San Francisco legislation would allow EMS providers to order psychiatric holds

San Francisco Mayor London Breed also announced a new Street Wellness Response Team to expand mobile mental health and social services


By Laura French

SAN FRANCISCO — Recently proposed legislation would allow some San Francisco EMS providers to order temporary psychiatric holds for individuals in severe mental health crises. 

The legislation, introduced by San Francisco Supervisor Ahsha Safai, would expand authority for 5150 temporary mental health holds to fire department paramedics and EMTs that are part of two special response teams, according to Safai.

Currently, only police officers can order psychiatric holds in the city. Safai's proposal would expand authority to members of the city's Street Crisis Response Team, which launched last November, and the Street Wellness Response Team, a new initiative announced by Mayor London Breed on Monday

"If someone is experiencing a severe mental health crisis and/or trying to harm themselves - the last thing you want to do is criminalize it," Safai tweeted. "If passed, this legislation would allow limited paramedics/EMTs the ability to provide compassionate & skilled health services to our communities. We may be one of the first, if not the first county to add 5150 holds to the toolkit of treatment for paramedics/EMTs." 

The Street Crisis Response Team currently consists of four groups serving four different neighborhoods or areas of the city, each including one paramedic, one behavioral health clinician and one peer health worker. The teams respond to mental health emergencies and have responded to more than 700 calls since November, diverting about 19% of "mentally disturbed person" calls from dispatch, according to Breed. The city plans to have a total of six Street Crisis Response Team units to cover the entire city by the end of this summer. 

The Street Wellness Response Team announced this week will respond to 911 or 311 calls for people who need immediate medical or social services but do not have emergent behavioral healthcare needs, Breed said in a statement. This may include calls for people with untreated minor injuries, calls about people who are asleep in public or homeless, and other wellness check calls. The team will consist of community paramedics and EMTs from the San Francisco Fire Department and Homeless Outreach Team members from the Department of Homelessness and Supportive Housing.

"Building on the early success of the Street Crisis Response Team, we are continuing our work to make a significant change to improve how we effectively serve people in need on our streets," Breed stated. "Many calls to 911 or 311 about someone who appears to need help on our streets don't require an armed police response, and often the services and care people need would be best provided by a paramedic or outreach worker instead of a police officer." 

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