San Francisco moving forward on plans to implement mental health crisis response teams

Mayor London Breed has proposed $17 million to fund the teams, which will include paramedics and behavioral health experts, for two years


Dominic Fracassa
San Francisco Chronicle

SAN FRANCISCO — In spite of the budget woes brought on by the shattering economic effects of the coronavirus pandemic, San Francisco is moving ahead with substantial investments meant to repair the city’s fragmented mental health care system. One of them will give the city its first street-crisis response teams, which will deal with psychiatric emergencies.

Over the next two years, Mayor London Breed’s proposed budget envisions spending nearly $76 million to begin implementing Mental Health SF, a sweeping vision of reform authored by Supervisors Hillary Ronen and Matt Haney.

San Francisco Mayor London Breed has proposed $17 million to fund four mental health crisis response teams, consisting of specialized paramedics and behavioral health experts, for two years.
San Francisco Mayor London Breed has proposed $17 million to fund four mental health crisis response teams, consisting of specialized paramedics and behavioral health experts, for two years. (AP Photo/Eric Risberg)

In addition to funding dozens of new beds for drug sobering, psychiatric skilled-nursing settings and board-and-care facilities, the budget includes money to begin hiring case managers for people with mental illness or substance abuse disorders, and for setting up a new, centralized office meant to ensure patients progress seamlessly through the city’s network of services.

“In the midst of a pandemic, with a massive budget deficit, to be implementing this reform to our system is extraordinary and exciting,” Ronen said. “This will lead to a different situation on the streets when it’s up and running.”

Perhaps the most visible element set to arise from the budget are new street-crisis response teams — specialized crews tasked with responding to mental health emergencies.

Currently, that’s a responsibility that falls largely to the police department. While the city does have several dedicated teams focused on addressing street homelessness and behavioral-health incidents, the street-crisis units would be the first to be solely dedicated to responding to 911 dispatches for mental health emergencies.

By doing so, city officials are making a deliberate choice to shift such service calls away from police officers — who, even despite added training, usually lack the expertise, experience and equipment needed to treat someone in the grips of a mental health crisis. Doing so was a key pillar of Breed’s blueprint for changing the day-to-day operations of law enforcement following nationwide calls for police reform.

With the street crisis teams and other investments, “We’re taking the first step toward redirecting nonviolent calls from police to other resources and are expanding behavioral health services in San Francisco,” Breed said in a statement.

Despite the time, energy and money spent on confronting the pandemic, “The other challenges on our streets with mental illness and substance use disorder haven’t gone away, and we must remain focused on addressing that ongoing public health crisis as well,” Breed said.

Breed’s proposed budget calls for investing nearly $17 million over two years to fund four, three-person teams, each made up of a specialized paramedic, a behavioral health clinician and a behavioral health peer — a person working with the city’s health department with first-hand experiencing dealing with mental-health crises.

Having trained specialists on the street-crisis teams is also meant to lessen the burdens on the city’s emergency room and psychiatric emergency services, since individuals in a crisis may be better suited for other types of care.

“Right now, we have a one-way express to an emergency room that starts with a police officer’s initial engagement,” said Simon Pang, section chief of the San Francisco Fire Department’s EMS-6 division, which handles calls dealing with the city’s highest-frequency users of emergency services, many of whom are homeless.

That one-way express, Pang said, “turns into a revolving door. An emergency room is a great place if you’re sick, but most people (treated by the crisis teams) have substance abuse and mental health problems and social needs.”

Police officers would still be called in for support in confrontations that could turn violent, Pang said. Currently, city officials are sorting through emergency call codes to decide what sorts of incidents the street-crisis teams will be responsible for. Pang said police responded to over 50,000 calls last year for incidents including people in distress wandering into city streets, to well-being checks to suicide attempts, some of which may fall into the street crisis team’s wheelhouse, Pang said.

“We recognize that right now in San Francisco there is an over-involvement of law enforcement in responding to people with substance abuse and mental health crisis on the street,” said Dr. Anton Nigusse Bland, the city’s director of mental health reform. “This is the first response where trained medical professionals are going out before police arrive at the scene, if it’s necessary for police to be involved at all.”

The Mental Health SF investments are largely dependent on city voters passing a business-tax reform initiative in November. In addition to recasting the city’s business tax structure, the measure would also unlock hundreds of millions of dollars in tax revenues that have gone unspent because of ongoing legal disputes.

Breed’s budget is now in the hands of the Board of Supervisors, which will hold hearings and make adjustments before sending it back for Breed’s signature before Oct. 1. Ronen said she intends to push for additional funding for Mental Health SF, which will likely necessitate cuts elsewhere in the budget.

She’s seeking nearly $12 million over two years to add a fifth three-person unit to the street-crisis response team and to expand the hours at the city’s Behavioral Health Access Center so it can stay open around the clock. Breed’s budget currently sets aside money for the facility to stay open longer, but Ronen said, in order to be effective, it needs to be open “24-7.”

“For Mental Health SF to work in a way where people see change on the street, then you have to have a service center open 24 hours a day and a crisis outreach team functioning 24 hours a day,” Ronen said. Without round-the-clock access to mental health clinicians, people who need treatment will invariably get sent to the “already overwhelmed” city emergency rooms, she said.

Ronen has also asked Breed to allocate the $12 million for those purposes should the city receive additional federal stimulus money.

“My inclination is four (street-crisis teams) is not enough. It’s possible five is not enough,” said Supervisor Rafael Mandelman, a member of the board’s Budget and Finance Committee. The number of teams “is a pretty important thing for us to push on. I’m with Supervisor Ronen on that,” he said.

“We want the status quo to change. And the status quo is one where every single day, most of us see one or two individuals out there who need a mental health intervention seemingly not getting it,” Mandelman said. “We can’t wait until COVID-19 is behind us to address these issues.”

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©2020 the San Francisco Chronicle

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