She goes to police calls in a Prius — part of new approach to mental health emergencies

If Fair keeps her close, it will ensure she is connected with the services she needs and prevent her from calling 911 dispatch, reducing the possibility of a full-blown crisis involving officers or unnecessary hospitalizations.

“I fill in the gaps,” said Fair. “It’s just a matter of getting her the right supports.”

It’s working, according to a new study of San Mateo County’s efforts from Stanford’s John W. Gardner Center for Youth and Their Communities, which found that pairing law enforcement officers with mental health clinicians reduces the likelihood of costlier and more intrusive interventions.

Fair was hired four years ago as part of a program to pilot this approach, also known as a “co-responder model,” across San Mateo County’s four largest cities — Daly City, San Mateo, Redwood City and South San Francisco. The idea was to free up police officers and provide alternatives to incarceration and hospital emergency rooms for people in a mental health crisis. Since then, the model has rolled out to police departments in nearly every city in the county. 

Researchers behind the Stanford study found the co-responder model decreased involuntary psychiatric holds by approximately 17% and reduced the likelihood of future mental health 911 calls among the four pilot cities. The hold allows a hospital to keep someone for up to 72 hours to determine if they are a danger to themselves or others. Given the reduction of roughly 370 involuntary psychiatric holds over the course of two years, researchers Tom Dee and Jaymes Pyne estimated an annual cost savings of roughly $300,000 to $800,000. 

“We’ve got to look to alternatives and really understand that police are not the best equipped to handle mental health crisis situations,” said San Mateo County Executive Officer Mike Callagy, who proposed the pilot after seeing cases that resulted in officers using force and in lawsuits.

During each visit with her client, Fair tries to help her check something off a list of things that have been bothering her. Today, they’re sitting next to one another as they call California’s social services department to ask about in-home care. They’re placed on hold and after five minutes, her client lets out a deep sigh. 

“I know, it’s a lot,” Fair said. “That’s why I’m here.”

As jazz music plays in the background of the call, Fair picks up a bottle of dry shampoo from the desk, reads the label aloud and asks her how she likes it. She brought the product over during one of their last visits — a bandaid solution that she devised because her client was having trouble bathing herself. 

“Have you tried it yet?” she asks. “Want me to spray it for you? Brush it first.”

Her client takes her hair out of its ponytail, brushes it with her fingers and runs her hands along the part. Fair stands up from her chair, shakes the bottle and mists it over her head. 

“Does it feel better?” she asks.

“Yes, but you sprayed it in my mouth,” her client says, letting out a big laugh. “It feels fresh.”

Rising number of mental health calls

Stanford’s research adds to a growing body of evidence about the positive impact of alternative first response programs, which have proliferated across the country amid calls for police reform in the aftermath of George Floyd’s murder in 2020. Those reforms are so nascent that not much is known about them, Dee said, and his study is one of a handful that provides a credible evaluation. 

“This is a common-sense reform with a great deal of promise,” he said. “That being said, it’s not a cut-and-paste kind of reform. There are serious design and implementation details that matter for realizing the promise of these sorts of initiatives.”

Some of those details include having buy-in from the police, training dispatchers on how to triage calls, and integrating mental health staff. 

San Mateo Police Chief Ed Barberini said it was a “risky proposition” when his agency decided to participate in the pilot program, worrying that his officers would push back. But mental health calls were on the rise, he said, and without clinical expertise, police officers were being put in a difficult position. That sentiment has been shared by law enforcement agencies across the state, some of which have recently distanced themselves from mental health calls. 

“We recognized that we were triaging problems and just finding short-term solutions,” said Barberini. “I’m pleasantly surprised with how things have turned out.”

Prior to the pilot program, San Mateo police officers who responded to mental health 911 calls had to decide whether to send the person to the hospital for a 72-hour involuntary hold, arrest them, or leave them to their own devices. By pairing them with a clinician, the agency has been able to provide safety planning, follow-up calls and connections to community partners for people in mental health crises. 

Mariela Ruiz-Angel, director of Alternative Response Initiatives at Georgetown Law’s Center for Innovations in Community Safety, said a co-responder model is fantastic — but it’s just the beginning of what a progressive city looks like. 

“This is really about evolving to a level in which we don’t have to send out cops or fire for basic-level need calls,” she said. “The idea was never about taking cops out of the equation altogether. The idea was that we don’t have to center them as the main response of 911. We don’t have to make public safety about cops. Public safety is about the appropriate response.”

De-escalating a family feud

The pilot program cost approximately $1.5 million over the course of two years, split between the county and the four participating cities. Once it ended, the San Mateo Police Department — an agency consisting of 116 sworn officers — converted Fair’s role to a permanent position as the agency’s first-ever mental health clinician. The city is also using grant money to employ an additional mental health clinician part-time. Every other participating city has also found a way to sustain its program. 

On a Monday morning, Fair responds to emails from police officers who have asked her to follow up with people they interacted with over the weekend. This time of year has been busy, Fair says, because the holidays can be lonely. In the last week alone, she’s had to respond to a variety of crises: evaluating a kid who had an interrupted suicide attempt and responding to a transgender youth who wanted to stab themselves.

A radio sits next to her desk. She pauses to listen more intently as a dispatcher relays information about a person who thinks they’re being followed by a federal agent. A family member called in to report the episode. A few minutes later, Fair slings her backpack over her arm, sticks the radio in her pocket and quickly winds her way through the hallway to the garage. In the backseat of her county car — a white Toyota Prius — is a bulletproof vest, which she says she rarely uses. 

Outside an apartment complex, Fair pulls over and turns on her flashers. The process, also referred to as “staging,” is when she parks two blocks away so police officers, who have already arrived, can vet the scene to make sure it’s safe for her arrival. 

A few minutes later, she opens the car door and jogs over in her black Nikes and tan cargo pants. An officer introduces her to the family and from there, Fair’s work unfolds. She moves back and forth between the family and their loved one, who’s sitting across the street on a bench, as she collects information from both parties: Is there a mental health history? What kind of substances have they used before? Are they currently receiving any treatment? Have they been hospitalized before? Did they make any threats? What do you want to see happen today?

After 10 minutes, Fair pulls one of the officers aside to let him know that the person doesn’t need to be hospitalized. “Let’s safety plan,” she tells him. It’s what the agency does if they receive a call that doesn’t rise to the level of an involuntary psychiatric hold. At that point, officers say, they’re “just playing peacemaker.”

Fair huddles beside the family to explain that the situation is no longer a police matter or a mental health crisis, but rather, a family matter. Still, she doesn’t want to leave them feeling alone. They create a “safety plan” that everyone can get on board with so that, as she later explains, “We don’t get another call in 10 minutes because they’re arguing down the street.” 

“We get calls like this — where it sounds like it’s going to be wild — and then we get here and it’s just a family matter,” she said. “It happens.” 

Cayla Mihalovich is a California Local News fellow. CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.