How Bay Area Police Changed Their Approach to Mental Health Calls

from Kayla MichalovichCalMatters

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Brianna Fair, a mental health clinician with the San Mateo Police Department, received a dozen voicemails from the same distressed caller over one weekend this month. She knew the voice. It was her client who said that a celebrity had hacked her phone, that she needed help moving to another apartment, and why was the process taking so long?

“Normally she wouldn’t make a call like that unless she was starting to get into a crisis,” Fair said.

Keeping Fair close will ensure she’s connected to the services she needs and prevents her from calling 911, reducing the possibility of a full-blown crisis involving staff or unnecessary hospitalizations.

“I’m filling in the blanks,” Fair said. “It’s just a matter of getting her the right supports.”

It works, according to a new study of San Mateo County efforts of Stanford’s John W. Gardner Center on Youth and Their Communities, who found that the pairing law enforcement officers with mental health clinicians reduces the likelihood of more expensive and more intrusive interventions.

Fair was hired four years ago as part of a program to pilot this approach, also known as the “collaborator model,” in San Mateo County’s four largest cities — Daly City, San Mateo, Redwood City and South San Francisco. The idea was to free up police officers and provide alternatives to incarceration and hospital emergency rooms for people in a mental health crisis. Since then, the model has been rolled out to police departments in nearly every city in the county.

The researchers behind the Stanford study found that the associate model reduced involuntary psychiatric holds by approximately 17 percent and reduced the likelihood of future 911 calls for mental health among the four pilot cities. A hold allows the hospital to hold someone for up to 72 hours to determine if they are a danger to themselves or others. Given a reduction of approximately 370 involuntary psychiatric detentions over two years, researchers Tom Dee and Jaymes Pyne estimated an annual cost savings of approximately $300,000 to $800,000.

“We need to look for alternatives and really understand that police are not the best equipped to deal with mental health crises,” said San Mateo County Executive Mike Callaghy, who proposed the pilot after seeing cases that led to officers’ use of force and lawsuits.

During each visit with her client, Fair tries to help her check something off a list of things that are bothering her. Today, they sit side by side as they call the California Department of Human Services to ask about foster care. They are put on hold and after five minutes her client lets out a deep sigh.

“I know, it’s a lot,” Fair said. “That’s why I’m here.”

As jazz music plays in the background of the conversation, Fair grabs a bottle of dry shampoo from the desk, reads the label aloud, and asks her how she likes it. She brought the product on one of their last visits, a bandage solution she came up with because her client was having trouble bathing herself.

“Have you tried yet?” she asks. “Do you want me to spray it for you? Brush it first.”

Her client pulls her hair out of the ponytail, combs it with her fingers, and runs her hands through the part. Fair stands up from her chair, shakes the bottle and mists it over her head.

“Is it better?” she asks.

“Yeah, but you sprayed it in my mouth,” her client says, letting out a big laugh. “It feels fresh.”

Increasing number of mental health calls

The Stanford study adds to a a growing body of evidence about the positive impact of alternative first-responder programs that have spread across the country amid calls for police reform since the killing of George Floyd in 2020. These reforms are so nascent that not much is known about them, Dee said, and his research is one of the few that provides a credible assessment.

“This is common sense reform with a lot of promise,” he said. “That being said, this is not a cut-and-paste kind of reform. There are serious design and implementation details that are important to realizing the promise of these kinds of initiatives.”

Some of those details include police support, training dispatchers on how to triage calls and integrating mental health personnel.

San Mateo Police Chief Ed Barberini said it was a “risky proposition” when his agency decided to participate in the pilot program, worried that his officers would push back. But mental health calls are increasing, he said, and without clinical expertise, police officers are put in a difficult position. That sentiment is shared by law enforcement agencies across the state, some recently distanced themselves from calls for mental health.

“We realized we were looking at problems and just finding short-term solutions,” Barberini said. “I’m pleasantly surprised at how things turned out.”

Before the pilot program, San Mateo police officers who responded to 911 mental health calls had to decide whether to send the person to the hospital for a 72-hour involuntary hold, arrest them or let them go. By pairing them with a clinician, the agency was able to provide safety planning, follow-up calls and connections with community partners for people in mental health crises.

Mariela Ruiz-Angel, director of Alternative Response Initiatives at the Georgetown Law Center for Community Safety Innovation, said the collaborative response model is fantastic — but it’s just the beginning of what a progressive city looks like.

“It’s really about evolving to a level where we don’t have to send cops or fire for basic-level calls,” she said. “The idea was never to take the police out of the equation altogether. The idea was that we shouldn’t center them as the primary response to 911. We shouldn’t make public safety about the cops. Public safety is about the appropriate response.”

De-escalation of a family feud

The pilot program cost approximately $1.5 million over two years, split between the county and the four participating cities. After it ended, the San Mateo Police Department — an agency comprised of 116 sworn officers — converted Fair’s role into a permanent position as the agency’s first mental health clinician. The city is also using grant money to hire an additional part-time mental health physician. Every other participating city has also found a way to support their program.

On Monday morning, Fair responded to emails from police officers who asked her to contact people they had been in contact with over the weekend. This time of year is busy, Fair says, because the holidays can be lonely. In the past week alone, she’s had to respond to a variety of crises: evaluating a child who had an aborted suicide attempt and responding to a transgender youth who wanted to stab himself.

There is a radio next to her desk. She pauses to listen more closely as the dispatcher relays information about a man she believes is being followed by a federal agent. A family member called to report the episode. A few minutes later, Fair slings her backpack over her arm, tucks the radio into her pocket, and quickly makes her way down the hall to the garage. In the back seat of her county car – a white Toyota Prius – is a bulletproof vest, which she says she rarely uses.

Outside an apartment complex, Fair stops and turns on her flashes. The process, also called “staging,” is when she parks two blocks away so that police officers who have already arrived can check the scene to make sure it’s safe for her to arrive.

A few minutes later, she opens the car door and runs in her black Nikes and brown cargo pants. An officer introduces her to the family, and from there Fair’s work begins. She goes back and forth between the family and their loved one, who sits across from her on a bench, while gathering information from both sides: Is there a history of mental health? What substances have they used before? Are they currently receiving any treatment? Have they been hospitalized before? Have they threatened? What do you want to see happen today?

After 10 minutes, Fair pulls one of the officers aside to tell him that the person does not need to be hospitalized. “Let’s make a safety plan,” she tells him. That’s what the agency does if it receives a call that doesn’t rise to the level of an involuntary psychiatric hold. At this point, the officers say they are “just playing peacekeepers.”

They honestly rally around the family to explain that the situation is no longer a police matter or a mental health crisis, but rather a family matter. Still, she doesn’t want to let them feel alone. They create a “safety plan” that everyone can join so that, as she explains later, “we don’t get another call in 10 minutes because they’re fighting in the street.”

“We get calls like this — where it sounds like it’s going to be wild — and then we get here and it’s just a family thing,” she said. “It happens.”

Kayla Michalovich is a contributor to California Local News.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.