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Mayor Breed Calls for Change to State Law to Expand Involuntary Mental Health Treatment
Sunday, January 23, 2022

Mayor Breed Calls for Change to State Law to Expand Involuntary Mental Health Treatment

At an emergency dispatch center on Tuesday, Mayor London Breed praised early results from the Street Crisis Response Team, a newly-formed group of paramedics and health workers that respond to mental health calls in lieu of police. But she also called for changes to existing law to make it easier to compel severely ill patients into treatment. 

According to the city, the new response teams responded to 4,616 calls between November 2020 and October 2021, with 2,532 of those calls resulting in engagement from a three-person team of a peer specialist, a paramedic and a behavioral health expert. The Department of Public Health, the Fire Department and the Department of Emergency Management introduced the street crisis response teams last November on a pilot basis and as an alternative to police response for 800-B mental health calls, which indicate an unarmed person who is in behavioral health distress. 

But existing responses aren’t enough to “see a real difference a lot faster in our city,” said Breed, who urged changes to state law governing the use of involuntary treatment. 

Breed described a recent ride-along with a crisis response team, during which they spent over an hour with a client who ultimately required a psychiatric hold. The crisis response team employs low-barrier treatment methods, meaning that treatment is optional except in cases of particularly unstable clients who require a psychiatric 5150 hold. 

“[The client] didn’t have a weapon and wasn’t going to harm themselves, [but they were] going in and out of traffic,” Breed said. “A car could’ve potentially hit them, or that person in the car who hits them could be harmed themselves. It was a real problem.” 

The crisis response teams are one of a few programs spun up last year to assist with behavioral, drug or wellness incidents in lieu of police; others include a Street Wellness Response Team (SWRT), a team of community paramedics managed by the fire department, and Street Overdose Response Teams, which respond to overdoses. 

Assistant Deputy Chief Sandy Tong chats with SCRT staff, SFFD Chief Jeanine Nicholson and others in front of the SCRT van on November 30, 2021. | Camille Cohen

The teams are an evolution of a now-discontinued Law Enforcement Assisted Diversion program, which attempted to train police in harm reduction practices but fell apart, in part, due to disagreements over the role of law enforcement in behavioral calls. On Nov. 19, police officers fatally shot a man who had a history of mental health problems and was brandishing a knife.

The crisis response teams began around-the-clock service in October 2021, and currently include six vehicles that are capable of responding to between 60% and 70% of mental health disturbance calls, according to director Kathleen Silk. The city plans to add a seventh soon, with the goal of responding to all 800-B calls by 2022. Silk said that in most cases the teams are successful in deescalating the situation, defined as a client remaining in the community to receive follow up consultation. 

“We don’t just leave them there,” Silk said, adding that a follow-up team attempts to track down and offer services to clients. The team has been successful in following up with 34% of the 2,532 clients thus far, while 27% went unlocated and 2% of individuals declined support, according to an October report

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“We can’t force someone to stay in our care. We can’t force someone to stay in a treatment bed. We can’t force someone to not behave a certain way. We can’t force someone to take their medication,” Breed said. “We don’t necessarily have the local jurisdiction to make those changes. We need a change in state law and we need a change in this country about how we address mental illness”

In 2019, the city opted in to a state bill that expanded the use of conservatorship for individuals who are placed in a 5150 hold more than eight times over a 12-month period. But the option hasn’t been widely used, with city officials citing narrow eligibility criteria and red tape in a March 2021 hearing. 

Law enforcement officers and licensed clinicians are permitted to initiate 5150 holds in San Francisco. In July, the Board of Supervisors passed an ordinance that gave fire paramedics meeting certain training requirements the authority to place involuntary holds, citing a high number of “frequent flyers” who were detained multiple times by police or clinicians over the course of a year. According to a report by the Department of Public Health, there were 450 individuals placed in involuntary holds in 2020, and 112 who were detained four or more times. In total, clinicians and police officers placed 8,975 total holds last year. 

“The point of our team is that we are trying the lowest threshold first, and there are people who don’t necessarily respond to that,” Silk said. “It would be nice to have tools to help those folks as well, but what we’re trying to do is resolving a lot of stuff in the community.” 

David Sjostedt can be reached at david@sfstandard.com.

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