Marin mental crisis team fortifies public safety system

When a senior kept calling 911, sometimes more than once a day, the fire department was at a loss on how to help.

The caller would report a symptom that required a paramedic response and subsequent ride to the hospital. Once the patient was discharged and back home, the 911 calls would resume.

First responders called the Marin County’s Mobile Crisis Response Team, a nine-person unit of specialists and clinicians who work with one of the county’s vulnerable populations — those experiencing mental health emergencies.

“The person was like, yeah, I use 911 too much but they aren’t meeting my need,” said Kellianne Martinez, a unit supervisor. “It’s just about having that conversation of, ‘What do you need? What is going on?'”

Equipped with four vehicles that are dispatched throughout the county, the team meets people where they are, often in distress, and works to assess them, stabilize them, provide resources and ease the burden on the county’s 911 system. Sometimes, that could be just listening to them, while other times it might mean a trip to the hospital.

“We often say we meet people on the worst day of their lives,” Martinez said. “And just being neutral, being calm, and being present for them can be a really reparative experience for a lot of people who have been in the mental health system.”

Based on Bon Air Road in Greenbrae near MarinHealth Medical Center, the unit is part of the county’s Department of Health and Human Services. The unit has a yearly budget of about $3 million, which includes funding from the county-level Mental Health Services Act and a grant through the state’s Department of Health Care Services for crisis care mobile units.

The team’s work, which is running into its eighth year, has reduced the strain on local emergency services as well as admissions to the emergency room, the crisis unit and the jail, according to team supervisors.

Emily Mann, a program manager, said the essence of the unit is to keep people who are in the midst of a mental health crisis, but who are nonviolent and not committing crimes, out of jail while also supporting them.

“It’s really an effort to assess more accurately what is going on with someone and what they may need rather than just observing a behavior and, because there’s a lack of other choices, taking someone to jail,” Mann said.

Evaluating people in their own environment allows clinicians to enter their world while also collecting important data. Mann said looking for details in their living space can help determine if patients are severely impaired by their mental health.

“They might come here and say they’ve been grocery shopping and have food at home, but then we go out there and it’s barren,” Martinez said. “We get a different lens.”

Megan Hinshaw, a unit supervisor, said sometimes people want support over the phone. She recently talked to a woman who believed she was having a panic attack. Hinshaw offered the woman a ride to the crisis unit, but the woman just wanted to talk. They spoke for 45 minutes.

“We’re always willing to answer the phone and talk to someone. We have that time, and time is such a luxury,” Martinez said.

When a call comes into the center, dispatchers go through a screening process to determine the next steps. Details such as demographics, concerns and medical history are reviewed. Most calls come from friends and family members who are worried about a loved one, according to Hinshaw, but they can also come from community members and police departments.

Providing support requires getting to the root of the issue, according to Martinez. Factors such as access to health care, food insecurity and financial stress can often contribute to mental health struggles.

Hinshaw said people knowing where to go is a huge barrier to getting help. The team can connect people to programs that provide care to those with recent suicide attempts or overdoses, showers and laundry services, or internet and phone access, among other help.

“We reduce barriers and improve that access so people know what services are available to them and they know how to get to them,” Hinshaw said. “That’s what we do in the crisis continuum, catch someone who feels like they’re having an emergency or a crisis but they don’t know where to go so they’re calling 911 or the ED and they’re at a loss.”

According to Michelle Funez, a crisis intervention team coordinator with the county, the team has responded to nearly 2,500 calls this year — over 60% of which came from San Rafael, Novato and Mill Valley.

While an overall goal is to reduce the interaction between police and those experiencing a mental health crisis, team members recognize that is not always possible. If there is the threat of violence, either to oneself or others, law enforcement might be called to clear the area of safety concerns.

Mann said the ongoing collaboration with the 13 law enforcement agencies in the county is essential. Police departments will often call the mobile crisis team if they feel a case would be better handled by the team.

“We’re able to de-escalate and safety plan and kind of resolve the crisis in the field,” Martinez said.

Novato police Sgt. Alan Bates said that while law enforcement will always have a place in emergency responses, police should be removed from mental health calls as much as possible. He said it is a more comfortable and beneficial situation for the patient.

“We prefer them to be sourced to people who can directly help long term,” Bates said. “We use it as often as possible. They’re a fantastic service.”

While the team does not have the staffing to handle long-term case management, it does conduct follow-up calls or visits for a couple weeks, according to Martinez. Even though the team serves a geographically large area, its size has helped it build familiarity with callers and people in crisis — which unit supervisors stress is essential in these situations.

“The two people who went out, it’s likely that you’ll see one or two of them if you call again,” Martinez said. “So that sense of trust and rapport is being built and so we’re able to speak to people and have them be more willing to be vulnerable and talk to us.”

At the Marin County Sheriff’s Office, Sgt. Adam Schermerhorn said deputies are trained in crisis intervention. Still, it is always best to have trained mental health professionals respond when possible, he said.

“Mobile crisis is an amazing resource that we try and utilize as much as possible,” Schermerhorn said. “We are very appreciative for their support during critical incidents and situations where a mental health professional is the best tool.”

Schermerhorn noted that the team’s staffing and hours are a challenge. He said that in the past year, the sheriff’s office has called the team 283 times when members were not available, a voicemail had to be left or the operation was closed.

This is something the unit leaders acknowledge. The team is available from 7 a.m. to 10 p.m. daily, but will be expanding to 24 hours a day, seven days a week within the next year because of a statewide mandate. Mann said the team is also in the process of hiring more staff with specializations such as responding to schools and youths in crisis.

The unit has helped people as young as 6 to those in their 90s. It is a non-billable service, and the members will respond to any call regardless of whether someone is housed or homeless. That said, callers have to willingly share their locations with the dispatchers.

Hinshaw recalled recently being dispatched to a middle school where a student had expressed thoughts of suicide. She had struggled to talk to her mother about her mental health, and the school counselor sought the mobile team’s help.

Hinshaw got the girl’s mother to the school, as well as a Spanish interpreter because the family had immigrated about six months earlier. She helped facilitate a group discussion about what mental health is, how depression manifests in younger people, what services are available, how to reduce risk at home and how to develop a safety plan. She connected them to a clinic and conducted a follow-up call with the parent and the school.

“I think that was a really valuable experience,” Hinshaw said. “Bridging that cultural language gap and helping the student feel more capable in sharing how she was doing with Mom.”

The conversation at the school took about two and half hours. Mann said the greatest gift the team can give to those in crisis is time.

“I think that’s something that’s really special that we can offer, our time with someone out there in the community, in their space, meeting them at their level, and really just interacting on a human-to-human level, which oftentimes is what people in crisis really need,” Mann said. “They need to know that there’s a human in front of them that cares and I think that’s an area where our team really thrives.”

The Mobile Crisis Response Team can be reached at 415-473-6392.