Shari Lachin works on one of San Francisco’s new street outreach teams responding to homeless people experiencing a mental health crisis in place of the usual system, which relied on police officers. On one recent call, she came across someone living on the streets of the Castro who was suffering severe psychosis, “arguing a lot with themselves, really with the voices in their head.”
The person was prone to cussing and “saying all of these really terrible things,” leading to a history of fights and isolation in the streets. She and another team member took their time. They approached the person and spoke to them, encouraging the individual to respond to reality rather than internal voices.
“They were able to respond to us in between the kind of arguing that they were doing so they were able to hear us,” Lachin said.
As a result, the team was able to place the person in a shelter-in-place hotel. “It was the same day,” Lachin said. “It’s so magic.”
It is stories like these that are bringing praise to San Francisco’s Street Crisis Response Team, which launched back in November.
This week, San Francisco’s effort to divert some tens of thousands of non-violent 911 calls away from law enforcement came into sharper focus in Mayor London Breed’s two-year budget proposal, which called for additional street response teams, increased 311 call takers and creating a new position to coordinate dispatch.
Breed said the early results are promising in addressing the needs of “the people who too often end up in bad situations when confronted by law enforcement.”
“These teams are working,” Breed said this week. “I’ve seen the results myself.”
Lachin acknowledged that they have had issues finding shelter or treatment beds for some of those they engage with. Breed also acknowledged this week the need for more treatment beds and permanent supportive housing for the persons encountered. Her budget proposal includes spending more than $1 billion over two years for housing and other services for the homeless and funding for the operation of 343 more treatment beds, on top of the approximate 2,000 existing treatment beds.
The Street Crisis Response Team responds to 911 calls for “mentally disturbed person calls” not involving weapons or violence. It began with one crew comprising a community paramedic, a behavioral health clinician, and a peer behavioral health worker through the Public Health and Fire departments. Now there are four crews with two more expected to launch by the end of the summer. The six crews cost $10.6 million annually. Breed is proposing to add a seventh crew in her budget for an additional $1.8 million a year.
“The seventh team would provide additional day time coverage to ensure that all non-violent calls for ‘mentally disturbed adults’ can be responded to,” Breed’s spokesperson Andy Lynch said.
The expectation is the seven crews will have the capacity to respond to the approximate 17,000 annual 911 calls for “mentally disturbed adults” not involving violence.
Between late November and April 2021, crews operating in the Tenderloin, Mission, Castro and Bayview neighborhoods responded to 1,027 calls, 20% of the total nonviolent “mentally disturbed person calls” made during that same time period, and connected with 592 people in need, most of whom were homeless, according to the most recent city data.
Sometimes they respond to calls and cannot find the person. Fifty-five percent had their crisis resolved on the scene, 18% were transported to the hospital, 18% were transported to a behavioral health setting like treatment beds or shelters, and 9% were placed on a 5150, an involuntary psychiatric hold.
In the aftermath of last year’s police killing of George Floyd in Minneapolis, alternatives to a police response are gaining traction in cities like San Francisco. One of the most popular models was launched in 1989 in Eugene, Ore., where it’s known as Crisis Assistance Helping Out on the Streets, or CAHOOTS.
Breed’s budget also includes a new kind of team to respond to 911 or 311 calls for what are called well-being checks. This is when people on the streets may need a wound cared for, appear unconscious in a doorway or are under-dressed for the weather.
She is proposing to spend $9.6 million over two years for five crews for a new Street Wellness Response Team. These crews combine community paramedics and emergency medical technicians from the Fire Department with Homeless Outreach Team members.
The five crews will do both proactive outreach and also take on a portion of the estimated 18,000 well-being check calls that armed police officers respond to every year. But it would take five additional teams to respond to all of these calls. The target is to launch the first team in January 2022.
As the alternative policing models take shape, The City anticipates an increase in 311 calls. That is why Breed’s budget proposal includes hiring 10 additional 311 call takers at more than $1 million a year in salary and benefits. There are currently 80 full-time and five part-time call takers at 311, which has an annual budget of $16.8 million.
“These ongoing changes in our public safety response require that we provide an alternative that works,” Lynch said. “311 operators are an essential part of this effort.”
To coordinate calls and ensure proper dispatching of teams, Breed’s budget includes adding a position at the Department of Emergency Management at about $200,000 a year.
For some, though, these efforts do not go far enough.
The Coalition on Homelessness supports using a different model for the well-being checks and expanding response to include other police calls involving the homeless, such as low-priority calls like trespassing.
Their proposed model, Compassionate Alternative Response Team, or CART, estimated to cost $6.8 million annually, excludes city departments and relies on community members with crisis-response training and those who have experienced poverty or homelessness. They want the funding to come from the Police Department’s budget, which increases in Breed’s budget proposal.
Lynch said the Breed administration does not support CART since it excludes city staff.
As The Board of Supervisors Budget and Appropriations Committee reviews Breed’s budget proposal in the weeks ahead, a debate over police funding is expected.
Supervisor Hillary Ronen, who sits on the committee, told the Examiner she would “most likely not” support the Police Department’s budget increase.
“I want the new teams that respond to mental health crises and complaints about people experiencing homelessness to run 24/7 and be fully staffed so police no longer have to perform these functions,” Ronen said. “If that is not the case in this budget then I’m ready to move money from SFPD’s budget to instead fund the teams led by community and trained health professionals.”
Those involved in the work believe they will make a noticeable difference on San Francisco’s streets.
“We do believe that the work that we are doing is making a change and we see it anecdotally even just in the short amount of time that we have been out there,” Lachin said. “We are hopeful that that will continue.”
As for the person they encountered in the Castro, weeks later Lachin said she heard positive news of their progress. They remained in the hotel room, connected with a psychiatrist, got on medication and met with a housing coordinator in hopes of moving into permanent supportive housing.
“That is amazing,” Lachin said. “In that moment, we were able to change the course for this person and hopefully end their cycle of homelessness.”