New approach to mental health crises in Calif. county

A pilot program will see mental health clinicians respond along with police officers to mental health emergencies in San Mateo County


Reprinted with permission from The Daily Journal

By Zachary Clark
Daily Journal

SAN MATEO, Calif.  — Three San Mateo County police departments this year are expected to enter into a pilot program aimed at enhancing their response to mental health crises.

The pilot is intended to complement existing programs in the county, including the San Mateo Assessment and Referral Team, or SMART. Pictured here is AMR Paramedic Nick Watts who is assigned to SMART. (Photo/Nick Rose/Daily Journal)
The pilot is intended to complement existing programs in the county, including the San Mateo Assessment and Referral Team, or SMART. Pictured here is AMR Paramedic Nick Watts who is assigned to SMART. (Photo/Nick Rose/Daily Journal)

The program will embed a full-time licensed mental health clinician within the San Mateo, South San Francisco and Redwood City police departments — there will likely be a total of four clinicians between the three cities — to respond along with police officers to mental health emergencies.

Conceived by San Mateo County Supervisor Don Horsley and being developed in partnership with the San Mateo County Manager’s Office, the program is expected to be rolled out by the end of the year following approval by the Board of Supervisors.

If the program is a success, it may expand to additional police departments in the county, Horsley said.

“This is really a change for responding to someone in mental health distress. I think this is really the future,” Horsley said of the pilot program. “The goal is efficient, effective and safe interaction with someone in a mental health crisis and after having a better connection between law enforcement and the follow-up resources that are available.”

The pilot is intended to complement existing programs in the county, including the San Mateo Assessment and Referral Team, or SMART, and the Psychiatric Emergency Response Team, or PERT.

Implemented in 2005, SMART is the first and only program of its kind in California. The program consists of two SMART vans staffed with paramedics available to assist with mental health crises anywhere in the county between 8 a.m. and 10 p.m. daily.

Only law enforcement can call a SMART medic, who provides a second opinion following the responding officer’s assessment of the situation and often speaks at length with the patient to figure out the best course of action. The SMART medic will then discreetly transport the patient in an unmarked vehicle to a facility of that person’s choice or to one of the county’s two psychiatric emergency departments, among other locations. And the ride is free, unlike the ambulance.

Launched in 2015 in San Mateo County, PERT consists of one sheriff’s detective and one licensed mental health clinician from the county’s Behavioral Health and Recovery Services department. PERT reviews all Sheriff’s Office cases involving possible mental health illness and conducts follow-up investigations when necessary, with the goal of “connecting patients and families with services and resources that can help manage acute crisis, prevent tragic outcomes and reduce hospitalizations and incarcerations,” according to the county’s website.

PERT only handles cases within the Sheriff’s Office’s jurisdiction, which includes Millbrae, San Carlos, Half Moon Bay and the coast, among other communities.

Horsley said both SMART and PERT are vital resources in the county, but also have limitations.

Direct response

Unlike the new pilot program in the works, SMART medics don’t arrive to the scene until police officers have assessed it and call them, and their training and credentials fall short of those of a licensed clinician, Horsley said. And he said while PERT at times responds directly to mental health calls, the program is typically used for followup on an incident.

The pilot program will have the clinician directly responding to calls with police as well as performing the follow-up work PERT is known for, Horsely said.

San Mateo Police Chief Ed Barberini at a meeting last month also described the differences between the pilot program and his department’s current approach to mental health incidents.

“It would be a response to a call with the police officer rather than police officers getting on scene, deciding they have to commit someone to the hospital, calling the SMART van and waiting for 40 minutes for the SMART van to show up — a much different model,” he said. “Right now, we’re simply triaging these calls. We’re getting there and all we’re trying to do is fix a problem that’s in front of us right at that moment and then once we fix it we move on to our next call for service.”

Barberini also anticipates the clinician will be in close contact with colleagues at Psychiatric Emergency Services and have access to patient information that police officers are legally restricted from accessing.

Barberini concluded the new approach will be timelier and more effective than the existing one with the ultimate goal of reducing the number of mental health calls.

“If we can provide more sustainable and effective care for folks experiencing these types of crises hopefully it’ll result in less and less of these types of calls,” he said.

Mental health cases on the rise

Horsley envisions the new clinician, a police officer and SMART medics all responding together to a mental health incident.

“The way the police chiefs and I visualize it is if we had clinicians and SMART we’d be much more effective,” he said. “But that remains to be seen.”

Horsley said he came up with the idea for the program after seeing over and over in the news incidents that “could’ve been handled better or maybe differently.” He also said mental health cases appear to be on the rise in recent years.

That impression is consistent with a statistic District Attorney Steve Wagstaffe provided. He said mental illness was a “primary component” of 75% to 80% of the officer-involved shooting cases his office reviewed over the past 10 years.

According to Barberini, the embedded clinician will only be available during peak call for service hours. And while the cost of the program has yet to be determined, it will be split 50-50 between the county and the city in which it is rolled out, Horsley said.

Horsley wants the pilot to be in place for at least two years, with regular and thorough evaluations of its efficacy.

“In the first year I think there’ll be a lot of learning and growing,” Horsley said. “I think in that second year we’ll really see the fruits of this program.” 

NEXT: 8 things to know before establishing a mobile crisis intervention co-responder program

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