HealthRite community paramedics gain authority to write holds for patients

The San Francisco County government meeting on July 4, 2025, focused on the challenges and developments in the local healthcare and emergency response systems, particularly regarding mental health crises and substance use disorders. Key discussions highlighted the evolving roles of community paramedics and the need for appropriate facilities to address these issues effectively.

One significant point raised was the ability of community paramedic captains to write holds for individuals in crisis, a capability that was recently enacted. However, it was noted that this new authority has yet to be utilized, raising questions about the barriers to intervention. Concerns were expressed about police officers' reluctance to initiate 51-50 holds, which can lead to lengthy off-street detentions for individuals in crisis. This reluctance stems from the perception that many individuals do not remain in psychiatric emergency services (PES) for long, potentially leading to recurring crises.

The discussion also touched on the effectiveness of current intervention strategies. While some interventions are resolving issues on the sidewalk, there is concern that these solutions are temporary and do not address the underlying problems faced by individuals in crisis. The need for more appropriate destinations for transport was emphasized, with community paramedics primarily taking individuals to urgent care facilities and sobering centers, rather than hospitals.

Data presented during the meeting revealed that a small number of individuals account for a significant portion of emergency responses. Five individuals with severe substance use issues have collectively required nearly 2,000 ambulance transports over five years, costing the city approximately $4 million. The meeting underscored the ongoing challenges in providing adequate care for these individuals, many of whom do not fit neatly into existing treatment frameworks.

In conclusion, the meeting highlighted the urgent need for improved resources and facilities to support individuals in crisis, as well as the importance of addressing the systemic issues that contribute to repeated emergency interventions. The discussions reflect a growing recognition of the complexities involved in managing mental health and substance use crises within the community.