San Francisco: Mayor London Breed Announces Plan to Create Behavioral Health Street Crisis Response Team

San Francisco, CA — Mayor London N. Breed today announced a plan to create a Street Crisis Response Team pilot program, which would begin the effort to fundamentally change the way San Francisco responds to 911 and 311 calls regarding behavioral health emergencies, involving mental health and substance use. The goal for this new team is to provide an appropriate non-law enforcement response to behavioral health emergencies in San Francisco and divert individuals in crisis away from emergency rooms and criminal justice settings into behavioral health treatment facilities.

"When people are experiencing a mental health crisis on our streets, we want to be able to respond in a way that is most appropriate and gets the person connected with the care and support they need," said Mayor Breed. "Often, calls to 911 or 311 about someone who appears to be having a behavioral health emergency don't actually need an armed police response. In fact, that type of response can sometimes makes things worse. With this pilot program, we're taking the first step toward redirecting non-violent calls from police to other resources, and are expanding behavioral health services in San Francisco. Because even though we've been focused the past few months on our COVID-19 emergency response, 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."

The Mayor's proposed budget for Fiscal Years 2020-21 and 2021-22 includes $4 million from the General Fund to pilot a Street Crisis Response Team to help San Franciscans who are experiencing behavioral health crises. If the consensus Business Tax Reform ballot measure passes in November, Proposition C revenues will enable the City to direct a total of approximately $16.8 million to the pilot program over two years, which would expand the program and create additional Street Crisis Response Teams.

"The Crisis Response teams are a critical part of the Mental Health SF law we authored," said Supervisor Hillary Ronen. "I appreciate that the Mayor has dedicated significant funding to implement our comprehensive law and I look forward to fighting for additional funds throughout the budget process."

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"We wrote Mental Health SF with frontline providers to address the suffering on our streets and the lack of immediate response and support for people in crisis," said Supervisor Matt Haney. "Maximizing 24 hour crisis response teams with experts responding to crises before they escalate is as essential and urgent as ever. This is a great start to fully implementing Mental Health SF."

"Every day San Franciscans encounter people in crisis on our streets but don't know who to call for help," said Supervisor Rafael Mandelman. "This city desperately needs a more effective response to behavioral health crises than the police can provide; we need teams of trained medical professionals and peers with the skills to actually make a difference in the lives of unhoused people with mental illnesses and the neighborhoods in which they take refuge. That's why street crisis response teams were identified as a top recommendation by the Meth Task Force, are a key component of Mental Health SF, and are a top priority in Mayor Breed's proposed budget. I am grateful for this important step towards full implementation of this critical reform."

The Street Crisis Response Team pilot program is part of the first phase of implementation of Mental Health SF, the City's strategic framework for improving the behavioral health response to people experiencing homelessness. In addition to funding the Street Crisis Response Team, Mayor Breed's proposed budget includes funding to establish an Office of Coordinated Care within the Department of Public Health, increasing behavioral health bed capacity to reduce wait times to access treatment beds, and expanding service hours at the Behavioral Health Access Center.

In June, Mayor Breed announced that the City is in the process of creating a system to divert non-violent calls from the Police Department to other first responders. Establishing a Street Crisis Response Team is an essential part of this system and enables appropriate calls to be directed toward behavioral health and medical professionals.

The Street Crisis Response Team will be a collaboration between the San Francisco Department of Public Health and the San Francisco Fire Department and will provide appropriate clinical interventions and care coordination for people who experience behavioral health crises on the streets of San Francisco. Each team will include a community paramedic from the Fire Department, and a behavioral health clinician and behavioral health peer from the Department of Public Health. The team will be dispatched to address calls for service by both the 911 and 311 call centers. In addition, individuals can be connected to additional services and would be supported by DPH to engage in these services and to ensure follow-up care is coordinated.

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Through pairing behavioral health specialists and medical professionals, the Street Crisis Response Team can begin to respond to some of the calls to which the San Francisco Police Department would otherwise respond. These include suicide or self-harm calls and calls for assistance to people who are presenting as disoriented, or who have other symptoms of intoxication or psychosis.

The service model for the Street Crisis Response Team is unique in the incorporation of peer support workers with lived experience of homelessness, mental illness, and/or substance use disorder. Peer support workers are people who have been successful in the recovery process and are skilled to help others experiencing similar situations. This team will coordinate with the Department of Public Health's Street Medicine team, the Department of Homelessness and Supportive Housing's Homeless Outreach Team, and the Fire Department's EMS-6 team.

"Department of Public Health clinicians and San Francisco Fire Department paramedics, who have a long history of partnership, will join people with lived experience of behavioral health challenges as they team up to resolve nonviolent crises on our streets," said Dr. Grant Colfax, Director of Health. "Bringing together these three distinct skill sets is an evidence-based crisis response model that we are proud to pilot in San Francisco."

"The San Francisco Fire Department has run a specialized unit for the past 4 years with trained community paramedics," said Chief Jeanine Nicholson, San Francisco Fire Department. "They provide compassionate advocacy and medical assessment in order to connect vulnerable people to definitive care for acute medical, mental health, and social needs. Our approach has proven very effective. We welcome the opportunity to collaborate with the Department of Public Health and expand this program. As a city, we will be able to provide these services on a larger scale and facilitate access to care for those experiencing behavioral crises on our streets."

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