Filling a gap in mental and behavioral emergencies

They will help figure out what the right kind of setting and care the person needs.

San Francisco’s Department of Public Health moved to fill a persistent gap in the way The City deals with mental and behavioral health emergencies.

Since 2020 the Street Crisis Response Team slowly has been replacing police with health care workers to respond to mental and behavioral health calls. But a lagging component has been how to help people after they experience a crisis.

That gap is the focus of The City’s latest public health initiative, the Office of Coordinated Care, that launched Friday. The idea is to create a team of 20 caseworkers who will connect people experiencing a mental health crisis or transitioning out of emergency care facilities with ongoing behavioral health services.

The case managers will follow up with people released from jail, leaving an emergency room or being discharged from an involuntary hold, known as a 5150 hold, in an effort to maintain contact beyond the 72-hour psychiatric hospitalization. They will also accompany clients to appointments and meetings, rather than simply referring individuals to services, which may be difficult for some to follow through on without support or housing.

The office is slated to expand to 40 caseworkers by the summer and estimates it will work with up to 4,000 people a year.

“This office fills a critical gap in our ability to help people get into care and stay connected to care,” said Dr. Hillary Kunins, director of behavioral health services at the Department of Public Health.

Often, individuals struggling with homelessness, substance abuse and mental illness receive fragmented support. Lacking adequate supportive housing options, many end up repeating stays in jail, the emergency room or psychiatric emergency services.

“They will help figure out what the right kind of setting and care the person needs, whether it’s outpatient care, intensive care or some sort of residential care,” Kunins said, adding that caseworkers will also assist clients with signing up for programs like Medi-Cal and connect them with housing opportunities.

“We know that people can be more successful in reaching good health outcomes when they have their basic needs met. Whether it is health care or other kinds of benefits and food assistance and housing. Facilitating assessment for housing is a vital part of what we will aim to help people with,” she said.

The idea behind the office already has been tested via a pilot program launched in April 2021. As of March, the team was working with 72 individuals who had been referred through the street crisis responders.

The office will be led by Heather Weisbrod, who has worked for the Department of Public Health for 16 years. It fulfills a key component of Mental Health SF, the 2019 legislation that overhauls San Francisco’s approach to dealing with mental illness, substance use disorder and homelessness.

Mental Health SF also includes a commitment to add 400 mental health and substance use treatment beds across San Francisco’s health care network and led to the creation of the Street Crisis Response Team, as well as the hiring of 200 new mental and behavioral health care workers.

The Street Crisis Response Team was created to replace law enforcement responses to acute nonviolent mental health crises on the streets and is staffed by paramedics, mental health professionals and community peers. Since the team was launched nearly two years ago, calls to police for mental health crises have gone down and calls to the alternative response team have increased, a recent report by the Board of Supervisors Budget and Legislative Analyst shows. That progress has been slow, however.

Kunins said opening the Coordinated Care office stalled due to pandemic-related strains on the health care workforce. She credited Mayor London Breed’s emergency declaration in the Tenderloin for allowing the department to more rapidly hire the staff needed to open the office.

“We are working to fix a system that simply has not worked well for so many of those we see struggling in our city every day,” said Breed. “This requires both new resources but also reforming how we deliver services around mental health and substance use disorders. We want people to get the consistent support they need to heal and thrive, not to endlessly cycle through the emergency room, jail or the streets. The Office of Coordinated Care will help get us on a better path.”

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