Crisis response crisis?

The process of finding a way to replace having police officers respond to “mental-health crisis” calls has taken awhile – and it’s not over yet.

When the police-reform subcommittee on “unbundling” published its draft report on January 24, it recommended that the City “contract with non‑profit or external governmental organization(s) to respond to non‑criminal calls for service, such as those related to individuals in crisis (including those with acute or ongoing mental health needs), unhoused individuals, welfare checks, and substance use.”  In addition, the City should “analyze incoming calls and implement necessary changes to the 9-1-1 system to redirect calls when services can be provided by other professionals.”

The police-reform steering committee’s final report reiterated these recommendations.  On March 16, Council accept the final report and directed staff to “evaluate options” to “shift responsibility for responding to mental health crisis from the Police Department to other City or County programs.”

Nearly two months later, after the death of Mario Gonzalez, Mayor Marilyn Ezzy Ashcraft and Vice Mayor Malia Vella called a special Council meeting.  Staff had not yet presented any options for a crisis-response program, and their referral instructed City Manager Eric Levitt “immediately” to “create a mental health‑oriented response model similar to the CAHOOTS program in Eugene, Oregon and the MACRO program in Oakland, California.”

The special meeting took place on May 8.  Mr. Levitt identified three alternatives for a “non-police response” program:  the CAHOOTS‑style and MACRO‑style approaches cited in the referral and a program to be run by the Alameda Fire Department and staffed by union firefighters.  (He stated no preference among the three.)  Council then directed Mr. Levitt to “shift response of as many Alameda Police Department calls for service to existing resources and return as soon as possible, and no later than the end of June, with a pilot program proposal and budget that incorporates City Council feedback received” at the meeting.

A month later, on June 15, Mr. Levitt presented his pilot-program proposals.  The fire department program – of course – was on the list.  But notably missing were any programs based on the CAHOOTS or MACRO models.  And there was a new entrant:  the Felton Institute, which the staff report described as San Francisco’s “largest outpatient mental health provider serving families and individuals of all ages with varying levels of mental and behavioral health challenges.”

Mr. Levitt hadn’t rejected either the CAHOOTS or MACRO models, he told Council.  “I do believe that other programs are possibly available,” he said, “but as far as trying to get something up and running available within 30 to 60 days . . . these are the two most viable programs that we found that could do what the council wanted. . . . [W]hat we were trying to do is get . . . something that would be viable by the end of the summer.”

By submitting a proposal from Felton, Mr. Levitt appeared to be following up on the preference – expressed most frequently by Mayor Ashcraft – for a program that was managed and staffed by mental‑health professionals.  According to Felton’s proposal, the goals of its program would be to:

1) Respond to critical mental‑ and behavioral‑health emergencies and non‑emergencies on an on-call basis to de‑escalate critical events and provide coordinated services;

2) Support, enhance, and address gaps in City‑contracted mental health and homeless engagement services;

3) Offer and provide “Motivational Interviewing” and “Harm Reduction” training to APD, AFD, and other “service partners”;

4) Work with identified homeless, substance abusers and mentally ill clients to improve functionality, tracking and engagement; and

5) Work with existing City of Alameda programs, departments and community‑based organizations/providers to complement and enhance their efforts in supporting mental health client populations.

Unfortunately for its chances of getting selected, Felton got off on the wrong foot.  In its proposal, Felton chose to highlight one of its existing programs called the “Healthy Streets Operations Center,” in which its outreach team “worked with” the San Francisco police department to respond to mental‑health-crisis and other calls.  This “collaboration” with the cops, the proposal stated, “helped with ‘buy in’ from Law Enforcement, erasing some of the stigma associated with harm reduction, restorative justice, and criminal justice reform,” and “helped us identify folks within the SFPD that were more open to using a social justice approach when engaging with individuals with [behavioral‑health] issues.”  Moreover, these “types of meaningful engagements” with the police “led to our outreach teams building rapport” with law‑enforcement agencies.

All of which may have sounded reasonable – indeed, even a selling point – for those reformers inclined to judge a crisis‑response proposal based on the variety of benefits it offers.  But it didn’t go over well, to say the least, with the small (one hopes) but vocal segment of Alamedans who hate the police with a passion.  (Any reader who thinks “hate” is too strong a word should listen to the public-comment portion of any Council meeting on police reform.)  Indeed, about a dozen of them called in to express their outrage that Council was even considering doing business with an organization that admitted it was willing to work with the cops, much less one that actually regarded such cooperation as beneficial.

Thrown a lifeline by Mayor Ashcraft, the Felton folks who spoke at the meeting (president and CEO Al Gilbert and program director Curtis Penn) defended themselves as best they could.  (If the Felton outreach team had a “crisis” under control and then a police officer showed up, Mr. Penn told Councilman Tony Daysog, they’d tell the cop he was “no longer needed.”)  Mr. Levitt also pointed out that it was impossible to remove the police entirely from the process of responding to mental‑health‑crisis calls.

This issue was still being batted around when, thanks to Mayor Ashcraft’s insistence on adhering to a firm midnight deadline, Council adjourned without voting on which proposal to accept.  (Vice Mayor Vella, Councilman Daysog and Councilman John Knox White wanted to make the decision that night, even if it meant busting the Mayor’s deadline, but it takes a supermajority to extend the meeting time, and Councilwoman Trish Spencer joined the Mayor in voting no.)  Instead, the item got kicked over to July 6.

Although we often recoil at the rhetoric used by some of the police‑reform advocates, their frustration with the delay in getting a “non‑police response” program up and running is understandable.  At the same time, we don’t believe it would be fair to cast aspersions on Mr. Levitt or his staff.  As the June 15 staff report points out, at its March 16 meeting, Council gave the City Manager 22 action items relating to police reform to work on.  At its May 8 meeting, Council added eight more items (there was some overlap with the previous list).  Maybe if the Council members had taken more care to set priorities, staff could have gotten the most important items done sooner.

In any event, the politicians and the public can mull over the choices for another three weeks.  Today, we’ve picked out a few areas in which to compare the AFD and Felton proposals.

Services

According to the staff report, the fire department has developed what it dubs the “Fire Forward” program in which it would establish a “Crisis Mobile Unit” that “would respond only to non‑violent behavioral health emergencies for clients.”  This unit would “respond to, treat, and/or transport members of the community who are in need [of] mental health services to Alameda County facilities appropriate for the client’s needs and provide services within the city related to mental health emergencies.”  A “Mental Health Clinician” then would “follow‑up with clients.”

The Crisis Mobile Unit would operate 24 hours a day, seven days a week.

The Felton Institute proposal – which it calls its “Behavioral Health Engagement Response Specialists” program – is similar but broader.  According to the staff report, Felton proposes to “provide mental health and homeless response services to those living with persistent behavioral and mental health challenges.”  This would include both “direct services” and “on‑call response.”  (Mr. Gilbert told Council that Felton maintained its own hotline that a person could call instead of 911.)  A “critical component” of the program would be conducting “mental health training for partner stakeholders including the City of Alameda Community Development Department, FD, including Community Paramedicine, and PD.”

At the June  5 meeting, Councilman Daysog posed a hypothetical that gave Mr. Penn a chance to illustrate how the Felton program would work in practice.  Suppose, Mr. Daysog said, Felton got a call at 1:15 a.m. about a woman who had been “yelling in the street for 40 minutes.”  What would the Felton outreach team do?

Mr. Penn replied:

What’s important is building a relationship, building a rapport, with this individual, immediately, getting the person’s name, see how much information you can get, see whether or not this individual had prior engagements with other [community benefit organizations] in the area, with other behavioral health agencies within an area, because we want to get a kind of a behavioral health [profile] on this individual.

The goal is to de‑escalate the situation immediately, and then build that rapport. . . .  Get as much information as possible, see if there’s some issues around family reunification, see if there’s some issues around substance use, if she is under the influence of anything, see if there’s any issues around whether or not she wants to harm herself.  Based on these questions, so we’ll do a quick intake on this person, and then an assessment and then what we call a plan of care, but she will be working directly with a clinical person. . . .

Felton gave the City two options:  it could provide its services nine hours (the June 15 staff presentation said 12 hours) per day, five days a week, or, for more money, it could provide them on a 24/7 basis.  Under the latter option, it would also conduct “night canvassing” from 7 p.m. to 7 a.m. daily in Alameda’s “most challenging communities.”

Not surprisingly, given the public comments, a lot of the discussion at the June 15 meeting focused on the role the police department would play in the process.

Both AFD and Felton acknowledged that there were circumstances in which the “first responders” sent to the scene of a mental‑health crisis call might need to bring in the cops.  As Acting Fire Chief Ricci Zombeck put it, “In an incident where there might be the potential for violence, then, of course, the police department would be needed there.”  But this scenario wasn’t the only area in which the police might get involved.

One issue involved dispatch.  As Acting Fire Chief Zombeck explained, at present all 911 calls go to the police department.  If the dispatcher determines the call isn’t one for the police, she routes it to the county’s regional emergency communications dispatch center, which then notifies the appropriate agency such as AFD.  This system is, at best, cumbersome, and it would need to be revised whether Council chose to go with AFD or Felton.  Moreover, as Councilwoman Vella pointed out, the dispatchers would need further training about which calls, both to 911 and to the non-emergency line, should trigger a “non-police response.”

Another involved so-called “5150” determinations.  At present, according to Mr. Levitt, in Alameda County only police officers can determine whether a person poses such a danger of harm to herself or others that she should be taken to a psychiatric hospital and placed on a 72‑hour hold.  AFD was seeking, he said, to get the County to extend this authority to the fire department as well.  In the meantime, a police officer still would need to be called to the scene.  The same would be true if Felton was running the program.

Staffing

The AFD program would be staffed by six union firefighters, with one firefighter/paramedic and one firefighter/EMT assigned to each of three shifts.  These firefighters would receive “MH clinician” training from Alameda County.  (The staff report did not specify how much, but at the May 8 Council meeting Acting Fire Chief Zombeck stated that the County had offered 90 hours of “de‑escalation” and “crisis intervention” training for AFD personnel.)  In addition, the City would hire a “Social Worker/Clinician” who would spend 40 hours per week providing “follow-up care.”

Staffing for the Felton program depends on whether it operates 24 hours a day, seven days a week, or nine hours a day, five days a week.  In the former case, the staff would consist of 3.5 “clinical staff” – a Felton spokesperson told us this referred to social workers – and five case managers.  In the latter, there would be 2.5 clinicians and four case managers.  In both cases, Felton stated, the program staff would be “supported by our wrap-around service systems that provide a continuum of care to address problem solving and support as a process not a Band‑Aid.”

At the June 15 meeting, the Felton representatives emphasized the demographic diversity of the people who would do the work.  “We’re staffing it with [a] majority of people of color,” Mr. Gilbert said, “because those are the people who are the majority of the people who we’re serving. . . .”  He added that Felton’s staff overall was “extremely diverse so we have the same amount of white, the same amount of Asian, the same amount of African American and Latino staff [as] the clients that we serve. . . .”

AFD cannot make a similar claim.  According to City Human Resources Director Nancy Bronstein, the most recent EEO data shows that, of 103 sworn firefighters in the department, 83 are white; nine are Asian; five are Hispanic; four are Black; and two are Native American.  Likewise, 101 firefighters are male; two are female.

Experience

At present, of course, the police department, not the fire department, is responsible for responding to mental‑health crisis calls (both emergency and non‑emergency) in Alameda.  Nevertheless, AFD does run a “community paramedic program” – staffed by one firefighter/paramedic supervised by a captain and a deputy chief – that it says has “served Alameda’s elderly, chronically ill, homeless, victims of domestic violence, and people experiencing behavioral health conditions for five years.”  The “Fire Forward” program would “build[] upon our existing infrastructure available through our Community Paramedic Program and the department’s EMS Division.”

According to its proposal, Felton currently operates about 50 programs in five Bay Area counties, many of them “mental‑health and social‑justice directed,” but an “emergency response program,” as such, is not one of them.  Indeed, Mr. Gilbert told Council that what Felton had in mind for Alameda was not so much a “crisis response program” as a “mental‑health services program.”  When Mr. Knox White pressed him on the point, Mr. Gilbert explained that “crisis response” would be “packaged” with other services Felton offers, such as referrals to its “partners” who provide housing.

Cost

At first blush, AFD seems to be offering the least expensive proposal: $300,000 for a
one-year pilot program.  But this low cost results from a bit of – entirely legal – financial legerdemain.  The budget for fiscal year 2021-22 already includes $1,022,000 to pay salaries and benefits for three of the six firefighters who were hired using a SAFER grant to staff a fourth ambulance for the department.  Even after the City decided not to put that ambulance into service during the pandemic, all six firefighters remained on the payroll.  Now that the SAFER grant has expired, the City has to pick up the entire tab for their compensation.

Under one option presented by AFD, the beginning of operations for the fourth ambulance would be deferred for another year, and the cost of the six “SAFER firefighters” would be assigned to the “Fire Forward” program instead.  So the only additional cost attributed to the program would be for the social worker’s salary, training, and a new vehicle.  Of course, if Council really wanted to accommodate the fire department and start using the new ambulance right away, it could create six more positions for the crisis‑response program alone and hire firefighters to fill them.  That would bring the cost to $1.1 million to $1.3 million for the one‑year pilot.

Felton’s numbers are more straightforward: the 24/7 program would cost $1,266,871; the nine-hours-a-day/five-days-a-week program would cost $832,608.

* * * * *

At the June 15 meeting, only one Council member – Ms. Spencer – voiced support for one proposal over the other.  She went all in for AFD – “when I heard the comments in regards to rapport and relationship,” she said, “our fire department has that already.  I know that is true.  They are in our community all the time” – and she moved to approve the less expensive of the two options proposed by the fire department.  Mr. Knox White seconded the motion, but the Mayor brought down the gavel before a vote was taken.

We don’t know what will happen on July 6.  The AFD proposal would be the easier choice:  our Council members know the principal promoters of the program well – not just Acting Fire Chief Zombeck, but Deputy Chief Jeff DelBono, the former IAFF Local 689 president who also appeared on the Zoom call – and the fire honchos apparently have been meeting with County officials since last July to grease the skids for an AFD-run program.  By contrast, Felton moved its headquarters to Alameda only recently, and we all know how much Alamedans resent newcomers.

Moreover, if Council were to select Felton, the politicians would risk incurring the wrath of their “progressive” supporters who are convinced that, by being willing to work with the cops, Felton has lain down with the devil.  We doubt that the explanations offered by Mr. Gilbert and Mr. Penn changed any minds in this crowd.  Reason seldom does.

In any event, it would appear that AFD already can count on three votes – Ms. Spencer and the two firefighters’ union favorites, Ms. Vella and Mr. Knox White – so it probably won’t matter how Ms. Ashcraft and Mr. Daysog vote.  We remain eager, however, to hear why the majority believes that Alameda firefighters are better able to provide services to mentally ill and homeless people than an organization who has been doing just that around the Bay Area for the last 11 years.

Sources:

Staff report: 2021-06-15 staff report

AFD, Felton proposals: 2021-06-15 Correspondence from City Manager