PRIMARY PROBLEM
1. Individuals experiencing mental health crises often interact with police and emergency departments. For communities that are historically unserved, underserved, and inappropriately served, interacting with law enforcement can be a frightening, distressing, and even deadly experience.
2. Communities with historical trauma because of police brutality and negative interactions with other government authorities do not call for assistance when needed because calling for assistance may at times lead to involuntary hospitalization and unnecessary incarceration, which can be traumatic and life-changing.
3. Santa Clara County has developed a mental health crisis response system that is efficient and effective. However, community members have expressed concerns that these teams require the inclusion of law enforcement in response to individuals in a mental health crisis. During community input meetings, many community members noted negative interactions with law enforcement, which has prevented them from seeking assistance from these programs.
4. Individuals who are assessed and deemed not needing a 5150 hold may not be linked to any supportive or therapeutic services post-crisis response. Data shows that this can lead to repeat calls for emergency services and lead to unnecessary transport to emergency rooms and other emergency psychiatric hospitals. “Due to a lack of access to appropriate quality care, African Americans are much more likely to have their first mental health treatment in an emergency room, or as the result of incarceration, with inadequate follow-up or referral for continuing care.” (CRDP, 2018)
5. Santa Clara County’s current practice only utilizes an ambulance to transport individuals on a 5150 hold to a hospital. Furthermore, law enforcement can only transport individuals if they sit in the back of the police car, and many times it also means being handcuffed, which can be traumatizing.
6. In Santa Clara County, people of color have reported that there are discrepancies in treatment between racial and ethnic groups. Consumers who are people of color, in particular, have reported during focus groups, a disparity in the caliber of treatment they receive from law enforcement when experiencing crisis compared to other racial groups, citing numerous negative experiences.
7. With the killing of George Floyd and other African/African Ancestry and Latin individuals, there is an increased need to reframe from utilizing law enforcement when responding to community behavioral health needs. Individuals representing these populations are less likely to seek help by calling 911 for fear of being mistreated or even killed.
8. Due to stigma related to seeking behavioral health services, community members who are people of color are less likely to seek assistance when needed.
PROPOSED PROJECT
The County of Santa Clara Behavioral Health Services Department (BHSD) provides an array of behavioral health services, including services for the crisis, acute inpatient psychiatric care, subacute, residential care, full-service partnerships, and outpatient services. Although various behavioral health services are available to the community, there is also an increased need to expand community-based crisis services to encompass a truly community-focused approach.
The new Community Mobile Response (CMR) Program seeks to maximize the ability to expand crisis response for individuals and families by adopting a community model that uses community residents, mental health workers, and emergency medical support to prevent a crisis.
“Communities of color have a number of assets that form the foundation for a community-based system of services that meets the mental health needs of all Californians. Community resiliency is developed when families, friends, churches, schools, and community groups work together to strengthen both individuals and communities. Individuals with strong ties to their community are more likely to increase their resilience, develop a positive cultural identity, and form networks.” (CRDP, 2018)
The scope of services will prioritize serving those who are deterred from calling 911 for assistance due to a history of negative experiences with law enforcement. The program will consider population size, geography, and trend/location usage, race, and ethnicity, cultural and community representation, LGBTQ population, disability, and other aspects that affect how someone responds to a crisis.
The CMR program will provide a safe and welcoming environment to reduce the stigma associated with seeking mental health services. Ensuring that all aspects of the services are inviting by being linguistically appropriate and lead by culturally informed individuals from the community with lived experiences. As indicated in California’s Reducing Disparities Project (CRDP) report from 2018:
“To effectively treat individuals with mental health needs, the system must provide safe and welcoming environments that encourage clients to ask for help. Culturally and linguistically appropriate outreach and education can help confront attitudes and beliefs about mental illness and cultural prohibitions against talking about mental health.”
The CMR Program intends to proactively help individuals in crisis: any situation where an individual needs assistance in resolving conflicts or stressful situations. The program team will help individuals experiencing an increased level of stress and anxiety by conducting assessments for medical and/or behavioral health needs to minimize and prevent further escalating the crisis and provide the individual the support they need during their time of need. This program is intended to utilize a community-based approach, this program is intended to be used by the community as an alternative to a law enforcement response. This program aims to serve individuals who do not feel safe contacting law enforcement for unusual situations that require outside intervention for resolution.
In light of the killing of George Floyd and events that took place in 2020, the Mental Health Service Act (MHSA) Stakeholder Leadership Committee (SLC) endorsed this new MHSA INN project: CMR to address current needs through a race equity and social justice lens and make available a program that can help the unserved and underserved. The CMR program will include a process in the program’s workflow to include other resources as needed and, when appropriate, link to other teams and programs, such as the County’s Emergency Medical Services (EMS) team, other County Mobile Response programs like the Mobile Crisis Response Team (MCRT), and Psychiatric Emergency Response Team (PERT).
Community Mobile Response innovative approaches ideas:
A) Family involvement – Utilize Assembly Bill (AB) 1424 which requires that all individuals making decisions about involuntary psychiatric treatment consider information supplied by family members, to encourage family involvement from the phone screening through the entire process including follow-up.
B) Prevention focused – Focus on lower acuity situations and diversion, by being culturally intuitive, utilizing compassion and de-escalation techniques to prevent high-stress situations from becoming a crisis, and prevent future calls by providing resources pre and post response.
C) Access through a trusted community phoneline – a centralized 3-digit number that is not 911 or 311.
D) Transformed trauma-informed mobile response vehicle – Designed by a local community artist and voted on by the community that can be utilized for field treatment or transport when needed.
E) Community Collaborators – Utilize community members in all aspects of the design, implementation, and evaluation process. Staff the program with individuals from the community, prioritizing people with lived experiences. A model detailing community collaborations can be found in the model titled “Community Collaborators” below.
F) Take a regional approach to learning by collaborating and communicating with other counties with similar programs. Potentially create a county collaborative on mobile crisis programming.
SERVICE AREAS:
Launch in two areas in Santa Clara County: East San Jose and Gilroy, with a plan to expand to other sites in future years: Morgan Hill and North County and eventually Countywide, if successful.
According to the Center for Disease Control and Prevention (CDC), the social vulnerability index for Santa Clara County, shown on the next page, the highest level of a vulnerability is concentrated in San Jose and South County, specifically Gilroy.
