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Mobile mental health services explored in SF

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David Elliott Lewis is taking the lead on the possible development of a fleet of Mobile Wellness Vans to provide mental health services. (Jessica Christian/S.F. Examiner)
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For the past three months a group of mental health board members have discussed launching a fleet of Mobile Wellness Vans to rove San Francisco streets to better address those with mental illness before greater calamity hits.

The effort could reduce the high demand of psychiatric beds and address some neighborhood complaints, possibly decreasing 911 calls and the expenses related to ambulance response and hospital stays. The vans could also bring services to areas of The City where residents are not close to mental health clinics.

At least one member of the Board of Supervisors supports the idea. Supervisor Katy Tang, who represents the Sunset District, told the San Francisco Examiner on Friday she would “welcome this being implemented.”

“In districts such as the Sunset, where we have very few service providers physically located out here, I see mobile wellness vans as a great cost-effective solution to providing a safe and helpful space for those needing urgent mental health services,” Tang said.

David Elliott Lewis is taking the lead on the effort as a member of the San Francisco Mental Health Board by chairing the board’s new Wellness Van Committee, which has held three meetings on the issue since it was initially proposed late last year. He also is a member of the Crisis Intervention Team Training for the Police Department, which teaches officers how to de-escalate a situation and handle those who may suffer from mental illness.

“Remember the ‘Peanuts’ comic strip, Lucy’s 5-cent psychiatry stand? Imagine crossing that with Lava Mae, which is a portable shower system for the homeless,” Lewis said.

Inspiration for the idea came from a presentation to the board late last year from Cecile O’Connor, a nurse who founded DORE Urgent Care Clinic on Dore Alley in SoMa.

“What she said is that in her eight years of running this place is she thought that a lot of problems could be solved in this city and money saved if we … could intercept somebody in crisis before it gets to the point that it needs to go to an emergency room,” Lewis said.

That’s where the vans come in. A draft resolution backing the idea is being discussed by the committee, which would call on the Department of Public Health to fund five 24-hour, seven days a week Wellness Mobile vehicles with appropriate and adequate staffing beginning July 1.

Lewis said he couldn’t yet provide a cost estimate for the service and the proposal remains in a design phase with unsettled issues such as appropriate staffing levels and how the vans would look.

“You can walk by a mental health clinic like Mission Mental Health on Mission Street and you would never know it’s there. Because it’s just windows and it’s blank storefront,” Lewis said. “I am hoping that our van won’t be blank. It will actually have a sign that says something like: Mobile Wellness Van. Welcome, come in and talk to us.”

He said there could be tea and cookies offered, and conversations held in and around the van, which could also serve as a base from which outreach workers could fan out into the neighborhood.

The City currently funds a Homeless Outreach Team and has a Behavioral Health mobile crisis unit, but Lewis said the Mobile Wellness Vans wouldn’t duplicate those services.

Lewis also said the vans wouldn’t specifically target the homeless. Rather, they’re for “anyone who needs to connect with another human being, homeless or not — homelessness is besides the point.”

Mental health conditions are prevalent among homeless residents. More than two-thirds, or 67 percent, of the 6,686 homeless identified in the 2015 point-in-time homeless count reported one or more health conditions, including physical illness and severe mental health conditions. Abuse of drugs or alcohol was the most common health condition at 37 percent, followed by psychiatric or emotional conditions at 35 percent.

“Hospitalizing someone who really just needs a few hours away from the street to calm down is expensive and takes acute psychiatric beds from others in greater need,” reads the draft resolution. “Wellness Mobile vehicles with appropriate and adequate staffing can deliver crisis de-escalation, mental health services and substance abuse referrals to neighborhoods which would otherwise be unable to access such services.”

The resolution also said that the demand for Psychiatric Emergency Services at San Francisco General Hospital “often results in the hospital reaching capacity.”

Department of Public Health spokesperson Rachael Kagan said the department was aware of the Mental Health Board’s discussion. “We look forward to learning more about what may be proposed and how it fits in with current 24-hour mobile crisis services and other mental health services provided by the Health Department,” Kagan said.

Lewis said the committee will meet again later this month to discuss the next steps.

“I am seeing this as a preventative approach when people are descending into darkness and panic attacks and having maybe suicidal ideations without the immediate intent,” Lewis said.

“Maybe if they had someone to talk to, a comforting voice, tea and cookies, a calm, safe environment maybe they can be diverted into our behavioral health system and get help before it escalates into a full-blown crisis.”

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