand the coverage to 24 hours a day.

The tragic killing of Perez underscores the need for mental health specialists to act as first responders. An estimated 44 percent of those in jail in the U.S. have a mental illness, compared with just 18 percent of the general population. In Texas, county jails essentially function as the largest mental–health system in the state. But now, mirroring a nationwide trend, Texas cities are launching teams to respond to mental health crises with care instead of incarceration or lethal force. Many 911 dispatchers are being trained to ask whether a caller is dealing with a mental health crisis. Among these efforts, a new program in Galveston is betting that its approach can save lives.

One late summer day turned out to be busy for the Galveston Police Department. There was a bomb threat at a big-box store. A reckless driver led patrol cars on a high-speed chase. And an unmarked white Ford Expedition driven that morning by Officer Justin Owens set out to respond to a different sort of emergency. Paramedic Matthew Heatley rode beside Owens, and in the back sat Keitha Douglas, a clinician with the Gulf Coast Center, a local mental health care provider. The three made up the department’s on-duty Compassionate Open Access to Services and Treatment—COAST—team.

An island resident had called 911 to report identity theft and said someone making vile threats had hacked her accounts. But the police officers who responded couldn’t find any evidence of such a crime. They suspected she was experiencing a mental health crisis and requested COAST’s help. Soon after the Expedition arrived, Owens asked the woman to explain again what she’d told the other officers. Pitched forward on her couch and focused intently on her phone, she showed him a variety of screenshots, photos, and social media posts that she felt substantiated her claims. Next, Douglas began asking her questions: Does she take any medications? Was she having suicidal or homicidal thoughts?

Gradually, the woman began to open up. Her husband had died years earlier and left her alone to care for their two young children. She’d suffered abuse. Other loved ones had died recently. Douglas suspected cumulative distress might be at the root of the woman’s paranoia. “I’m sorry for all of your losses,” Douglas said. “That’s a lot of trauma.” The woman softened a bit. “I’m dealing with it,” she said, explaining that she had previously seen a mental health care provider. Douglas offered her the services of the Gulf Coast Center as well. When the COAST team left, they had listened to the woman’s concerns, given her options for care, and promised to follow up with her in the coming days.

Many of the team’s calls follow a similar pattern. Before COAST’s launch last March, patrol officers might have tried to calm the woman and ensure she was safe, but they didn’t have the expertise to do much beyond that. “You’re literally leaving somebody with not necessarily access to resources, so by having the COAST team, you have that follow-up, you have that instant access to services,” says Lieutenant Renaye Ochoa, GPD’s special operations commander, who oversees the unit.

By the end of October, COAST teams had responded to 673 calls. Of those, 36 resulted in an arrest and 33 an emergency detention, in which the subject was deemed an immediate threat to themselves or others and was taken to a mental health facility. During 128 calls, someone was connected to medical care. In the other cases, the matter was resolved at the scene or the subject declined services or couldn’t be located. “The big goal of this thing is that we don’t arrest people and we don’t put them in the hospital, unless we absolutely have to,” Ochoa said.

Douglas, who has two master’s degrees—one in public administration and one in social work—was drawn to join COAST in part because she understood that many police officers aren’t suited for the role of de facto social worker that they’re too often asked to play. She wanted to “get between a not-so-friendly cop and a person that was having a crisis and see if I can help them out.”

Ochoa said Galveston officers quickly saw that COAST could relieve them of the burden of sometimes frustrating mental health calls. Too often these encounters would wear on an officer’s patience, which could have the effect of further agitating someone undergoing a mental health crisis. “I believe that has caused a lot of mental health consumers to go to jail needlessly,” Ochoa said. “It’s no fault of anyone’s; it’s just the system that we had.”

That summer afternoon, the COAST team was also called to a house in a historic neighborhood near the beach, where a young woman had threatened to kill her cats and her mother before taking her own life. Douglas and her colleagues had visited this house the day before and successfully defused the situation. They’d set up an appointment for the young woman to see a counselor at the Gulf Coast Center. But matters had since escalated, and the mother no longer felt safe with her daughter in the house.

Owens asked the mother, who was making animated gestures while holding a long metal bolt that her daughter had allegedly threatened her with, to step into another room with him. Meanwhile, Heatley examined the medications prescribed to the young woman, and Douglas asked her to describe what had changed since the previous day. “I was mad and confused,” the young woman said. “But I don’t feel that way now.”

Even if it didn’t seem likely in that moment, the COAST team decided they couldn’t run the risk of the young woman acting on her threats, especially with a potential weapon involved. She had been admitted to a mental health facility recently, but the team didn’t see any signs that her condition today met the standards for hospital admission. She was alert and coherent and claimed not to be suicidal. Owens asked the daughter to stand up and put her arms behind her back so that he could lead her out to another officer’s patrol car, which would take her to the county jail.

While these programs are designed to avoid arrests whenever possible, “an arrest doesn’t always mean failure,” says B. J. Wagner, the senior vice president of health and public safety at the Meadows Mental Health Policy Institute. “Excessive use of force, harm, death, death at the hands of law enforcement—that’s failure.” Meadows, a Dallas-based nonprofit, helped the City of Galveston design COAST and secure philanthropic funding for the program.

In 2019, before the advent of COAST, two mounted Galveston police officers arrested Donald Neely, a Black man with a history of mental illness who’d had repeated encounters with GPD. The officers led him through town by a rope clipped to his handcuffs. Photos of the incident drew nationwide condemnation and quick apologies from the department. It was a shocking example of not just the officers’ poor judgment but also the inadequate mental health resources available to Galveston residents and police.

The creation of COAST is part of the community’s response to that need. The county also set up a mental health court to divert defendants with mental illness away from jail and into treatment. And officials plan to open a new mental health crisis center with twenty beds this year; damage from Hurricane Ike caused Galveston’s only psychiatric hospital to close in 2009.

COAST is based on a program launched in Dallas in 2018. Four years earlier, Dallas police had killed Jason Harrison, a 38-year-old man experiencing a mental health crisis who was armed with only a screwdriver. After the public outcry over that shooting, local authorities partnered with Meadows to develop the RIGHT Care program, which deployed a multidisciplinary response team—the first of its kind in Texas. It initially served just one patrol district but has since expanded to cover the whole city.

Despite the early promise demonstrated by the multidisciplinary approach, some critics argue that even more should be done to separate law enforcement from mental health care. Before San Antonio’s CORE was launched, local activists pushed for police officers to be excluded from the response teams. These critics point to programs such as the CAHOOTS (Crisis Assistance Helping Out on the Streets) system developed three decades ago in Eugene, Oregon, which dispatches only a medic and mental health crisis worker to such emergencies.

Jennifer Eno Louden, an associate professor of psychology at the University of Texas at El Paso, whose research focuses on the intersection of mental health needs and the criminal justice system, says we don’t yet have enough data about multidisciplinary programs, such as COAST and CORE, to determine whether they’re worthwhile. “I’m optimistic that they can be helpful,” she says. “I think that for communities to make convincing arguments for more money to establish or expand these types of programs, there needs to be research, just so we know that we’re putting our resources to good use.”

Louden acknowledges that there are some calls—when a firearm is involved, for instance—that may need to involve police in the response. Nonpolice crisis teams exist in Austin, Houston, and Round Rock, but unlike in some other states, in Texas the presence of a police officer, judge, or legal guardian is required to send someone to a mental health facility against his or her will. “It makes a lot of sense to try to avoid having police respond to mental health crises as much as possible, as long as it doesn’t compromise people’s safety,” Louden says.

Ernie Stevens, who served on San Antonio’s police force for 26 years, understands the dynamics of responding to mental health crises. He helped build the department’s mental health unit, and in 2019 he and his partner, Joe Smarro, were the subjects of Ernie and Joe: Crisis Cops, an Emmy Award–winning documentary that celebrated the unit’s work. The film shows how the partners put their lives at risk to offer mental health resources to San Antonians in need. In one segment, Stevens and Smarro talk a young woman off a highway overpass, where she’d planned to kill herself. They then directed her to care and checked in with her over the ensuing months.

“Every call can be very fluid; it can go from good to bad in a hurry,” says Stevens, who now oversees mental health and policing initiatives for the Council of State Governments Justice Center, a nonprofit based in New York City. When he heard about the tragic killing of Melissa Perez, he was horrified but not entirely surprised. He doesn’t argue that police should never respond to these calls, but he’s emphatic that we need to understand the stakes when they do.

The presence of a gun, he says, increases the risk of violence tremendously. “There’s a hundred percent chance that every time you send an officer to a call involving a mental health crisis, there’s going to be a gun involved,” he says. “Does it need to be?”  

This story originally appeared in the January 2024 issue of Texas Monthly.

COAST was designed by the Meadows Mental Health Policy Institute. The initiative is a collaboration between Meadows and The Pew Charitable Trusts and is funded and supported by the Cynthia and George Mitchell Foundation and several Galveston-based foundations, including the Moody FoundationHarris & Eliza Kempner FundIppolito Charitable FoundationMary Moody Northen Endowment, and the Sasser Family Foundation.

For additional information about Galveston COAST and to schedule a ride-along with a COAST team, please contact Brett Holmes at  

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