Reimagined Crisis Response

This article is intended to supplement information available from San Mateo County’s Department of Behavioral Health and Recovery Services (BHRS). The Mental Health Emergency Guidelines for Calling 911 brochure is available at https://www.smchealth.org/mh911. This brochure can be viewed online, printed out, or printed copies can be requested from BHRS.

Be Prepared

We also recommend that family members of those who have experienced mental health emergencies in the past, as well as those who anticipate possibly doing so in the future, review, download and complete (as much as possible) the Information From Family Member form, available at: www.smchealth.org/sites/main/files/file-attachments/familyform_english.pdf?1488924926. Keep this form current and have a few copies on hand to share with different agencies as HIPAA regulations prohibit agencies from sharing client information. It is also suggested that Psychiatric Advance Directives also be completed and ready in the event of a crisis.

A Different Philosophy

NAMI SMC is aware that there have been changes in the last year of how law enforcement responds to mental health emergencies. Details of these changes have not been formally announced and are currently being developed. They are a result of changes in legislation and case law. The changes are intended to reduce negative outcomes in mental health emergency responses, and to limit law enforcement liability when things don’t go well. While it is generally agreed that the best practice is to have mental health experts respond to mental health emergencies, with, or even without law enforcement, the fact is that this service is in very short supply in San Mateo County. While we are fortunate to have Mateo Lodge, that has been around for years, and is a veritable prototype for what is being done elsewhere now, they are small, under resourced and will only respond under very specific circumstances. There are also some pilot programs being initiated in four cities in the County that would send a clinician to mental health emergencies, but these are still in the early stages. Chances are it will still fall to law enforcement to respond to a mental health emergency call. Law enforcement recognizes the need for safe and respectful responses to 911 mental health calls. For 16 years, SMC law enforcement, BHRS and NAMI have collaborated to conduct Crisis Intervention Team (CIT) training coordinated by the Sheriff’s Department. This week-long (40 hours) training is intended to educate law enforcement and related agency personnel to better respond to mental health emergencies. Almost all law enforcement in the County now have this training, but as it states in the BHRS brochure, when calling for a response to a mental health crisis, it is advisable to request officers who have CIT training.

The Changes

Especially if you have previously called for a mental health emergency response, you may notice that the current process will seem to develop slowly. Law enforcement is going to be more deliberate than in the past. Officers may call you while enroute to confirm what they heard from the dispatcher, and obtain more information. They may not come to the exact location where the mental health emergency is occurring, instead maintaining some distance so as not to immediately escalate the situation. You may need to leave the place where the situation is developing to meet with them a safe distance away. When doing this, it will be best to be prepared, with communication devices, relevant phone numbers (i.e. providers), the family member form, advance directives and other documents and information that might be relevant. They will probably secure the area, call for back-up, and even wait for a supervisor to arrive. This is because they are assessing the “priority of life”. They will consider carefully whether the person is a threat to others, including you, and the officers themselves, before taking any action. In some instances, they may choose to not intervene at all. They cannot provide any assurances in terms of possible outcomes either. If law enforcement cannot engage with the person experiencing a mental health challenge, they may recommend that the reporting person contact behavioral health agencies and depart. This is called “disengagement”. Law enforcement will also be very cognizant of whether there have been any penal code violations. In the absence of any criminal actions, they may not take any direct action with an individual who is “only” a threat to themself. Under these circumstances, they may reach out to treatment team members, case workers, and others who are familiar with the person and their circumstances. They need to be careful not to “bring the risk” or “create a danger”. They do not want to initiate a sequence of events that results in force needing to be used, as that could put them at fault. Also, be aware that law enforcement will be much less likely to enter any premises when responding to a suicide emergency call. It is very unlikely they will enter anyone’s home uninvited regardless of the circumstances, unless there has been a crime. Destruction of property within a dwelling, or even damage to the dwelling itself, is not a significant enough crime to warrant law enforcement entering a residence during a mental health emergency call. They also may not enter even if invited, unless someone other than the person experiencing the crisis is in danger. If inside, they will not break down a door to gain access to someone, even if there is a possibility of a suicide attempt occurring. To prepare, have in mind what you might do in these circumstances. Also, if the call is for a response to your home, you might want to be ready to leave for the night in the event the premises cannot be made safe. As difficult as it may be, it will be important to be patient, even though time may not be on the side of the person in crisis. Risks taken in the past to try to save someone are no longer considered justifiable under the law, or public scrutiny. Law enforcement is trying to balance their legal obligations with their moral obligations.

Continue to Call 911 in Crisis Situations

And, even though the law enforcement response may be different from what you have experienced in the past, and/or not meet your expectations, it is important that you continue to contact law enforcement in the event of mental health emergencies. Until/ unless viable alternatives are developed and deployed, this is the appropriate course of action. The record and paper trail created by these contacts may be needed for other legal remedies, including conservatorships and restraining orders.

Planning and Preparation are Critical

In addition to the Information From Family Member form, there are other ways to prepare for mental health crises. Wellness Recovery Action Plans (WRAP) are a great tool. You can learn more about these at: https://copelandcenter.com Having a release form allowing your family member’s medical information to be shared with you is important as well. And remember, even if providers cannot talk to you, you can talk to them and provide crucial information. Have a conversation with your loved one with a mental health condition about services being very limited, and how their active participation in care is critical during these changing times. Unfortunately, another thing to be prepared for is that if your loved one does get put on an involuntary hold (5150), and are taken to County General Hospital, chances are they will actually be hospitalized in another county! In-patient Psychiatric Unit beds, which were already in short supply, were cut last year in a cost saving measure. This could mean trips to Marin, Santa Clara or even Monterey County. But it is still preferable that your loved one go to the hospital as opposed to jail. As part of your plan and preparation for a mental health emergency, when your loved one is able to collaborate with the family discussion, plan for treatment or hospital psych. emergency before illness escalates to the degree of needing to call 911. A call for emergency response should be a last resort, after other options with providers, case workers and other available professionals have been exhausted.

Join Us at NAMI SMC

A reminder that NAMI SMC is the leading organization in San Mateo County for supporting family members of people who experience psychiatric emergencies, and other mental health challenges. We offer Family to Family classes and specialized support groups, but most importantly, a community of people with shared experience navigating a mental health system that is, at best, challenging. And always, if you know someone who is in a suicidal crisis or emotional distress, please reach out for 24/7 confidential crisis support: call 650-579-0350 (or 1-800-273- 8255) or text “BAY” to 741741.

Contributors are: Twila Dependahl, Liz Downard, William Elting, Ruan Frenette, Pat Way

In February 2021, Rebecca Bauer-Kahan, Assemblymember District 16, introduced legislation calling for a new three-digit phone line, 9-8-8, for suicide prevention and immediate, localized emergency response for individuals in mental health crisis by trained mental health professionals. This bill will designate crisis hotline centers to provide intervention 24/7 through call, chat, and text. These call centers will be able to deploy crisis services – such as mobile crisis teams and crisis stabilization services. To ensure long-term success, centers will also follow up with callers to ensure they receive ongoing care.

For more information about AB 988 – The Miles Hall Lifeline Act, check out this fact sheet and visit www.justiceformileshall.org.