Pilot street crisis response teams divert hundreds of behavioral-health 911 calls; early data show majority of contacts resolved in community

Angelica Almeida, who leads DPH's street-based behavioral programs, told the Health Commission on April 20 that the Street Crisis Response Team pilot is expanding across San Francisco and producing early, promising results.

Almeida described a three-person rig model: a community paramedic from the Fire Department, a DPH behavioral health clinician and a peer specialist. The teams launched in phases (Tenderloin in November, Castro-Mission in February and Bayview in early April) and DPH plans six teams by the end of the fiscal year to approach citywide coverage. Almeida said the Bayview launch was intentionally prioritized for equity reasons despite lower 911 call volumes there.

DPH provided early performance data from the pilot: in March the teams responded to 256 calls and, cumulatively since November, had 756 responses, representing diversion of about 19% of the code-800 (mentally disturbed person) calls identified in the 2019 baseline. The teams' average arrival time in the first four months was reported at roughly 15 minutes. Immediate dispositions in March and in cumulative reporting showed 53% of individuals remained in the community after the response, 20% were taken to a hospital (medical or psychiatric), 17% were transported to a social or behavioral setting (shelter, detox, shelter-in-place hotel) and about 10% resulted in 5150 involuntary holds; Almeida noted dispositions can overlap.

Almeida stressed the pilot's equity emphasis and data limitations: many contacted individuals were experiencing homelessness and demographic fields were incomplete, so the team plans to supplement DPH records with hospital Epic data and Office of Coordinated Care follow-up. She also described evaluation plans: a local evaluation by Harder & Company to monitor call types, response metrics and outcomes, and a Robert Wood Johnson Foundation-funded study led by Dr. Goldman to examine individual longitudinal outcomes and system-level impacts (reduced jail or emergency room contacts).

Commissioners asked technical and operational questions about triage, juvenile responses, backup protocols and frequent utilizers. Almeida said juvenile crises would be handled by the comprehensive crisis services team and that, when six teams are operational 24/7, the city plans to shift to an EMD ambulance-backup protocol so an ambulance rather than police would be the default backup when STRT is unavailable. She said other city programs (door urgent care, detox, low-threshold case management and the planned drug sobering center) provide linkage options.

Commissioners praised the early diversion numbers and asked for continued reporting on equity metrics and follow-up outcomes.

Almeida said DPH will return with more data on follow-up and longitudinal client outcomes as the evaluation work matures.