According to the National Institutes of Health (NIH), 57.8 million Americans were estimated to have a mental illness in 2021—a cohort that represents 22.8% of all adults in the U.S. The same report estimates that 14.1 million of them have a condition defined as Severe Mental Illness (SMI), equaling 5.5% of U.S. adults.1
According to the U.S. Centers for Disease Control and Prevention (CDC), suicide is a leading cause of death, and its frequency is surging: “Suicide rates increased approximately 36% between 2000–2022. Suicide was responsible for over 49,000 deaths in 2022, which is about one death every 11 minutes. The number of people who think about or attempt suicide is even higher. In 2022, an estimated 13.2 million American adults seriously thought about suicide, 3.8 million planned a suicide attempt, and 1.6 million attempted suicides.”2
Faced with this grim data, public health authorities, mental health experts, and public safety agencies are working together to address the issue by developing better, more innovative responses and intervention practices. Nationwide rollout of the 988 system as a national mental health hotline has been one of them. Another has been the creation of responder teams that can provide mental health professionals, rapidly, to the side of patients calling 911 for assistance.
The City of San Francisco has been working on this problem for several years, and one of its most effective solutions has been the creation of a specialized team of mobile professionals that can respond rapidly to at-risk patients needing assistance for a wide range of behavioral problems, social ills, and low-acuity medical problems. “The Street Crisis Response Team (SCRT) is initiated through calls from the public to San Francisco’s 911 call center and provides rapid, trauma-informed care to people in acute behavioral health crisis or who have needs that may not require an ambulance or transport to an emergency department. SCRT provides linkages to shelter, drug and alcohol sobering centers, mental health clinics & residential programs, urgent care, care coordination and other needed support for people with complex health needs.”3
San Francisco’s Department of Emergency Management (DEM)—the agency responsible for managing the city and county’s 911 system, worked with the International Academies of Emergency Dispatch (IAED) to develop a study protocol, which modified the existing dispatch protocol in the Medical Priority Dispatch System (MPDS®). The IAED modified MPDS Protocol 25 (Psychiatric/Mental Health Conditions/Suicide Attempt/Abnormal Behavior) to add a “C” suffix to its dispatch coding system in order to identify those patients that qualify for a SCRT response (C for crisis team). The MPDS is a standardized, proven, detailed dispatch protocol that triages patients based on their condition, including their primary complaint, symptoms, behaviors, scene hazards and circumstances. The “C” suffix was added to MPDS cases within Protocol 25 where the patient was determined to be absent of any serious medical conditions that may require an emergency ambulance response as well as demonstrating little or no imminent danger to others, negating the need for a police response.
On 6/22/2022, the Department of Emergency Management (DEM) began the use of the “C” suffix on MPDS Protocol 25 for calls that were previously counted as a Police radio code 800- Behavioral health and a generic code- 25A0 (Fire- non-ProQA). Between 6/22/2022 and 2/5/2023 there were 6,731 cases that had been coded with the “C” suffix.
“In March 2023, SCRT reconfigured its team composition to include one community paramedic, an EMT or second paramedic, and either a Peer Counselor or a Homeless Outreach Team (HOT) specialist. Behavioral health clinicians continue to be a core part of the SCRT and work under the expanded Office of Coordinated Care (OCC) providing follow-up and connection to behavioral health care for clients referred by SCRT units.”3
The latest patient engagement outcome data shows that over 70 percent of patients were either managed on-scene and stayed in the community or were transported to a non-acute care social or behavioral setting. Only 20 percent were transported to a hospital. Indeed, the SCRT has proven to be a valuable alternative to both traditional police response, and an ambulance transport to the hospital emergency department.3
The San Francisco pilot was so successful that the IAED has now expanded the use of the “C” suffix code in its most recent protocol release—available to all MPDS dispatch agencies—and even added this suffix to a second newly released protocol: Caller in Crisis (Protocol 41). This new protocol will build on the practice of using well trained 911 dispatchers to help manage patients experiencing serious mental health problems, dispatching responders better suited to their specific professional needs while emphasizing more discreet use of police and ambulance services.
References:
1. Mental Illness - National Institute of Mental Health (NIMH) (nih.gov)
2. Preventing Suicide. Centers for Disease Control and Prevention. 2024. Accessed July 15, 2024. https://www.cdc.gov/suicide/facts/
3. STREET CRISIS RESPONSE TEAM (SCRT).May 2024. Report from the City and County of San Francisco. Accessed July 17, 2024. https://www.sf.gov/sites/default/files/2024-07/May%202024%20SCRT%20Report.pdf