The CARE program begins

The City’s pilot program for responding to “mental health crisis” calls began operating on December 16, 2021.  Today, the Merry‑Go‑Round will report on the results thus far.

Under the program, both a police unit with two officers and what the City calls a “CARE team” consisting of a firefighter/paramedic and a firefighter/EMT are sent out when the police communications center receives a mental‑health-crisis call.  (The acronym stands for “Community Assessment Response & Engagement.”)

If the information provided to the dispatcher suggests that the subject is armed or that “active violence” is occurring, the police officers make first contact and the CARE team stands by until the cops deem the situation safe.  In all other circumstances, the CARE team makes first contact and the cops stand by until the team releases them.

Once on the scene, the CARE team assesses the subject’s physical and mental condition and decides what further action, if any, to take.

From December 16, 2021, through January 15, 2022, the CARE team responded to 44 calls, and Fire Chief Nicholas Luby graciously provided us with a breakdown and answered our follow‑up questions.

The CARE team was unable to locate the subject on six occasions, and four people refused service.  In addition, the team cancelled six calls at the scene after determining that no further contact with the subject was necessary.  (For example, there were times when a third party had called 911 to report a person the caller was concerned about, but upon arrival, the CARE team found that the person was not experiencing a mental‑health crisis.)

Of the remaining 28 calls,

• The CARE team placed “5150 holds” – under which a person determined to be a danger to himself or others can be detained for up to 72 hours – on five people. (Two of these holds were placed on people encountered on the street; the other three involved people whom the team had been summoned to meet in the emergency room at Alameda Hospital.)

• On two occasions, the team called for an ambulance staffed by other AFD paramedics to give medical treatment to a person who needed it.

• Using its own SUV, the team transported six people to various locations (two to Highland Hospital; one – voluntarily – to John George psychiatric hospital; one to the Village of Love shelter at Alameda Point; one to BART; and one to an Oakland destination given by the client).

• On one occasion, the team determined that no treatment or transport was required.

• The team referred 14 people to Alameda Family Services, which has contracted with the City to provide follow‑up care.  Seven of those people received case management services, and the other seven did not respond to AFS’s attempt to reach them or declined AFS’s services.

Fire Chief Luby (along with Police Chief Nishant Joshi and AFS executive director Katherine Schwartz) filled in for us a few details about how the pilot program operates.

When a 911 call comes into APD’s “ComCen,” the dispatcher must decide whether it qualifies as a mental-health-crisis call, and, if so, whether to designate it as a “PD5150 call,” in which the cops make first contact with the subject, or an “AFD5150 call,” in which the CARE team goes first.

(Last December, APD issued a training bulletin setting forth this policy.  Among other things, the bulletin states that, for calls in which the CARE team makes first contact, patrol officers “should make themselves available to AFD to provide support if needed and will not enter the scene unless there is an immediate threat to AFD personnel.”  If the officers aren’t required to intervene, they “shall stage nearby to focus on reducing visibility.”)

Necessarily, the dispatcher bases the determination about how to classify a call on the information provided by the caller.  We asked Police Chief Joshi to elaborate on the process, and he sent us this response from Marassa Williams, APD’s communications supervisor:

A caller who indicates a subject is possibly suffering from a mental health issue will be asked further investigative questions.  The dispatcher will attempt to identify what the caller is witnessing, whether they are aware of any specific statements or threats made.  They may also try to determine any known history of mental illness or known medications based on a specific diagnosis.  Those questions in addition to identifying any violence, weapons, drugs/alcohol use are the most common components used to classify a call.

Instances where the reporting party has limited information, the dispatcher may rely on witnessed behaviors only.  Often times this is the individual observed walking into traffic, talking to themselves, making aggressive movements at no one in particular.  The indicators vary and dispatchers will make their best attempt to classify the call appropriately, at times using the combination of observations to assign it as a possible mental health call.  The same series of questions regarding violence, weapons, drug/alcohol are also used as part of the assessment in this scenario.

Of the 44 mental‑health‑crisis calls in the first month, eight were classified as PD5150 calls and the rest as AFD5150 calls.  The CARE team ended up being cleared to respond to all of the calls in the former category, and it never had to get the police involved on any call in the latter.

A total of 18 firefighters are taking part in the pilot program.  Nine of them are paramedics, who completed a seven-day mental‑health-responder training program offered by a private non-profit agency called Bonita House.  In addition, the paramedics got training from Alameda County Behavioral Health Care Services that entitled them to issue 5150 holds.  All 18 firefighters also have attended, or will attend, crisis intervention training classes run by the Oakland Police Department.

A CARE team is available 24/7, with a separate team for each of the three fire department shifts.  The assignments last for two months, and the next scheduled rotation will occur later this month.  Neither the paramedic nor the EMT wears a uniform; instead, they are attired in polo shirts with the CARE team logo.

Once a CARE team arrives on the scene, its first task is to assess the subject’s physical and mental condition.  This evaluation, of course, derives primarily from the team’s observations of, and conversations with, the subject himself, but the team also may talk to friends or family members whose names it obtains from that person.  In addition, it may consult an on‑call AFS clinician, whose approval also is required for a 5150 hold.

When the subject is demonstrating a mental‑health problem, the CARE team usually will fill out a “personal safety plan” that contains information about such matters as “warning signs,” “cues,” and “coping skills,” as well as a “daily maintenance plan” and a list of “action steps.”  The plan is then signed by the subject and given to AFS.  (Of the 14 referrals to AFS, 11 were accompanied by a personal safety plan.)

Based on the evaluation, which has taken as long as three hours, the CARE team has a number of options available.  For a subject needing medical attention, it can call for an ambulance if other paramedics can provide the necessary treatment or transport the subject to the hospital if they cannot.  For a subject presenting a danger to himself or others, it can issue a 5150 hold and transport the subject either directly to John George or (if medical clearance is necessary first) to Alameda Hospital.  And for a subject who doesn’t need treatment and isn’t dangerous, the team can take him where he can meet up with a friend or family member – or just leave him where he is – and then make a referral to AFS.

When AFS gets a referral, it reaches out to the person and offers what Ms. Schwartz called “intensive case management” services, which are “designed to link individuals to whatever service they need to help stabilize them so as to reduce the likelihood that they will go back into crisis and will instead move towards sustained stability.”  For example, she told us, AFS has “referred clients for therapy, assisted getting them connected to long-term case management support (our program is very short-term), helped access medication, assisted connecting clients with food assistance and medical care, [and] provided assistance in accessing housing.”  Follow-up calls are scheduled for 30 and 60 days.

It is, of course, too soon to ascertain, based on one month’s worth of results, whether the City’s pilot program is working as intended.  Nor would we presume to substitute our judgment for the professionals’.  (We’ll leave that to Those Who Know Best.)   Nevertheless, if the primary goal of the program is – as Chief Luby told us – to “help an individual in need get services,” it appears to be achieving that goal.  Accordingly, the ordinary Alameda citizen has every reason to be satisfied with the results so far.

Sources:

Program background: 2021-09-21 staff report re alternative response program

APD training bulletin 21-04: TB 21-04 Mental Health Crisis-APD

December-January report: 012322_ACT_Data_ALCOEMS[13545]