Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 30 the service utilizer and reduce their risk of harm; however, they shared that phone support may not always be sufficient for every mental health crisis.
Overall, there was consensus among stakeholders that there is a lack of successful linkages and connection to follow-up services beyond John George Psychiatric Hospital. Many participants felt that hospitalization may not be appropriate care for everyone experiencing a mental health crisis. Crisis responders and providers reported service utilizers requesting to not be sent to John George, but that as service providers they do not feel they have other options. For service utilizers, trauma histories can be re- triggered by congregate shelters, psychiatric care or hospitals, and police interactions. Stakeholders elevated a need for increased options for where people can be transported during a crisis.
Finally, there is a perception that the quality of the City’s first responder crisis response services is inhibited by a lack of training that sufficiently addresses harm reduction, racial justice and cultural sensitivity training, and successful de-escalation. Service providers shared examples of clients’ needs not being taken seriously, such as instances of individual EMTs not responding to unsheltered clients and/or clients of color. These examples demonstrate how stigma, dehumanization, and racism decrease quality of services.
Given the constraints of how the existing crisis system is funded and resourced currently, stakeholders elevated that any changes to program hours of operation, locations, staffing, phone numbers, and/or other logistical/programmatic decisions be shared regularly and distributed to the partnership network in order to improve availability, accessibility, and quality of service provision. They felt that the ideal alternative crisis response options would include 24/7 mental health crisis response and should address the desired competencies of harm reduction, racial justice and cultural sensitivity, and de-escalation to increase community safety and promote health and well-being.
Additional Perspectives from the SCU Survey
“They tend to exist in ways that are
the most convenient for the service
providers, not for the person in need.
Mental Health Services don't really
happen outside of their offices. How
can disordered, homeless people be
expected to make and keep
appointments at some unfamiliar
address? The drug epidemic is
complicating things and I have seen
no evidence that this city wants to
commit to rehab on demand which is
what we need. We need to be able
to offer help when it is needed- not
when it is convenient.”
“I’ve been doing outreach work for
more than a year in Berkeley now
and access to mental health crisis
support is almost nonexistent. It is
highly needed as many individuals
are experiencing some level of
mental health issues.”
“… My experience with the police
response has been that the City of
Berkeley crisis team has been
understaffed or not working the day
that I phoned, or my report of the
need for crisis support was minimized,
and it was explained that the person
"wasn't breaking any law." Crisis
doesn't often intersect with law
breaking, nor does an individual
always meet the criteria for a 5150.
There are trained individuals who can
help with this, and police often offer
heavy handed threats of arrest, or
physical violence, in attempt to stop
a behavior.”
“The resources we have
are helpful, but we
need more. We
especially need
affordable housing
units. The mobile street
medicine teams have
been very helpful.
Shelters are ok for some
people, but often
exclude people with
disabilities who need
assistance the most.”
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 31 Stakeholder perceptions of insufficient crisis services for substance use emergencies
Perceived Strengths
• EMTs respond well to
substance overdoses
• EMTs are well-trusted
by many unsheltered
communities and
encampments
Perceived Challenges
• Not enough SUD
training for clinicians
providing complex
mental illness care
• High rates of transport
to emergency facilities
for substance use
emergencies
• Infrequent referrals to
substance use
management services
• Too few resources to
meet high volume of
substance use
emergencies and
management needs
Stakeholder Ideas
• Incorporate harm
reduction framework
into all crisis response
• Distribute NARCAN
• Distribute harm
reduction supplies
(e.g., sharps disposal,
clean needles, etc.)
Stake
holders explained that mental health crises often include substance use emergencies, but they felt that variety and uniqueness of substance use emergencies is often overlooked and not adequately served in the existing crisis response. Stakeholders described many examples of physical and psychosocial health needs related to substance use that do not involve an overdose. Service providers shared that substance use emergencies and mental health crises are often co-occurring as substance use is common among people with histories of trauma and is used as a form of self-medicating.
Substances can alter someone’s mental state and contribute to or exacerbate what is perceived as a mental illness. Stakeholders elevated that when a person is in distress, providers should assume that something is triggering that distress, be it an event or intoxication. One of the most frequently and emphatically emphasized points by service providers was the need to address mental health and substance use in tandem. “Decriminalization is
key to "illegal" drug use
and harm reduction
methods of dealing
with addiction and
drug use save lives
and alleviate the
stigma.”
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 32 In the event of a substance overdose, stakeholders felt that Berkeley EMTs are well-trained, follow protocols, and administer effective treatment for users that have overdosed. Stakeholders reported that EMTs are well- trusted by marginalized substance-using communities, including homeless encampments. Seabreeze encampment residents shared that they avoid calling 911 for any emergencies except to specifically request an EMT during an overdose.
Stakeholders described many challenges to how the system currently addresses substance use emergencies. They felt that the physical health and mental health needs of a service user experiencing a substance use emergency are treated as separate needs. Service providers explained that whichever presents as more immediately pressing often dictates the classification for the call; they felt that this results in inadequate service provision during a crisis.
Community-based providers elevated that when seeking care for clients with complex trauma or chronic mental illness, they are rarely put in contact with a provider that has SUD training. Service providers expressed a need for an integrated approach to substance use emergencies, with providers working together to tend to both the psychological and physical health needs of their clients.
Substance users reported frequent transport to hospitals and sobering centers when emergency providers respond to crises. Interviewed substance users shared that they were only informed of other substance use management options when other case managers shared those options (not emergency services personnel prior to transport).
Stakeholders suggested ways that the current crisis response system could better address the needs of substance use emergencies, including incorporating a Harm Reduction framework into first responder's approach to drug use, distributing Narcan, and distributing harm reduction supplies such as clean needles, pipes, and safe sharps disposal kits.
Additional Perspectives from the SCU Survey
“I am a Nurse Practitioner... Some camps in Berkeley have agreements internally not to call the police on each other. If someone does, there is retaliation, sometimes in the form of lighting the person's tent on fire. This means people do not call 9-11 when there is a mental health emergency. While I
completely understand why the mobile crisis unit has police officers, it is not used as often as it could be because of that fact...Many unhoused folks we meet use meth in part to stay up all night so they will not get raped or robbed during the night.
This is of course not the only reason folks use meth and other drugs--there are mental health issues, addiction, etc. But until people are housed, it is very, very hard for them to cut down or quit, because the risks can outweigh the benefits in their minds.”
“...Offering safe use and drug checking
sites, so we can reduce harm that comes
from unsafe drug use. Creating
accessible, affordable, and temporary
housing for each phase of a person's
recovery from crisis. Ensuring people
have access to food, safe shelters, and
access needs are met.”
“The people with
mental illness should
get treatment. In crisis,
they should be housed
with treatment. those
with substance abuse
should have treatment
available. Being
homeless probably
makes people mentally
ill. I think I would be
mentally ill if homeless.”
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 33 Stakeholder perceptions of a need for a variety of
crisis transport options
Perceived Strengths
• Transport is provided
to emergency sites
during medical
emergencies
Perceived Challenges
• High rates of
involuntary transports
(5150s) do not align
with service needs
• Lack of options for
transport to non-
emergency sites
• Ambulances and
emergency services
can be cost-
prohibitive for service
utilizers
Stakeholder Ideas
• Provide voluntary
transport to non-
emergency sites
• Provide services and
supplies during
transport process
Cris
es can vary in levels of acuity, and not everyone calling in to report a mental health emergency needs transport to a psychiatric facility, hospital emergency department, or inpatient setting. Both EMTs and police shared that they provide free transport to a medical facility, which is important in the event of medical health emergencies. However, Alameda County has the highest rates of 5150s per capita in California.24 Service providers described full emergency departments and service utilizers not being admitted upon arrival. There are also financial implications for being transported in an ambulance, which providers suggested may deter service utilizers from requesting emergency services.
Stakeholders felt that there are few to no options for service utilizers to request transport to a different, non-medical facility or location.
Stakeholders did provide some examples of CBOs and non-emergency programs that provide transportation to their clients, though they shared that these services are not for the general public and barriers to transportation persist.
Given the need for addressing a variety of transport needs, stakeholders elevated the importance of an SCU team to have the ability to provide voluntary transport services to any secondary location, such as a sobering center or a public location. Service providers and community members suggested that the transport vehicle should have available supplies to provide care during a transport, such as one-off doses of psychiatric medicines, food, and water. There was a shared sense that providing 24 California Department of Health Care Services. (2017, October).
California Involuntary Detentions Data Report; Fiscal Year (FY) 2015-2016. https://www.dhcs.ca.gov/services/MH/Documents/FMORB/FY15- 16_Involuntary_Detentions_Report.pdf
“With all the services
available, as a
firefighter, all we can
really do is take
someone to the ER,
which is not definitive
care for homelessness.
Mobile support of
homeless services
would be a game
changer, much the
way mental health
comes out into the
field.”
- SCU Survey Respondent
Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 34
transport options that meet the mental health needs at varying levels of acuity has important implications for the safety and well-being of crisis responders and service utilizers.
Additional Perspectives from the SCU Survey
“...Another challenge is the lack of options for
people in crisis either hospitalization or nothing
which is very harmful. Another issue are people
who feel terrible but are not exactly in crisis but
because there are not enough mental health
providers they are forgotten or left to their own
devices.”
“I need to know that if I call for help, a
compassionate response will arrive and be able to
take a person to a humane location, respite of
some kind. Not forcing them into a hospital where
they are stripped of agency, but giving them a
place where they can stabilize without adding to
their feeling of trauma and powerlessness.”
Stakeholder perceptions of a lack of sites for non-
emergency care
Perceived Strengths
• Drop-in centers, day
centers, sobering
sites, and respite
centers provide
essential non-
emergency services
Perceived Challenges
• No drop-in site for
mental health
emergencies or crises
in Berkeley
• Too few drop-in sites
for non-emergencies
to meet the volume
of need
• Lack of support for
people released
from a psychiatric
hold
Stakeholder Ideas
• Offering drop-in sites
with counselors and
Peer Specialists, a
phone line, and no
service/time limits
• Offering office hours
and/or relationship-
building opportunities
between the SCU
and service utilizers
Stakeholders shared examples of sites that can support non-emergency care and felt that they are effective for mitigating further crises. These examples include drop-in centers, day centers, sobering sites, and respite centers. Services providers believe that such spaces allow individuals to meet their basic needs – including access to restrooms, showers, clothing, food, and rest – as well as have a safe space for self-regulation and self- soothing. Stakeholders, particularly service providers, feel that these types of resources are essential for harm reduction, crisis intervention, health promotion, and crisis prevention. Stakeholders shared that these sites can be a safe and trusted source for someone to access so that a primary caregiver can have a break, such as a parent that provides an adult child behavioral health support and care. Participants mentioned other CBOs
Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 35
that operate drop-in sites, such as the Women’s Drop-In Center or Berkeley Drop-In Center, but service providers indicated that there is still an unmet need for more sites that serve sub-acute needs. Because there is not a drop-in center for emergencies, service utilizers and community service providers described relying on either 911 or the CSS 24/7 phone line. Similarly, stakeholders felt that the availability of non-emergency drop-in centers for individuals to have non-emergency, indoor downtime is too limited to meet the volume of need. CBO service providers as well as crisis responders described situations of individuals being released from psychiatric holds without adequate support upon their release. They felt that these individuals would greatly benefit from the availability of additional drop-in centers.
Service utilizers and community-based service providers emphasized that it would be useful for the SCU to have an office available for community members to develop relationships with the team, like Aging Services’ Senior Centers. They suggested that a drop-in site could have a social worker or peer counselor to accept and direct phone calls, answer questions, and support those accessing the drop-in site.
Additional Perspectives from the SCU Survey
“…addressing the connection to community in the
long term - spaces for people to gather publicly
without needing to pay money, so we can get to
know our neighbors.”
“… We need wrap- around services, a halfway
house or drop-in center for people being released
from a psychiatric hold, to ease them back into
their lives and connect them with ongoing
services.”
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 36 Stakeholder perceptions around supporting the full
spectrum of mental health crisis needs
Perceived Strengths
• Relationship building
is important in crisis
response
Perceived Challenges
• Wages, retention,
and union
agreements may
affect type of staff
on crisis response
team
• Crisis response
lacking sufficient
supplies and
expertise for SUD
treatment, de-
escalation, and
system navigation
• Crisis responders are
not often
representative of
service utilizers
Stakeholder Ideas
• Incorporate
clinicians, social
workers, and peer
counselors on crisis
response team
• Increase
compensation for
Peer Specialists and
non-clinical staff
Sta
keholders shared many strengths of crisis responders across a spectrum of non-clinical and clinical background and expertise, emphasizing the importance of empathy and building trusting relationships. For instance, TOT staff received positive feedback across stakeholder groups for their follow-up work post-crisis, especially due to their diverse staff and rigorous training in preparation for field work. Service providers emphasized the importance of Peer Specialists to support service utilizers by reassuring them from their own background of lived experience, especially during transport or if the team applies physical restraints.
Crisis responders and service utilizers shared that the pre-existing relationships paramedics have with community members, particularly those that repeatedly need crisis response services, allows paramedics to deliver better care. Some CBOs have observed similar success when incorporating Nurse Practitioners on their street outreach teams. Overall, stakeholders believe that the ability for the same personnel to be providing crisis response services over an extended period can lead to positive outcomes of relationship building and knowing a client’s background.
However, stakeholders raised some potential challenges that must be considered when deciding how to staff a crisis response team. Crisis responders explained that paramedics often have a higher salary than other crisis responders and their skills can be under-utilized during a mental health crisis. They felt that this could make staffing a crisis response “A response team
targeted at de-
escalation and risk
reduction would be
best; it would be best
staffed by those who
can actually connect
people in need to
resources rather turning
a crisis into a criminal
matter, such as police
do.”
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 37 program with paramedics less financially efficient. On the other hand, they shared that other crisis responders, such as peer specialists, can be underpaid for their level of contribution, which they suggested might make retention a challenge. One additional consideration shared by crisis responders is that staff can have different union agreements that restrict the number of hours that can be worked per shift, which would affect the program’s overall staffing model and schedule.
Stakeholders felt that some of the services most important for mental health are not always standard practice among current crisis response teams. The types of clinical services that stakeholders reported as most important for mental health crisis response include prescribing psychiatric medicines, administering single-dose psychiatric medicines, quick identification of a substance overdose and/or the need for Narcan intervention, as well as a nuanced understanding of drug-psychosomatic interactions. The types of non-clinical services that stakeholders reported as most important for mental health crisis response included de- escalation, resource linkages and handoffs, system navigation, providing perspective from providers with shared identities or experiences, building ongoing relationships with frequent utilizers, and overall building trust and rapport with the community.
Given the considerations around the types of needs that various specialties can address during crises, as well as the implications for financial feasibility, stakeholders elevated additional ideas for how to staff crisis response teams. Stakeholders expressed support for a crisis response team with a medical provider (e.g., advanced practice nurses, psychiatric mental health nurse practitioners, EMTs, or paramedics), social workers, and especially peer counselors. Stakeholders expressed that non- clinical staff are equally valuable to clinical staff in a crisis response team, a value which should be reflected in their salaries.
Additional Perspectives from the SCU Survey
“We need a crisis response team with trained
social workers, case managers, and clinicians
trained in de-escalation techniques. This team
should be able to connect people in crisis with
emergency shelter and other services.”
“I do not believe that the police are trained to
respond to the needs of an individual, homeless,
or otherwise, experiencing a crisis. Mental health,
substance use, and homelessness related crisis are
best responded to by someone who has been
trained to work with these issues, or a peer who,
along with a trained professional, can provide
support and most importantly, follow up.”
“I think professionals
who are trained to
resolve these crises
non-violently is key. For
example, social
workers.”
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 38 Stakeholder perceptions of a need for post-crisis
follow-up care.
Perceived Strengths
• Positive experiences
with existing referral
services (i.e., TOT
and CAT)
Perceived Challenges
• Existing programs do
not meet the volume
of need
• Difficulty contacting
service utilizers for
follow-up care
• Lack of warm
handoffs to follow-up
providers
• Limited long-term
service availability
• Strict missed
appointment policies
Stakeholder Ideas
• SCU provides follow-
up care
• SCU builds
relationships to
support before,
during, and after a
crisis
• Providers should be
familiar with case
history, triggers, etc.
a
For crisis services provided by the City of Berkeley, the Transitional Outreach Team (TOT) is the primary resource for post-crisis follow-up care.
Service utilizers and community-based service providers elevated many strengths about the TOT team, including their ability to connect service utilizers to longer-term care options and social services when interested.
At the same time, stakeholders uplifted a need for additional follow-up care after a mental health emergency. TOT staff and Berkeley Mental Health leadership described many challenges TOT face in meeting the level of need across the crisis spectrum. The team is not adequately staffed to meet the current demand for their services. TOT is a team of only two staff with limited business hours for providing linkage to care. TOT staff also shared that the service provider that responds during a crisis (i.e., MCT) is not the same provider that makes follow-up connections (i.e., TOT), and that there are many potential providers to provide ongoing, long-term care (e.g., Berkeley Mental Health, Alameda County Behavioral Health, or private providers). They felt that this can create challenges for them to provide successful referrals and handoffs to post-crisis follow-up care, sharing background information on clients, and building trust and establishing rapport.
TOT staff also shared many challenges they face in reaching clients, particularly those leaving an inpatient or emergency facility, such as John George or Alta Bates Hospital. They explained that clients are sometimes discharged prior to their connection with TOT, often outside of TOT’s hours of operation. They find it particularly difficult to connect with service utilizers that do not have a cell phone or a consistent residence, which they explain is common among high-utilizer community members, such as those with severe mental illness or those experiencing homelessness. “I think police officers
already deal with so
much, there's often an
acute need they're
responding to when in
fact these individuals
need long-term care.”
- SCU Survey Respondent
Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 39
In general, many people that experience mental illness or mental health crises require or are recommended to long-term therapy or extended sessions. However, it is the perception of stakeholders that services are primarily devoted to high-acuity and short-term and service utilizers are unable to access long-term therapy. Stakeholders felt that the providers who do offer therapy or counseling are unable to meet the volume of weekly appointment needs of service utilizers due to budget and billing constraints. Therapy is not only a form of post-crisis care but also a pre- crisis prevention tool; service providers suggested brief intervention therapy in non-emergency settings (such as a service utilizer walking in during a crisis) to augment the existing crisis response system.
Outside of Berkeley Mental Health services, there are often strict policies around missing appointments, largely tied to insurance and billing requirements, that result in service disruption or termination for service utilizers. Service providers and service utilizers feel that these strict missed appointment policies are inaccessible to many low-income service utilizers and often result in the discontinuation of services. Stakeholders described some barriers that service utilizers may face in maintaining their appointments, including working more than one job (especially during standard business hours), having a reliable cell phone, having access to a calendar, and/or having a reliable mode of transportation.
The importance of follow-up care was elevated by all stakeholder groups as a priority for the SCU. Service providers argued that there may be benefits to having the same people providing care before, during, and after a mental health crisis, to build relationships, establish trust, and understand an individual service utilizer’s care history, behaviors, triggers, and needs.
Additional Perspectives from the SCU Survey
“I would like for the police to be removed from
crisis services and to have a rapid response
available when I call...I would like for there to be
more connection to services and follow up as part
of the planning. There is often not a resource
available for the person, and living on the streets is
stressful, so repeated contact is essential. It can’t
be a one and done and often would mean an
increase in FSP teams.”
“Alternative trained individuals, such as social
workers or mental health professionals as part of this
time, increased community-based mental health
care services, social and rehabilitative services that
highlight social reintegration, such as Supported
Housing, Supported Employment, and Supported
Education.”
We need clean, safe
shelters for people to
spend the night if
they're homeless
and/or under threat.
Kicking them out of
shelters doesn't make
the problem go
away.
- SCU Survey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 40 Stakeholder perceptions of barriers to successful
partnerships and referrals across the mental health
service network
Perceived Strengths
• Providers know the
referral options
available for their
clients
Perceived Challenges
• Limited coordination
and information
sharing between
providers of shared
clients
• BPD engages with
many high utilizers
but is not connected
to the network of
providers
• Lack of trust and
understanding across
service providers
Stakeholder Ideas
• Engage providers in
discussions on system
improvement
• Increase
collaboration
between cities,
counties, and
providers
• Address systemic
factors of crises
• Increased outreach
and care
coordination of
referrals
There w
as consensus among stakeholder groups that the existing mental health and crisis service network is complex, involves many providers, and can be a challenge for both clients and providers to navigate. Across these entities, establishing partnerships and referral pathways can be done informally (such as knowing which organization provides which types of services) or can be formalized (such as holding regular case management meetings for shared clients). Among community-based service providers, interviewees shared that they typically do know the scope of options available to their clients.
In general, stakeholders elevated a perceived lack of coordination between service entities in Berkeley. For example, a single client might receive emergency services from John George or Highland Hospital, but also have a primary care provider, have engaged frequently with the LifeLong Street Medicine Team, and have a case manager at the Women’s Drop-In Center for wraparound services. Stakeholders shared that there is not active collaboration across all these entities or an established infrastructure to facilitate an understanding of all the touch points between providers and a service utilizer. Ultimately, stakeholders feel that this obstructs the visibility of how a service utilizer moves through various points in the system. Some providers explained that they may not share the full case history or behavior details of a client with other service providers initially because they fear the client will be rejected or denied service, particularly for violent behaviors. They feel that this prevents informed and well-placed referrals and service provision.
TOT staff shared that service coordination is lacking between hospitals and TOT for post-crisis follow-up care. To connect with an MCT service “A 24-hour crisis
line/team or at least a
team more available
than currently. Police
and that team should
attend the regular city
coordination meetings
with the current teams
that are doing
outreach.”
- SCU S
urvey Respondent
Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 41 utilizer at the hospital, TOT explained that they must rely on the discharging facility to contact them and coordinate the release of the shared client. TOT staff reported needing to spend time in hospitals to establish relationships with new case managers, front desk staff, nurses, and orderlies to facilitate this information sharing and warm handoff of clients; they described a lack of standardized protocol for such coordination.
BPD also reported feeling disconnected from the care continuum and lacking coordination with trusted CBOs and behavioral healthcare providers around shared clients. BPD routinely engages with frequent crisis service utilizers and sometimes carries supplies like food and clothing, though there is not an existing pathway for BPD to identify, contact, and coordinate with a case manager. BPD elevated that these frequent utilizers would be better served by a case manager.
Service providers also reported that BPD does not routinely bring service utilizers to their locations for support, and some questioned whether BPD know that their programs and services exist. Still, others felt that police presence at their sites is disruptive and may prevent potential service utilizers from coming if they witness police officers around the premises.
Stakeholders offered possibilities to enhance the referral pathways and partnerships across the crisis response network at both structural and provider levels. At a structural level, stakeholders suggested having a regular convening of local care providers to discuss opportunities to improve the mental health crisis system. Stakeholders also suggested having more inter-county and inter-city coordination on systemic issues related to housing and healthcare. Stakeholders suggested that the crisis response system should be expanded and augmented to include more non-mental health related service provision on the spot and not only connections or linkages to resources. Additionally, stakeholders expressed a desire for more outreach and partnerships with long-term care to enhance coordination and referrals across the service network.
At a provider level, stakeholders suggested having more coordination between providers and outreach teams. Service providers also expressed an interest in having regular meetings with the SCU to discuss shared clients, which could improve care coordination as well as client outcomes.
Additional Perspectives from the SCU Survey
“The challenge is, and has been, to have adequate staffing to provide services to those in crisis, with severe mental health diagnosis and/or dual diagnosis in the moment and following a crisis response.
Successful efforts have been proven by street health teams to engage and provide treatment on the street, which often include de-escalation. The struggle lies on helping folks transition into care in the clinics, recovery programs, or a combination of both: with adequate staffing to provide long term services. So, challenges would fall under budget & funding to expand staffing and programming, including crisis residential, and Board and Care Homes...The City appears open and willing to try an approach that will better meet the needs of its citizens.” Attachement 2
Cit
y of Berkeley Mental Health Crisis Response & Perspectives | 42 Stakeholder perceptions of needs to integrate data
system and data sharing to improve services
Perceived Strengths
• Some medical
clinics use the
same EHR
• Some agencies
use a shared
Alameda County
Community
Health Record
Perceived Challenges
• Limited data
integration across
providers inhibits
care coordination
Stake holder Ideas
• Expand data
integration across
providers and
provider access to
case history
• Increase care
coordination across
providers
• Notify case
managers after
discharge from
hospital
Servi
ce providers feel that better system integration and data sharing across the service provider network can support providers in meeting the needs of service utilizers. Stakeholders feel that system integration and data sharing are strongly related to the successes and challenges of partnerships, referrals, and connectivity across the service network.
The numerous entities that span the mental health, substance use, and homelessness service network include CBOs and government agencies across the City of Berkeley, Alameda County, and other cities and counties. Service utilizers also move across these regions, accessing services in multiple cities or counties. As a result, system integration could happen at many levels.
Fortunately, subsets within the service network do have data integration and sharing capabilities. For instance, providers shared that all federally - qualified health centers (FQHCs) are on the same network as hospital Emergency Departments.
Some program directors also discussed a recent effort at the county level to integrate data into one Community Health Record for service utilizers. 25 This system integrates medical, mental health, housing, and social service data into one platform. There are currently over 30 organizations within 25 Alameda County Care Connect. (n.d.). Why AC Care Connect? Why Now? Retrieved October 11, 2021, from https://accareconnect.org/care- connect/#faq-item-5
“I would also feel safe
knowing that the City
and County were
working together to
identify ways to
increase funding for
mental health services
in conjunction with
housing to meet the
mental
health/substance use
recovery needs of the
community.”
- SCU
Survey Respondent
Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 43
Alameda County who are using the community health record, with a goal of every agency being onboarded onto the system.26
Until then, the current multitude of agency data systems are not yet fully integrated. Providers explain that they are unable to identify shared clients or high utilizers of multiple systems, track those service utilizers’ touchpoints across the service network, or view patient history across those service touchpoints. Case managers share that they are not notified when a client is discharged from a medical facility or community provider of care. Service providers feel that this lack of data integration affects collaboration, referrals, and, ultimately, client outcomes. The limited visibility of a service utilizer’s prior history was raised by service providers as a challenge to supporting safety when trauma histories, triggers, and recent mental health crises cannot be incorporated into care planning.
Additionally, except for diagnosis and treatment purposes, HIPAA privacy regulations require service utilizers to give consent and Release of Information (ROI) to providers for external case managers’ names, information, and service documentation to be included in medical records. This limits the collaboration between case managers and other providers on a case-by-case basis.
Stakeholders elevated that it would be ideal to have all service providers, including an SCU, utilizing the same data platform. They also indicated that non-medical CBO providers and case managers should have contact with the client’s health home (if established), especially for substance use management and medication management. Case managers could then be notified when a service utilizer is engaged or discharged from care. Service providers emphasized the importance of understanding someone’s medical and social history to provide appropriate care and anticipate what could trigger or escalate them.
Service providers also warned to not overburden the SCU with documentation requirements.
Additional Perspectives from the SCU Survey
“… Secondly, we need significantly greater inter-municipal and inter-county collaboration in order to tackle structural problems that homeless and mentally ill clients face…Increasingly, our clients are more mobile, have longer commutes, and with gentrification and sprawl, landscapes of poverty and wealth are shifting. We need to be able to be responsive to clients across municipalities and communities, as people who seek services in Berkeley, particularly homeless and low -income clients, often no longer have the means themselves to be able to live in Berkeley.”
26 Raths, D. (2021, October 4). Alameda County’s Social Health Information Exchange Expands. Healthcare Innovation.
https://www.hcinnovationgroup.com/interoperability-hie/health- information-exchange-hie/article/21240807/alameda-countys-social- health-information-exchange-expands
“… But we need more
training in mental
health, de-escalation
and interagency
training and
coordination. We
have a lot of great
people working these
issues, we just need a
little more cross
pollination of effort.”
- SCU Survey Respondent
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Stakeholder perceptions of a need for increased
community education and public awareness of crisis
response options
Perceived Strengths
• 911 is well-known by
the general public as
a crisis response
option
Perceived Challenges
• Lack of clarity that
MCT responds with
police, undermining
trust
• Limited knowledge
around services and
availability
• Distrust of system can
prevent people from
calling 911
• Incidents of
unnecessary use of
911
Stakeholder Ideas
• Launch a public
awareness
campaign for new
SCU and clearly
distinguish it from
MCT
• Work with partners
and service providers
to advertise SCU
• Increase community
education on use of
911 and techniques
for conflict resolution
A common perspective among stakeholders is that the general public is unclear around when police will or will not be involved in a response.
Many service providers and service utilizers do not know the current options and availability of services in Berkeley to support during a mental health crisis. Overall, stakeholders share that there is a lack of understanding of what services are available and which entity provides those services. They feel that this undermines a sense of safety and contributes to distrust of the current mental health crisis response system.
One common challenge raised by many stakeholders has been the lack of understanding of MCT’s co-responder model. Many providers shared that they have contacted the MCT line specifically to avoid calling 911 and were surprised when MCT was accompanied by police. Many providers, therefore, stopped calling MCT because of its collaboration with BPD. Similarly, service utilizers shared that there is a lack of trust that MCT can manage a crisis without police presence. Service utilizers are concerned that their safety is endangered in these instances and that they may experience retaliation or police surveillance after requesting service provision from MCT, especially when they request help during substance use emergencies.
Stakeholders spoke to the importance of promoting community education and public awareness to address these challenges. They feel that the success of an SCU would be contingent on community education and public awareness around whether there would be police involvement in an SCU response. Service providers shared that connecting with local CBOs, leveraging existing partnerships, and building trust will be essential for an SCU to have buy-in among service providers to call a new “In the past, I have
witnessed unsafe
situations or people
who look like they
could use support, but I
am too afraid to call
the police in those
situations, for fear that
they could show up
and harm or kill the
person.”
- SCU Survey Respondent
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service that they have not used before. Service providers are interested in understanding more closely how services will be provided, the techniques that will be used for de-escalation and crisis intervention, and the SCU’s relationship with the police.
Stakeholders also shared challenges around the general public’s use of 911 and ideas for how to increase responsible use of 911. Stakeholders shared many instances of inappropriate use of 911, such as during disputes among neighbors or because a housed person or business does not want an unhoused neighbor to be near them. For these reasons, stakeholders emphasized the importance of a community education campaign around appropriate uses of 911. Stakeholders suggested that such a campaign could include strategies and techniques for managing conflicts and disputes without calling for crisis responders as an additional form of promoting community safety through methods that do not require law enforcement.
Additional Perspectives from the SCU Survey
“Merchants in the shopping districts should not be able to call the cops like they're calling customer service when a homeless person is not breaking any laws. It would be great if crisis services were more friendly and less coercive (cops), if the mental health delivery system was more robust, if crisis teams could respond in a timely way, if clinicians didn't use police radios on mobile crisis calls, if actual risk assessments were done on calls where no one would ever need a cop (when the person is willingly ready to go to the hospital), if hospitals would actually keep and treat the most ill patients rather than turning them away after 24 hours in a waiting area, if there were more mental health respite beds run by people who aren't ready to call the police if someone is agitated.”
“More trained & well-
compensated and
insured crisis response
staff, especially at night,
around the full moon, or
public events, & other
times of increased
disturbances, & more
info put out there about
what they do to help.”
- SCU Survey Respondent
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Throughout stakeholder engagement, participants were asked to share their ideas for alternative approaches to mental health and substance use crises as well as to share community needs for a safe, effective mental health and substance use crisis response. These perspectives help illuminate the gaps in the current system that could be filled by a future Specialized Care Unit.
The following perspectives provide guiding aspirations for reimagining public safety and designing a response system that promotes the safety, health, and well-being of all Berkeley residents.
Community Aspirations
Stakeholder-identified opportunities to address the root causes that contribute to mental health, homelessness,
and substance use crises
Stakeholder-identified opportunities for centering BIPOC communities in crisis response
Stakeholder-identified opportunities for community
oversight to ensure equitable and transformative crisis care
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Stakeholder-identified opportunities to address the
root causes that contribute to mental health,
homelessness, and substance use crises
Stakeholders unanimously pointed to the context surrounding the conversation on mental health crises: there are intersecting, state-wide crises of homelessness due to the lack of affordable housing 27 and the opioid epidemic. When reflecting on alternative ideas and community needs, stakeholders expressed desires for addressing the root causes that manifest in the present-day rates of mental illness, homelessness, and substance misuse and abuse. Stakeholders discussed possibilities for shifting funding away from the criminal system and policing to overall community infrastructure (such as jobs, housing, and education) and increasing preventative healthcare to address the root causes of mental health, homelessness, and substance use emergencies more adequately.
Stakeholders also emphasized how stigma and criminalization of drug use and/or mental illness continue to exacerbate crises. Stigma and criminalization are barriers to accessing care and addressing these crises at both the individual and structural levels. At the individual-level, stakeholders identified that internalized stigma around mental illness, homelessness, or substance use, can prevent individuals from seeking care and that service providers can reinforce stigma through their actions and/or withhold care. They described instances of criminalization of mental illness, homelessness, and substance penalizing individuals who do seek care, preventing or terminating employment or housing, and consequently perpetuating a cycle of these experiences. At a structural level, stakeholders emphasized that stigma and criminalization shape the prioritization of funding and budget allocations away from quality healthcare, affordable housing, and evidence-based harm reduction approaches that promote community safety and health. Stakeholders also identified that the gaps in the existing crisis response system are because the crisis response system was designed around the stigma and criminalization of these experiences rather than designed to provide care and promote well-being.
27 In 2019, Berkeley passed a resolution calling on the Governor to declare homelessness a state of emergency.
https://www.cityofberkeley.info/Clerk/City_Council/2019/02_Feb/Docume nts/2019-02-19_Item_10_Declaring_a_California_Homelessness.aspx “Berkeley should
decriminalize the use
of all drugs, it needs
to create housing for
the chronically
mentally disturbed, it
needs to have very
well-trained people
responding to crises.
Berkeley together
with Alameda
County, should be
providing
wraparound services
for the mentally
disturbed and
substance abusers. It
needs to stop
criminalizing people
who are homeless.
- SCU Survey Respondent
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y of Berkeley Mental Health Crisis Response & Perspectives | 48 Additional Perspectives from the SCU Survey
“As with every other part of the United States, we
too are dealing with a rather poorly run medical
care delivery system. We are also dealing with the
war on drugs which is a total failure and has
criminalized for too many people for a drug
related problem, which is a public health issue and
should never have been a criminal justice issue.”
“Honestly we need more than just mental health
crisis teams. We need a holistic approach. One
that considers not just the crisis but also everything
before. We need to address the underlying cause -
child abuse, domestic violence, individualism and
lack of community.”
“The system is overwhelmed. It has been
extraordinarily difficult to link clients to shelter or mental health consistently in Berkeley. The
problems that most clients suffering from mental
illness in the region face are primarily systemic in
nature, and there is an extreme lack of resources
available in the way of permanent housing,
shelter, or frontline community mental health
services. Furthermore, for clients who are low-
income, learning disabled or struggle with
executive functioning, or homeless, engaging in
the kind of time-intensive, linear, multi-step
bureaucratic processes necessary to enter into the
shelter and mental health systems is often all but
impossible without intensive agency advocacy
and persistency. Homeless clients in particular
struggle with agency-based barriers to care, often
move between counties and municipalities, lack
targeted outreach, and experience outreach
primarily as criminalization, a tragedy given that
cost of living, region-wide housing shortages, and
past failures of criminal justice policy are
disproportionately responsible for endemic
homelessness in the Bay Area.”
“Firstly, funding priorities need to shift. We need to
address the root causes of mental illness,
substance use, and homelessness - trauma, often
created or exacerbated by decades of failed
criminal justice policy and lack of investment in
community infrastructure and social services,
criminalization of drug users as opposed to
investment in substance use counseling and harm
reduction programs, and the legacy of a
suburbanized and disjointed approach to regional
housing policy and governance. We need to shift
funding priorities in Berkeley and the region
towards funding social services, especially mental
health and substance use rehabilitation,
education, parks and transit infrastructure, and
encourage policies that protect renters and the
working poor, especially families. We need to not
only shift towards social workers and mental health
responders as the primary agents in engagement
with clients suffering from mental illness, and not
only increase homeless outreach - we also need to
acknowledge the history of homeless-led political
engagement in Berkeley and the region, and
employ a model that politically values the voices
of homeless clients themselves…”
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Stakeholder-identified opportunities for centering
BIPOC communities in crisis response
Stakeholders emphasized that people of color, particularly Black or African American people, are most often harmed by police. They also named that in Berkeley, the structures that put people at risk of homelessness disproportionately affect Black residents, which results in Black Berkeley residents disproportionately experiencing homelessness. 28 Some service providers also shared incidences of racial bias and discrimination by BPD against their Black clients. For example, at a CBO provider of non-emergency services, case managers reported calling 911 because MCT was closed; the case managers reportedly gave specific instructions that a young White woman was threatening staff and refusing to leave the premises. Yet, upon arrival, BPD harassed and threatened to arrest a Black client.
Black service utilizers and service providers alike elevated their own experiences navigating systems with entrenched racism, including interactions with police and medical facilities. For example, one Black clinician shared the important and unique ways that Black personnel promote a sense of safety, security, and trust for Black service utilizers. The provider shared that the comfort and reassurance of a shared identity increases the opportunities to be more honest, especially during medical or mental health crises.
Stakeholders shared that reducing contact between police and Black residents, especially Black unsheltered residents, is important to public safety. Stakeholders also shared that Black residents and other community members of color should provide input and feedback as an SCU is designed and implemented in Berkeley.
Additional Perspectives from the SCU Survey
“less arrests and escalation by police, I worry
because the homeless population is mostly African
American.”
“…The proportion of folks who are Black among
those homeless in Berkeley is much higher than the
general population. We know that police
interacting with POC is a dynamic that all too
often leads to harm.”
28 City of Berkeley. (2019). City of Berkeley Homeless Count & Survey – Comprehensive Report. Retrieved October 11, 2021, from
https://everyonehome.org/wp-
content/uploads/2019/09/2019HIRDReport_Berkeley_2019-Final.pdf
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Stakeholder-identified opportunities for community
oversight to ensure equitable and transformative crisis care
Due to system distrust and the current climate around Berkeley’s Reimagining Public Safety efforts, stakeholders expressed a desire and need for ongoing community input and oversight of crisis response, especially by those most impacted by crisis services.
Stakeholders suggested leveraging the Mental Health Commission, which they feel is currently underutilized. They also expressed the importance of ensuring that engagement and oversight opportunities are accessible for the most structurally marginalized residents and residents utilizing SCU and crisis response services.
Additional Perspectives from the SCU Survey
“Crisis response that reaches out to the
community to ask what they want; particularly
communities of color, and enlist this community in
the creation of the programs…”
Thoughtful, constructive ways for integration and
engagement of the challenged community with
the community of Berkeley residents and workers.”
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Appendices
Appendix A. Sample Interview Guide
CBO Staff Focus Group Guide
Focus Group Details
Date
Facilitator
Community groups in attendance
Overview
[Introduce facilitator and notetaker]
We are gathering information about mental health and substance use crisis response in the City of Berkeley, including by contacting (211, 911, BMH crisis triage line, etc.) and who responded (if at all): social workers, medics/EMT, fire and/or police in our city. We are interested in hearing specifically about your experiences, and/or your perceptions of, mental health and substance use crisis response in the City of Berkeley. We are gathering this information to inform the development of a Specialized Care Unit (SCU) for the City of Berkeley as a non-police crisis response to mental health and substance use calls.
At the end of the discussion, if you feel like you didn’t get to share something, or you think of something else you want to share later, feel free to visit our website for additional ways to provide feedback. https://sites.google.com/rdaconsulting.com/city-of-berkeley-scu/
This focus group will last approximately 90 minutes. If possible, please leave your video on and keep yourself muted when you are not speaking. You may respond to our questions verbally or in the chat, whichever you prefer.
Our goal for today is to understand your experiences as providers and advocates and do not expect you to share private details of your clients’ experiences. Your own responses will be kept confidential and will be de-identified in any report back to the City of Berkeley.
We understand that some experiences with the current crisis response may have been harmful to you and/or your clients; if you would like to take a break or leave the focus group, please do so at any time.
Does anyone have any questions before we begin?
Questions
Warm-up
To get us started, we would like to do some introductions.
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1. Please introduce yourself to the group by sharing your name, group or organization you are representing, your role, how long you’ve been there, and a word or phrase that comes to mind when you think about “mental health and substance use crisis services”.
Experience with and perceptions of mental health and substance use crisis response Now I would like to ask you some questions about your experience with and perceptions of the mental health and substance use crisis response options in the City of Berkeley.
2. What do you know about the existing mental health and substance use crisis response options in the City of Berkeley?
a. What kinds of crises do these services respond to?
b. What is missing?
3. How do the services your organization or program provides intersect with mental health and substance use related crisis services?
4. Are individuals referred to your program after experiencing a mental health or substance use related crisis?
a. If so, what services do you typically provide
b. How are those clients connected to your program?
5. Where would your clients go/who would they call if they were experiencing a mental health or substance use related crisis?
a. If, as a provider, a client was experiencing a mental health or substance use related crisis is there a program that you would call for support? i. If so, who would you call? How do you decide who to call? ii. How effective has the response been?
iii. Please share an example of a situation where you needed to contact someone to support a mental health or substance use related crisis for a client.
1. Do you feel that the service was helpful? If so, how?
2. If not, what could have been done differently?
6. Do you feel comfortable/safe calling for support from the existing mental health or substance use related crisis service options? Why or why not? a. Do you feel that the existing mental health or substance use related crisis response options are helpful to clients? Why or why not?
7. Are there times that you have chosen not to call for mental health or substance use related crisis response services? Why or why not?
a. What did you do instead?
b. What might have made you feel more comfortable calling for support when a client was experiencing a mental health or substance use related crisis?
8. What do you feel that your clients typically need when they are experiencing a mental health or substance use related crisis?
a. Where might you refer a client if your program or organization can’t provide the help they need during a mental health or substance use related crisis?
9. Are there local organizations or groups that you collaborate with that are maybe not considered part of the “system”?
a. If so, who are they and what kinds of support do they provide? i. Do you think they would want to talk with us? [if yes, get contact info for follow up]
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In this section we will be discussing what the system is doing well and what the system is not doing so well.
10. In your opinion, what are some of the strengths of the current mental health or substance use related crisis response options?
a. If your clients have experienced a mental health or substance use related crisis, were they able to get help? How so?
11. In your opinion, what are some of the weaknesses of the current mental health or substance use related crisis response options?
a. Why do you think things aren’t working?
b. Do you think mental health or substance use related crisis response services are difficult for your clients to access? How so?
c. What are some of the gaps related to mental health or substance use related crisis response options?
12. Do you feel that some people are served better than others by the current crisis system? a. If so, who is left out?
b. Are people treated differently based on their race, gender, culture, sexuality, or disability? If so, how?
Ideas for alternative model
In this section I’m now going to ask you for your ideas for an ideal response for someone experiencing a mental health or substance use related crisis.
13. What would an ideal mental health or substance use related crisis response look like for you and the people you serve?
a. What kind of response would best meet the needs of your clients? b. What would make it more likely for you to reach out to a crisis team for support? c. What would make it less likely for you to reach out? d. Who should, and should not, be involved in a mental health or substance use related crisis response? (i.e., Police, EMT, clinicians, peers, social workers, others?) e. What do you consider to be essential features of an effective mental health or substance use related crisis response that is responsive to, and respectful of, the clients you serve?
14. What do you feel needs to be included in a new mental health or substance use related crisis response for you to feel safe calling for or providing those services?
Wrap up
We are hoping to talk to people one on one who are less likely to attend a focus group, but who have lived experience and would like to provide feedback on the development of a Specialized Care Unit. We are asking you to think about the people your program serves and consider if there are individuals who might want to share their experience with us in an interview either in person or over the phone.
15. What do you think are the best ways to engage your clients in this process? a. How can we make sure that everyone’s voice is heard? b. Who is the best person to interview them?
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c. Would they be comfortable talking with someone from RDA or is there another person who might be more suited to talk with them?
d. [Note contact information for follow up if applicable]
16. Is there anything else that you didn’t get to share today that is important for us to know?
Closing
Thank you for your participation. We genuinely appreciate the time you took to speak with us today. We will be conducting interviews with other organizations and community members over the next few months and compiling a report based on the feedback, which will be shared with you and the community. If you would like to share any additional information with the City of Berkeley, feel free to visit https://sites.google.com/rda consulting.com/city-of-berkeley-scu/.
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Appendix B. Demographics of Community
Engagement Participants
As a reference point, it is important to understand the demographics of the Berkeley population.
Table 1 below shows the demographics of Berkeley’s overall city population (in July 2019) and the Medi-Cal recipient population (FY 2019-2020). Medi-Cal population demographics are included because the majority of City of Berkeley ongoing funded mental health services are restricted to this population, due to funding requirements. Relative to Berkeley’s overall population, Black or African American residents are overrepresented in the City’s Medi-Cal population, while Whites and Asians are underrepresented.
Table 1. Berkeley Population and Medi-Cal Recipient Demographics (2019) City Population
(July 2019)29
Medi-Cal
Recipients
(FY 2019-2020)
Population Size 121,363 18,548
Race Ethnicity (%)
White 53.3% 26%
Black/African American 7.9% 22%
Hispanic/Latino 11.4% 12%
Asian/Pacific Islander 21.5% 10%
American Indian/Alaska Native 0.5% 0%
Other (including 2+ races) 7.5% 33%
Gender (%)
Female 50.5% 51%
Male 49.5% 49%
In the charts shown below, “provider participants” are those who were interviewed by RDA as part of CBO interviews and focus groups. “Service utilizer participants” are clients of CBOs or encampment residents who were interviewed by RDA. And “survey participants” are individuals who responded to RDA’s online survey; these respondents could be a mix of providers, servicer utilizers, and/or other Berkeley residents or stakeholders.
29 United States Census Bureau. (2019). QuickFacts – Berkeley city, California. https://www.census.gov/quickfacts/berkeleycitycalifornia Attachement 2
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Figure 1 below shows the age distribution of the individuals that participated in this process.
Overall, RDA received information from more people in the 30-44 range (39%) than any other age range.
Figure 1. Participants by age (n = 122 individuals)
Figure 2 below shows the racial and ethnic distribution of participants in RDA’s data collection.30 Participants were asked to note all races/ethnicities that they identified with, so these are duplicated counts; for this reason, specific percentages should not be interpreted from this data.
A large proportion of participants were white, especially among the survey respondents who participated. Most of the Black or African American participants contributed their perspectives via RDA’s in-person focus groups or interviews. As compared to Berkeley’s overall population, service utilizers and providers who identified as Black or African American were overrepres ented in RDA’s data collection efforts, (see Table 1).
30 13 participants selected more than one racial or ethnic identity, so these numbers are duplicated. For example, if a participant selected White and Black or African American, they are counted in both the White and African American categories.
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Figure 2. Participants by race/ethnicity (n = 122 individuals)
Figure 3 below shows the number of transgender and cisgender participants of RDA’s data collection. Overall, there were far more cisgender participants than transgender participants.
However, a higher proportion of service utilizer respondents (13%) were transgender, while less than 4% of survey respondents and 3% of provider respondents were transgender.
Figure 3. Participants by transgender/cisgender (n = 122 individuals)
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Figure 4 below shows the gender identity distribution of participants to RDA’s data collection.
RDA collected feedback from more than double the number of female-identifying participants (72) than male identifying participants (31). There was an even distribution among service utilizer respondents (41% female and 41% male) compared to survey respondents (67% female vs. 20% male) and provider respondents (69% female, 16% male). Overall, there were very few genderqueer or nonbinary participants (<1% and 6% respectively).
Figure 4. Participants by gender identity (n = 122 individuals)
Figure 5 below shows the sexual orientation of participants of RDA’s collection. Over one third (35%) of participants identified as heterosexual or straight, while over one fourth (28%) identified as LGBTQ+. The remaining participants did not share their sexual orientation or it was not asked of them. Over half of survey respondents (57%) identified as straight, while only 31% of provider respondents and 10% of service utilizer respondents identified as straight.
Figure 5. Participants by gender identity (n = 122 individuals)
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Figure 6 below shows the geographical distribution of participants of RDA’s data collection. The most common zip code of participants was 94710 (25%), in large part due to the number of Seabreeze encampment residents that participated in this process. Closely following were the Berkeley ZIP codes of 94702, 94703, and 94704 with 11%, 12%, and 18% of participants, respectively.
Figure 6. Participants by ZIP code (n = 122 individuals)
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Appendix C. Process of a Mental Health Call
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Appendix D. Mental Health Call Responses –
Call Volume and Demographics
Data Collection Methods and Challenges
Early on in this project, RDA submitted requests to Berkeley Mental Health’s Mobile Crisis Team (MCT) and the Berkeley Fire Department (BFD) to receive data on responses to all mental health related calls. MCT shared basic service-level data of their responses for FYs 2015-2020. BFD shared data from BFD and Falck (the city’s contracted ambulance services provider for mental health crises) that was limited to responses to 5150 calls in Berkeley between calendar years 2019-2021.
RDA did not submit a data request to the Berkeley Police Department (BPD) for two reasons. First, from another evaluation project that RDA currently has with the Berkeley Mental Health Division, RDA already had basic service-level data from BPD regarding their responses to calls originating for 5150s, for the period of CYs 2014-2020. Second, in April 2021, the Berkeley City Auditor released a comprehensive report on its extremely in-depth data analysis of BPD’s responses. For the purposes of RDA’s project regarding the Specialized Care Unit (SCU), there was no need to replicate any of the work and findings that came from the Berkeley City Auditor. Please see the Berkeley City Auditor’s report for a detailed description of its methods, findings, data limitations, and data recommendations for BPD.
31 The findings that are shared in this report from the Berkeley City Auditor’s study are extrapolated directly from the data about BPD calls (from CYs 2015-2019) that was included in the Auditor’s report.
In general, RDA’s analysis of MCT, BFD, Falck, and BPD call data yielded high-level summary plots about subject/patient demographics and call volume. The general limitations of all available data prevented a more in-depth analysis of the data. More detailed tabular findings are not shared in this report for two reasons: 1) given that all of the quantitative data are under representations of the true volume of crisis responses and callers in Berkeley, only the trends about the volume of mental health related calls and caller demographics should be interpreted from this data, not the specific numbers; and 2) in order to protect the privacy of the few individuals who populated some of the specific categorizations of this data, RDA cannot disclose data which includes small sample sizes.
There were limitations to the quantitative datasets that RDA received. Of greatest impact is that the data entry practices across each agency were not consistent with each othe r, thus limiting which data could be pulled for analysis as well as which findings could be compared between agencies. For example, due to data limitations, RDA was unable to present a total call volume across agencies or the unmet need for mental health intervention during 5150 transport. Though estimates on call volume and unmet need are relevant to understanding crisis response options, inconsistent data collection and reporting across agencies would make this calculation inaccurate and misleading.
31 Berkeley City Auditor. (2021, July 2). Data Analysis of the City of Berkeley’s Police Response. https://www.cityofberkeley.info/uploadedFiles/Auditor/Level_3_- _General/Data%20Analysis%20of%20the%20City%20of%20Berkeley's%20Police%20Response.pdf Attachement 2
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The data challenges that RDA encountered were very similar to those faced by the Berkeley City Auditor; please refer to the Berkeley City Auditor’s report of its findings of Berkeley’s Police Response for a thorough description of their data challenges. 32 Mental Health Call Volume
Mobile Crisis Team: From the call data that MCT shared with RDA, findings are limited to only showing the total volume of calls that MCT responded to during 2015-2020. Due to missing data and data elements across the various years, there were not any consistent elements for which findings could be determined over the full five-year period. Figure 7 below shows the volume of MCT’s total incidents and which of those incidents resulted in a 5150 for each year between 2015-2020.
Figure 7. Mobile Crisis Team (MCT) Incidents in 2015-2020 - Total Total Incidents 5150s Only
Since 2015, there has been a gradual decline in the number of total and 5150 incidents that MCT responded to in Berkeley due to staff vacancies as well as the COVID -19 pandemic.
Berkeley Police Department: For the period of 2014-2020, RDA received data from BPD that included all calls initially coded by BPD as needing a 5150 response. This was the only type of designation that could be queried in BPD’s data for mental health related calls. From this dataset, RDA identified the variety of other types of incidents that were coded alongside “5150” for each call.
Figure 8 below shows the top ten incident types for all the 5150 calls that BPD responded to in 2014-2020.
Figure 8. Top 10 Berkeley Police Department (BPD) 5150 Incident Call Types, 2014-2020
32 Berkeley City Auditor. (2021, July 2). Data Analysis of the City of Berkeley’s Police Response. https://www.cityofberkeley.info/uploadedFiles/Auditor/Level_3_- _General/Data%20Analysis%20of%20the%20City%20of%20Berkeley's%20Police%20Response.pdf Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 63
Disturbance, welfare check, mentally ill, and suicide were the most frequent incident types of all 5150 calls to BPD.
The Berkeley City Auditor conducted a qualitative analysis of its BPD call response d ata to explore the differences between calls that were or were not mental health related. Because BPD’s data does not have an explicit variable that denotes whether each call is mental health related or not, the Berkeley City Auditor did a keyword search for mental health related terms in the open narrative fields of BPD’s call entries. Figure 9 below shows the differences in mental health related and non-mental health related calls that BPD responded to between 2015-2019, stratified by call type.
Figure 9. Berkeley Police Department (BPD) Call Types, 2015-2019
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Around 40% of BPD’s welfare check calls included a mental health related facet to the response, followed by around 20% of disturbance calls, and around 10% of calls regarding suspicious circumstances.
Berkeley Fire Department: The data that BFD shared with RDA (which included data from BFD and Falck) included information on the facilities that BFD and Falck transported 5150 cases to between 2019-2021. Falck conducted the large majority of 5150 transports in Berkeley. Most 5150 transports were to Alta Bates Medical Center and John George Psychiatric Emergency Services.
BFD only transported 5150 cases to Alta Bates, Oakland Children’s Hospital, and Kaiser. As contracted, Falck conducted 5150 transports to all the agencies noted below.
Figure 10. BFD and Falck 5150 Transports by Destination, 2019-2021
BFD also shared data regarding their and Falck’s time on task for each 5150 response and transport. Time on task represents the time from which BFD or Falck arrive at the scene to the point in which they complete the transport of the patient to the destination. Of the 95 5150 transports that BFD conducted between 2019-2021, BFD’s average time on task was 20 minutes.
Of the 1,523 5150 transports that Falck conducted between 2019-2021, Falck’s average time on task was 115 minutes. This is because Falck is the designated ambulance provider who is transporting 5150 cases around Alameda County. These calls can take more time and can be to farther locations. Figure 11 below shows the average time on tasks for BFD and Falck.
Figure 11. BFD and Falck Time on Task for 5150 Transports, 2019-2021 Attachement 2
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BFD, Paramedics Plus (or PPlus, the contracted ambulance provider prior to Falck), and Falck’s data on their 5150 call responses also included information on the day of the week and time that each 5150 call was initiated. RDA analyzed this data to search for any notable trends regarding when 5150 calls originate. Figure 12 below shows when each agency’s 5150 call responses occurred; this data spans the years 2018-2021. From this data, it appears that 5150s are least frequent during the very late-night and early-morning hours (2:00-8:00am), and the most frequent between 10:00am – midnight. There is no noticeable difference in the frequency of 5150s across the seven days of the week.
Figure 12. BFD, PPlus, Falck 5150 Transports by Time of Day and Day of Week, 2018-2021 Attachement 2
City of Berkeley Mental Health Crisis Response & Perspectives | 66
Demographics of Mental Health Call Responses
Mobile Crisis Team: For the five-year period of FY 15/16 through FY 19/20, the Berkeley Mental Health Division’s Mobile Crisis Team (MCT) shared data about both their overall volume of responses as well as those pertaining specifically to 5150 calls. Figure 13 below includes four figures that show MCT’s incidents by gender (first row), and then incidents by race/ethnicity (second row) by each fiscal year.
Figure 13. Mobile Crisis Team (MCT) Incidents in 2015-2020 - Gender, Race/Ethnicity Total Incidents 5150s Only
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MCT incidents were with slightly more males than females, and very few trans individuals. And, regarding race/ethnicity, MCT cases were most often White, followed by African American, other/unknown, Asian Pacific Islander, and Hispanic or Latino. Given that African Americans comprise only 7.9% of Berkeley’s population (see Table 1), they are very overrepresented in MCT’s service utilizer population.
Berkeley Police Department: For the six-year period of CY 2014 through CY 2020, the Berkeley Police Department (BPD) shared data regarding demographics (age, race, and sex) for each of its calls that were originated as designated 5150 responses. Since 2019, the majority of 5150 responses were conducted by Falck - an ambulance services provider contracted by BFD - because Falck is the designated entity (between the two agencies) to conduct 5150 transports in Berkeley.
Figure 14 below includes six figures that show: 1) the summative demographics of BFD’s 5150 subjects, and 2) the incident types stratified by subject demographics.
Figure 14. Berkeley Police Department (BPD) 5150 Subjects in 2014-2020 - Demographics and Incident Types33
Subjects by Demographics Incident Types by Demographics
33 Data noted as (blank) represent data points where data were missing.
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Of the BPD 5150 calls that had demographic variables coded, most responses were with individuals between ages 26-59, White, or male. Liked noted above with MCT’s service utilizer population, given that African Americans comprise only 7.9% of Berkeley’s population (see Table 1), they are also very overrepresented amongst BPD’s 5150 population. Most BPD 5150 calls were also coded as disturbance calls, welfare checks, mentally ill individuals, and suicide. Each incident type is not mutually exclusive, so any particular incident could have one or multiple more incident type logged towards it in addition to being a 5150.
The Berkeley City Auditor’s report (released in April 2021) on BPD call responses included a variety of tables with data on the demographics of the subjects of their officer -initiated stops by race and age; please refer to the Berkeley City Auditor’s Report in Figure 19: Officer-Initiated Stops by Race and Age, 2015-2019.
34 RDA took the data shared in that figure to produce
different visual representations of all subjects that BPD responded to between 2015 -2019; this data includes responses to non-mental health related calls, as well.
34 Berkeley City Auditor. (2021, July 2). Data Analysis of the City of Berkeley’s Police Response. https://www.cityofberkeley.info/uploadedFiles/Auditor/Level_3_- _General/Data%20Analysis%20of%20the%20City%20of%20Berkeley's%20Police%20Response.pdf Attachement 2
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Figure 15. Berkeley Police Department (BPD) Officer-Initiated Calls in 2015-2020 - Race and Gender (via Berkeley City Auditor’s Report on BPD Calls)
Berkeley Fire Department: For the three-year period of CY 2019 through CY 2021, the Berkeley Fire Department (BFD) shared data regarding demographics (age, race, and gender) and incident type for each of its calls that were originated as designated 5150 responses. Figure 16 below includes six figures that show: 1) the summative and combined demographics of BFD and Falck’s 5150 patients, and 2) the differences in volume of BFD and Falck 5150 responses stratified by patient demographics. Figure 17 below shows the total combined 5150 responses by BFD and Falck, first grouped by gender by race, then by race by gender.
Figure 16. Berkeley Fire Department (BFD) and Falck 5150 Patients in 2019-2021 - Demographics
Patients by Demographics Transport Agency by Demographics
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Figure 17. Berkeley Fire Department (BFD) and Falck 5150 Patients in 2019-2021 - By Gender and Race
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Similar to the incidents that MCT responded to, the 5150 patients that BFD and Falck responded to are mostly between ages 26-59, White, or male. Falck also conducted a large majority of the 5150 transports in Berkeley, as compared to BFD.
Attachement 2
Speci
alized Care Unit
Crisis Response Recommendations
City of Berkeley
Attachment 3
City of Berkeley
Specialized Care Unit (SCU)
Crisis Response
Recommendations
Sarah F
errell
Caroline de Bie
Sasha Gayle-Schneider
Amalia Egri Freedman
Nicole Gamache-Kocol
Jamie Dorsey
Kevin Wu
Thi
s report was developed by Resource
Development Associates under contract with
the City of Berkeley.
Resource Development Associates, 2021
Attachment 3
Table of Contents
Executive Summary 1
Introduction 3
The SCU Model 8
Recommendations 10
System-Level Recommendations 57
Conclusion 60
Appendix 64
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SCU Crisis Response Recommendations | 1
Executive Summary
As part of the larger effort to Reimagine Public Safety, the City of Berkeley contracted with Resource Development Associates (RDA) to conduct a feasibility study for a Specialized Care Unit (SCU), an alternative mental health and substance use crisis response model that does not involve law enforcement.
This is the third of three distinct reports for this effort. The first report (“Crisis Response Models Report”) presents a summary of crisis response programs in the United States and internationally. The second report (“Mental Health Crisis Response Services and Stakeholder Perspectives Report”) is the result of engagement with stakeholders of the crisis system, including City of Berkeley and Alameda County agencies, local community-based organizations (CBOs), local community leaders, and utilizers of Berkeley’s crisis response services, and presents a summary of key themes to inform the SCU model.
This third report is intended to guide implementation of the SCU model and includes:
• Core components and guiding aims of the SCU model;
• Stakeholder and best practice-driven design recommendations; • Considerations for planning and implementation;
• A phased implementation approach;
• System-level recommendations; and
• Future design considerations.
Each recommendation put forth in this report is deeply rooted in the stakeholder feedback included in the two previous reports. This report presents RDA’s recommendations based on this year-long project, which the City of Berkeley may adapt and adjust as necessary.
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SCU Crisis Response Recommendations | 2
Key Recommendations
1. The
SCU should respond to mental health crises and substance use emergencies without a police co-response.
2. The SCU should operate 24/7.
3. Staff a three-person SCU mobile team to respond to mental health and substance use emergencies.
4. Equip the SCU mobile team with vans.
5. The SCU mobile team should provide transport to a variety of locations.
6. Equip the SCU mobile team with supplies to meet the array of clients’ needs.
7. Clearly distinguish the SCU from MCT.
8. Participate in the Dispatch assessment and planning process to prepare for future integration.
9. Ensure the community has a 24/7 live phone line to access the SCU.
10. Plan for embedding a mental health or behavioral health clinician into Dispatch to support triage and SCU deployment.
11. Fully staff a comprehensive model to ensure the success of the SCU mobile team, including supervisory and administrative support.
12. Operate one SCU mobile team per shift for three 10-hour shifts.
13. SCU staff and Dispatch personnel should travel to alternative crisis programs for in- person observation and training.
14. Prepare the SCU mobile team with training.
15. Contract the SCU model to a CBO.
16. Integrate the SCU into existing data systems.
17. Collect and publish mental health crisis response data publicly on Berkeley’s Open Data Portal.
18. Implement care coordination case management meetings for crisis service providers.
19. Implement centralized coordination and leadership across city agencies to support the success of mental health crisis response.
20. Continue the existing SCU Steering Committee as an advisory body.
21. Solicit ongoing community input and feedback.
22. Adopt a rapid monitoring, assessment, and learning process.
23. Conduct a formal annual evaluation.
24. Launch a public awareness campaign to promote community awareness and education about the SCU.
25. The SCU mobile team should conduct outreach and build relationships with potential service utilizers.
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SCU Crisis Response Recommendations | 3
Introduction
Project Background
In response to the killing of George Floyd by Minneapolis police in May 2020 and the ensuing protests across the nation for this and many other similar tragedies, a national conversation emerged about how policing can be done differently in local communiti es.
The Berkeley City Council initiated a wide-reaching process to reimagine safety in the City of Berkeley. As part of that process, in July 2020, the Council directed the City Manager to pursue reforms to limit the Berkeley Police Department’s (BPD) scope of work to “primarily violent and criminal matters.” These reforms included, in part, the development of a Specialized Care Unit (SCU) to respond to mental health crises without the involvement of law enforcement.
In order to inform the development of an SCU, the City of Berkeley contracted with Resource Development Associates (RDA) to conduct a feasibility study that includes community-informed program design recommendations, a phased implementation plan, and funding considerations.
The Need for Specialized Mental Health Crisis Response
Just as a physical health crisis requires treatment from a medical professional, a mental health crisis requires response from a mental health professional. Unfortunately, across the country and in Berkeley, police are typically deployed to respond to mental health and substance use crises.
Without the proper infrastructure and resources in place, cities are unable to adequately meet the needs of people experiencing a mental health and/or substance use crisis.
Relying on police officers to respond to the majority of mental health 911 calls endangers the safety and well-being of community members. Tragically, police are 16 times more likely to kill someone with a mental illness compared to those without a mental illness. 1 A
November 2016 study published in the American Journal of Preventative Medicine estimated that 20% to 50% of fatal encounters with law enforcement involved an individual with a mental illness.
2 As a result, communities have begun to consider the
urgent need for crisis response models that deploy mental health professionals rather than police. An analysis found that the 10 largest police departments in the U.S. paid out nearly 250 billion dollars in settlements in 2014, much of which were related to wrongful-
1 Szabo, L. (2015). People with mental illness 16 times more likely to be killed by police. USA Today. https://www.usatoday.com/story/news/2015/12/10/people-mentalillness-16-times-more-likely-killed- police/77059710/
2 DeGue, S., Fowler, K.A., & Calkins, C. (2016). Deaths due to use of lethal force by law enforcement. American Journal of Preventive Medicine, 51(5), S173-S187. https://www.ajpmonline.org/article/S0749- 3797(16)30384-1/fulltext
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SCU Crisis Response Recommendations | 4
death lawsuits of people in a mental health crisis. 3 Law enforcement should not be the primary responders to mental health crises.
A 2012 Department of Justice report outlines that policing in the U.S. does not necessarily keep people safer but instead, militaristic policing causes more harm than good and disproportionately impacts communities of color. The report further assessed that over- policing requires more resources without producing benefits to public safety, draining resources that could otherwise be used for more effective public safety strategies. 4 Nationally, the negative impacts of policing and police violence have been declared a public health issue.
5 Extensive data shows that aggressive policing is a threat to physical and mental health: inappropriate stops are associated with increased anxiety, depression, PTSD, or long-term health conditions like diabetes. In 2016, at least 76,440 nonfatal injuries due to law enforcement were reported and at least 1,091 death s were reported. However, due to insufficient monitoring and surveillance of law enforcement violence, these statistics are underestimated.6
The impacts of policing disproportionately harm people of color, especially Black Americans, making policing an issue of racial justice. Police disproportionately stop, arrest, shoot, and kill Black Americans. Other marginalized populations, such as people with mental illness, people who identify as transgender, people experiencing homelessness, and people who use drugs, are also subjected to increased police stops, verbal and sexual harassment, and death.7
In California, Alameda County has the highest rate of 5150 psychiatric holds in the entire state,8 which may indicate inadequate provision of mental health crisis services. Of those individuals placed on a 5150 psychiatric hold in Alameda County and transferred to a psychiatric emergency services unit, 75-85% of the cases did not meet medical necessity criteria to be placed in inpatient acute psychiatric care. This demonstrates an overuse of emergency psychiatric services in Alameda County. Such overuse creates challenges in local communities such as lengthy wait times for ambulance services which are bu sy
3 Elinson, Z. & Frosch, D. (2015). Cost of police-misconduct cases soars in big U.S. cities. Wall Street Journal. https://www.wsj.com/articles/cost-of-police-misconduct-cases-soars-in-big-u-s-cities-1437013834 4 Ashton, P., Petteruti, A., & Walsh, N. (2012). Rethinking the blues: How we police in the U.S. and at what cost.
Justice Policy Institute, U.S. Department of Justice. https://www.ojp.gov/ncjrs/virtual- library/abstracts/rethinking-blues-how-we-police-us-and-what-cost 5 American Public Health Association. Addressing law enforcement violence as a public health issue. Policy number: 201811. 2018. https://www.apha.org/policies-and-advocacy/public-health-policy- statements/policy-database/2019/01/29/law-enforcement-violence. 6 Ibid.
7 Ibid.
8 INN Plan – Alameda County: Community Assessment and Transport Team (CATT) (2018, October 25). California Mental Health Services Oversight and Accountability Commission. https://mhsoac.ca.gov/sites/default/files/documents/2018- 10/Alameda_INN%20Project%20Plan_Community%20Assessment%20and%20Transport%20Team_8.6.2018 _Final.pdf
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SCU Crisis Response Recommendations | 5
transporting and discharging individuals on 5150 holds. The overuse of involuntary psychiatric holds can be traumatizing for people experiencing crisis, as well as for their friends and family.
The overuse of involuntary psychiatric holds is also an issue of racial justice. Police and ambulance workers have been found to bring Black patients with psychoses to psychiatric emergency service more frequently than non-Black patients with psychoses. 9 For example, in San Francisco, Black adults are overrepresented in psychiatric emergency services, relative to overall population size. 10
Based on 911 call data from 2001 to 2003 in San Francisco, a study found that neighborhoods with higher proportions of Black residents generate relatively fewer mental health-related 911 calls. The authors suggest that underutilization of 911 by the Black community can result in delayed treatment, therefore increasing the risk posed to the health and safety of people in crisis and their communities. The study highlights the common distrust of law enforcement among communities of color. Such distrust and fear of law enforcement may mean that people of color do not trust that mental health - related calls will be handled appropriately if they seek support for a mental health crisis through 911. The study reinforced that “law enforcement officers’ role in the disposition of calls makes them de facto gatekeepers to safety net services for persons with mental disorders.”
11 It is within this context that many Berkeley community members are calling for a more just, equitable, and health-focused crisis response system, in part due to the distrust of institutions of policing or those closely intertwined with police. A variety of stakeholder groups, including the Berkeley Mental Health Commission and the Berkeley Community Safety Coalition, have long advocated for a community-designed 24/7 crisis care model and to reduce the role of law enforcement in crisis response. 9 Kessell, E.R., Alvidrez, J., McConnell, W.A. & Shumway, M. (2009). Effect of racial and ethnic composition of neighborhoods in San Francisco on rates of mental health-related 911 calls. Psychiatric Services, 60(10), 1376- 1378. https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.10.1376 10 Ibid.
11 Kessell, E.R., Alvidrez, J., McConnell, W.A. & Shumway, M. (2009). Effect of racial and ethnic composition of neighborhoods in San Francisco on rates of mental health-related 911 calls. Psychiatric Services, 60(10), 1376- 1378. https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.10.1376 Attachment 3
SCU Crisis Response Recommendations | 6
In a concurrent project for the City of Berkeley’s Reimagining Public Safety initiative, the National Institute for Criminal Justice Reform found that among many Berkeley residents, there is a lack of trust in and satisfaction with the Berkeley Police Department. They found that:
12 • Non-White respondents were more likely to indicate that the Berkeley Police Department is not effective at all compared to White respondents; • 17.1% of Black respondents and 7.6% of Latinx respondents reported that police had harassed them personally in comparison to only 4.3% of White respondents; • Respondents are less likely to call 911 during emergencies related to mental health or substance use crisis (57.9%) in comparison to an emergency not involving mental health or substance use (86.2%); and
• Substantially more Black respondents indicated extreme reluctance to call 911 as compared with other groups.
Additionally, the report shared that across all respondents, 65.9% indicated a preference for trained mental health providers to respond to mental health and substance use emergencies “with support from police when needed” and 14.9% indicated a preference “with no police involvement at all.” In total, 80.8% of respondents indicated a preference for trained mental health providers to respond to calls related to mental health and substance use.
13 Clearly, there is an urgent need for a more racially just, equitable, and health-focused mental health crisis response system. The SCU could be well poised to address these inequities by providing specialized mental health crisis intervention, de-escalation, and stabilization without the presence of law enforcement.
Inputs to the Recommendations
This report includes core components and guiding aims of the SCU model, considerations for planning and implementing the SCU model, a phased implementation approach, stakeholder-driven design recommendations, system-level recommendations, and next steps and future design considerations. Each recommendation that RDA puts forth in this report is deeply rooted in the following sources of input:
• Crisis Response Models Report (Report 1 of this series of 3) • Mental Health Crisis Response Services and Stakeholder Perspectives Report (Report 2 of this series of 3)
• Ongoing engagement with the SCU Steering Committee and the City’s Health, Housing & Community Services Department (HHCS)
12 National Institute for Criminal Justice Reform (2021). Reimagining public safety: Draft final report and implementation plan. https://www.cityofberkeley.info/uploadedFiles/Clerk/Level_3_- _Commissions/Draft%20Final%20Report%20and%20Implementation%20Plan%20FNL%20DRFT%2010.30.21.pdf 13 Ibid.
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SCU Crisis Response Recommendations | 7
• Learnings from the simultaneous Reimagining Public Safety initiative • Best practices research
The recommendations presented in this report are directly informed from the strengths, challenges, gaps in services, and lessons learned from crisis response programs around the country. Those considerations, however, must be uniquely tailored to the Berkeley community based on the existing crisis response system and the needs and perspectives of Berkeley residents. Together, the recommendations and implementation approaches presented here are informed by findings from the robust community engagement and citywide processes of the past year.
Crisis Response Models Report
As part of this feasibility study, RDA reviewed the components of nearly 40 crisis response programs in the United States and internationally, including virtually meeting with 10 programs between June and July 2021. A synthesized summary of RDA’s findings, including common themes that emerged across the programs, how they were implemented, considerations and rationale for design components, and overall key lessons learned can be found in the Crisis Response Models Report .
Mental Health Crisis Response Services and Stakeholder Perspectives Report With the guidance and support of the SCU Steering Committee, facilitated by the Director of City of Berkeley’s Health, Housing and Community Services Department (HHCS), RDA conducted a large volume of community and agency outreach and qualitative data collection activities in June and July 2021. Because BIPOC, LGBTQ+, unhoused, and other communities are disproportionately represented in public mental health and incarceration systems— particularly ones designed for punishment and sentencing to prisons— their input was sought to advance the goal of achieving health equity and community safety.
Crisis response service users described their routes through these systems, provid ing their perspectives about their experiences and how these experiences impact their lives in a way that other stakeholders are not able or qualified to do. The goal of the immense amount of outreach and qualitative data collection was to understand the variety of perspectives in the local community regarding how mental health crises are currently being responded to as well as the community’s desire for a different crisis response system that would better serve its population and needs. Such perspectives are necessary to improve the quality of service delivery and, moreover, to inform structural changes across the crisis response system.
The synthesis of the City of Berkeley’s current mental health crisis system and themes from qualitative data collection can be found in the
Mental Health Crisis Response
Services and Stakeholder Perspectives Report
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SCU Crisis Response Recommendations | 8
The SCU Model: Planning & Implementation
Core Components
The recommendations presented in this report represent a model that is responsive to community needs, but as planning continues throughout 2021 and into 2022, new considerations and constraints may arise. As dynamics evolve and more information is obtained and assessed, the model must be flexible and adaptable. There are several components that should, however, remain core to the SCU model:
• The SCU responds to mental health and substance use crises. • The SCU responds with providers specialized in mental health and substance use. • The SCU model does not include police as a part of the crisis response. • The SCU is not an adjunct to nor overseen by a policing entity (e.g., Police, Fire, or CERN
14).
With these core components in mind, the SCU model and phased appr oach were designed to address the challenges, gaps in services, and community aspirations shared by numerous stakeholders throughout Berkeley. The SCU model seeks to:
• Address the urgent need for a non-police crisis response. • Disrupt the processes of criminalization that harm Black residents and other residents of color, substance users, people experiencing homelessness, and others who experience structural marginalization.
• Increase the availability, accessibility, and quality of mental health crisis servi ces. • Provide quality harm reduction services for substance use emergencies. • Strengthen collaboration and system integration across the crisis and wraparound service network.
• Be responsive to ongoing community feedback and experiences. • Build and repair trust with community members and increase public awareness of newly available services.
A System-wide Change Initiative
The development of a mental health crisis response model as a component of the City of Berkeley’s emergency services should be understood as a systemwide change initiative of great magnitude. Developing a shared narrative around community health and well - being while reducing harm, trauma, and unnecessary use of force may build collective support for the SCU model across City of Berkeley agencies and departments. Other cities implementing non-police crisis response models found that garnering buy-in from other 14 Community Emergency Response Network (CERN) is a model recommended by the National Institute for Criminal Justice Reform through the Reimagining Public Safety process.
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SCU Crisis Response Recommendations | 9
city or county departments requires collaboration from the earliest planning stages. Cities shared that when they focused these conversations about shared objectives between the crisis response program and the police, police began to see the program as a resource to them, as mental health professionals could often better handle mental health crises because of their training and backgrounds. Alignment on shared goals and values may support leadership across the City of Berkeley to identify and advance the best resource(s) for responding to mental health needs and substance use crises. An effective systemwide change initiative will also require all involved leaders to communicate and champion the shared vision.
The SCU model requires not only collaboration, but also structural changes and integration across other entities. For one, the SCU’s ability to respond to crises relies in large part on the 911 Communications Center (“Dispatch”). However, in 2019, a Berkeley City Auditor’s report
15 elevated that the understaffing of Dispatch has led to staffing levels that cannot meet the call volume of residents and has increased call wait times .
Increased wait times for 911 callers have negative implications for the safety and well - being of service utilizers and community members. Increased wait times also have negative implications for service providers and crisis responders that are responding to a potentially more advanced state of crisis. Additionally, inadequate staffing levels rely on overtime spending to fund Dispatch, which increases the cost of the entity.
The Auditor’s report also recommended increased training for Dispatchers to manage and respond to mental and behavioral health crisis calls, including the management of suicidal callers and persons with mental illness. The well-being and stress of call takers are also of concern. In all, if they are not addressed, such resource shortages and unmet training needs could have a significant impact on the SCU’s success.
Other entities that will be affected by the implementation of the SCU model include Berkeley Fire, who responds to crises through Dispatch, and the Mobile Crisis Team (MCT), who provide mental health crisis services in partnership with the Berkeley Police Department. These entities, in addition to Dispatch and the SCU, will have to establish new working relationships and protocols to effectively serve the community together.
Dispatch is an immensely complex system. Integrating the SCU into such a system, while addressing staff capacity and training needs, will take significant planning and coordination, as well as funding. For these reasons, the recommendat ions for the planning and implementation of the SCU model are laid out in a phased implementation approach to allow for sufficient preparation of Dispatch while providing urgently needed mental health crisis response to community members.
15 Berkeley City Auditor. (2019, April 25). 911 Dispatchers: Understaffing Leads to Excessive Overtime and Low Morale. https://www.cityofberkeley.info/uploadedFiles/Auditor/Level_3_- _General/Dispatch%20Workload_Fiscal%20Year%202018.pdf
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SCU Crisis Response Recommendations | 10
Recommendations
Overview
This report presents recommendations that address what is required for SCU model. Figure 1, below, provides an overview of the specialized care unit’s response. Figure 2 shows the many components required for a comprehensive 24/7 SCU model.
The Specialized Care Unit: Crisis Response
Community members experiencing or witnessing a mental health or substance use crisis will be able to call the SCU through a 24/7 live phone line, from which the SCU mobile team will be deployed to the crisis. The SCU mobile team will include specialists who support a person in crisis with intervention, de-escalation, and stabilization techniques. If necessary, the SCU will also be able to transport a person in crisis to locations that promote the person’s safety and care.
Figure 1: An overview of the SCU crisis response.
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SCU Crisis Response Recommendations | 11
The SCU Model: A Comprehensive 24/7 Crisis Response
The SCU is not solely a mobile team that delivers specialized care during mental health and substance use crises, but rather requires a comprehensive model. This model includes clinical and administrative staff to ensure 24/7 live access to the phone line and SCU mobile team. The model also requires centralized leadership and system integration to realize systemwide changes. As this new model is implemented, it will require ongoing data collection, assessment, and iteration to ensure it is meeting the needs of the community. And, the model requires that community members know that they can call a non-police, specialized mental health and substance use crisis team.
Figure 2: An Overview of the comprehensive 24/7 SCU model.
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SCU Crisis Response Recommendations | 12
Phased Implementation
A phased approach will support a successful rollout of the SCU model while planning for integration across city agencies. These timelines may be ambitious given the magnitude of this systems -change initiative and the dependencies of the various model components. While the phased implementation approach represents an ideal timeline and is responsive to the urgent need for specialized mental health and substance use crisis response in Berkeley, it may need to be adjusted to realize the success of the S CU.
Refer to Appendix A for a complete phased implementation roadmap.
Figure 3: An overview of the phased implementation approach.
PHASE 0 PHASE 1 PHASE 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+
• Engage SCU
Steering
Committee &
community
stakeholders on
RFP; launch RFP
• SCU staff:
Contracting,
hiring, training
• Dispatch:
Planning &
assessment
• Establish
preliminary
triage criteria,
workflows and
protocols
• Launch public
awareness
campaign
• SCU implements crisis
response services
• Dispatch implements
integration or
components based on
Phase 0 planning
• Conduct rapid
assessment, monitoring,
and iteration
• Engage centralized
leadership in
coordination
• Review annual
evaluation and
rapid
assessments
• Prepare for
Phase 2
• Implement
changes
based on
evaluation and
community
need
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SCU Crisis Response Recommendations | 13
SCU
Mobile Team
The goal of the SCU is to provide specialized care during mental health crises and substance use emergencies, including crisis intervention, de-escalation, and stabilization. This specialized care does not require a police response but instead should be a three-person team of medical and behavioral health specialists. The SCU will need to be equipped to address the nuanced variety of crisis needs across mental health and substance use emergencies.
By providing 24/7 SCU services, the City of Berkeley asserts that mental health crisis response is of the same importance as other crisis services and limits the need to use the police to respond to such crises. Overall, the SCU model aims to disrupt the criminalization of substance use and mental illness and advance racial justice in the City of Berkeley. There are several considerations for how to most effectively promote the safety of crisis responders, persons in crisis, and general community members.
The following recommendations are aligned to best practices and emerging alternative models, while being rooted in community-driven recommendations. Each recommendation is tailored to the City of Berkeley and provides key considerations to support planning and implementation:
Key
Recommendations
1. The SCU should respond to mental health crises and substance use emergencies without a police co-response.
2. The SCU should operate 24/7.
3. Staff a three-person SCU mobile team to respond to mental health and substance use emergencies.
4. Equip the SCU mobile team with vans.
5. The SCU mobile team should provide transport to a variety of locations.
6. Equip the SCU mobile team with supplies to meet the array of clients’ needs.
7. Clearly distinguish the SCU from MCT.
Attachment 3
SCU Crisis Response Recommendations | 14
Recommendation #1
The SCU should respond to mental health crises and substance use emergencies without a police co-response.
The goal of the SCU is to provide specialized care during mental health crises and substance use emergencies. Below are suggested guidelines of when the SCU should and should not respond to a call.
Types of calls SCU should respond to:
• Suicide
• Drug overdose
• Welfare check
• Suspicious circumstance
• Complaint of an intoxicated person
• Social disorder
• Indecent exposure
• Trespassing
• Disturbance
Location of calls SCU should respond to:
• Public settings (e.g., parks, sidewalks,
vehicles)
• Commercial settings (e.g.,
pharmacies, restaurants)
• Private settings (e.g., homes)
Types of calls SCU should not respond to:
• Confirmed presence of firearm, knife,
or other serious weapon
• Social monitoring and enforcement
(e.g., of unsheltered residents in
public spaces)
• Calls that Dispatch already deems
do not need an in-person response
(e.g., argument with a neighbor,
minor noise violation)
Note: These guidelines and types of calls will need to be further explored to develop triage criteria that adequately reflect all the considerations for when the SCU will respond to crises.
Why isn’t the SCU responding with police?
Stakeholders consistently emphasized the need to provide non-police mental health crisis response options, noting that police are primarily trained in issues of imminent public safety threats, not mental health care. Rather than duplicating the MCT's model, the SCU model provides a new option for those better served by a non-police response. A dedicated response unit for mental health, behavioral health, and substance use emergencies will also help to build community trust and increase the likelihood that someone will call for help when they are in a crisis.
Why is the SCU responding to calls at public and private locations? Is that safe? A mental health crisis can happen anywhere, so the SCU must be able to respond to mental health and substance use crises in both public and private settings. Any variables around the safety of responding to a crisis in a private setting should be assessed before deploying the SCU team (e.g., the presence of a serious weapon).
Attachment 3
SCU Crisis Response Recommendations | 15
How were the types of calls decided?
Research from alternative models in other cities, community stakeholders ’ perceptions of existing needs in Berkeley, and input from crisis responders in the City of Berkeley all indicate that these call types may be well suited for behavioral health and mental health specialists instead of police. The nuance s within any of these call types will be further planned for throughout Phase 0.
Considerations for Implementation
Safety & Weapons:
● Not all weapons pose the same risk to crisis responders, so triage and deployment protocols should be aligned to best practices and standards of practice. The SCU may be able to respond to some calls where a weapon is present. The criteria for this safety precaution should be evaluated and planned for during Phase 0.
● If there is a mental health or substance use emergency where a weapon is present, then MCT-Police co-response should be deployed rather than the SCU.
● If the SCU mobile team is on scene but feels their safety is in imminent danger, they should have the ability to call in the MCT-Police co-response as backup support.
Coordinating with Other Entities
● Mobile Crisis Team: The types of calls, triage criteria, and workflows will need to be differentiated for deploying MCT versus SCU.
● Berkeley Police Department: When BPD is on scene and MCT is not available, BPD and SCU will need clear processes for whether police can bring the SCU to support. Similarly, BPD and SCU will need clear processes for when/how SCU leaves if they call the BPD to a scene.
University of California Police Department: Plan for differentiation or ongoing collaboration between UC’s new mobile crisis unit and the SCU, such as for crises on the UC campus or for students in crisis.
Attachment 3
SCU Crisis Response Recommendations | 16
Recommendation #2
The SCU should operate 24/7.
The SCU mobile team should be available to respond to a crisis in person 24 hours per day, 7 days per week.
Not having services available 24/7 was the most common challenge expressed by stakeholders about the current mental health crisis response system. In contrast, other crisis services like Fire and Police are available 24/7. By operating the SCU 24/7, the City of Berkeley asserts that mental health crisis response is of the same importance as other crisis services and negates the need to use police to respond to such crises. The need for 24/7 service is supported by national trends, as although some cities have implemented alternative crisis models with limited hours, many of them shared that they plan to expand to 24/7 to meet community needs.
Why does the SCU need to be available 24/7? Why can’t it operate only during peak hours? A mental health or substance use crisis can happen at any time. Stakeholders stressed the importance of having mental health crisis response services available 24 hours per day and 7 days per week. If community members are to trust in the SCU as an ongoing and authentic alternative to police involvement, services need to be available whenever someone calls.
Considerations for Implementation
All other supporting elements described throughout this report will need to accommodate 24/7 availability, such as:
● Phone access to the SCU
● Certain personnel roles, like a Clinical Supervisor
● Staffing structure that allows redundancy of personnel to cover each shift ● Equipment and infrastructure including the number of vans for the mobile team Attachment 3
SCU Crisis Response Recommendations | 17
Recommendation #3
Staff a three-person SCU mobile team to respond to mental health and substance use emergencies.
The array of mental health, behavioral health, and substance use services offered by the SCU requi re staff with varying professional specialties. The following roles are necessary to adequately provide these services:
1. A Mental Health Specialist
This role will be the primary provider of mental health services with the ability to conduct 5150 assessments, and therefore need to be licensed. They should have significant training in mental health and behavioral health conditions and disorders, crisis de-escalation, and counseling. • Recommended position: Licensed Behavioral Health Clinician • Possible positions: Licensed Clinical Social Worker (LCSW), Associate Clinical Social Worker (ASW), SUD or AOD Counselor, psychologist
2. A Peer Specialist
This role should have lived experience with mental health crises and systems, substance use crises or addiction, and be equipped to support system navigation for a person in crisis. • Recommended position: Peer Specialist
• Other possible positions: Community Health Worker, Case Manager
3. A Medical Professional
This role should be able to identify physical health issues that may be contributing to or exacerbating a mental health crisis, including psychosomatic drug interactions . They should be able to administer single-dose psychiatric medicines and have training in harm reduction theory and approaches. They can also assess and triage for higher levels of medical care as needed. • Recommended position: Psychiatric Nurse Practitioner (Psych-NP) • Other possible positions: Nurse Practitioner (NP), EMT, Paramedic Why a three-person team?
These three distinct roles create a team that can effectively provide the necessary range of specialized services and can engage in organic collaboration to address each crisis. Cities who have implemented similar models spoke to the advantage of team members taking different roles in each scenario based on each client’s needs and preferences.
Why is the mental health specialist conducting 5150 assessments? The SCU’s aim is to reduce the overall number of involuntary holds through effective crisis intervention, de- escalation, and stabilization. However, ensuring the SCU has the ability to conduct 5150 assessments and involuntary holds rather than calling in the police to do the assessment can reduc e interactions between people experiencing mental health crisis and police. Additionally, enabling th e SCU to conduct the 5150 Attachment 3
SCU Crisis Response Recommendations | 18
assessment is a more trauma-informed model because it eliminates the need for a person in crisis to interact with multiple teams and reduces the time it takes to respond to a crisis from start to finish.
Why is there a peer on the team?
The peer is a critical member of the crisis team. Other systems shared that a person in crisis may be most responsive to a peer who has gone through a similar experience and th at, at times, peers’ unique training and skills allow them to engage that person more effectively than other specialties. Berkeley stakeholder participants emphasized the invaluable contributions of peer specialist s, noting that they may be best equipped to lead the de-escalation before the mental health specialist or medical professional steps in to administer care because a person in crisis may be most responsive to someone that has similar lived experience.
Why is there a medical professional on the team? Why a Psych -NP? Mental health and physical health needs often co-present, with physical needs ranging from basic first aid (e.g., wound care, dehydration) to reactions to substances, such as overdoses or drug interactions. A medical professional, such as a Psych-NP, brings the clinical expertise to understand how physical ailments, chronic medical conditions, and psychiatric conditions affect a service utilizer (e.g., someone with hypertension and schizophrenia using methamphetamines). Other medical prof essionals, such as NPs, may also have sufficient training to meet the mental health and substance use needs of service utilizers. These situations do not require the expertise of a paramedic or doctor who are trained to respond to emergencies and deliver life-saving care.
Considerations for Implementation:
● The number of mobile teams required will be based on multiple variables including community needs, call volume, and budget (for a more in-depth description, refer to recommendation #12). ● There may be challenges in staffing the SCU mobile team with these specific roles, such as the Psych-NP. The SCU model may need to allow for a variety of specialists to fill each of the three main roles.
● Across these roles, the SCU mobile team should have the following co mpetencies:
○ Lived experience of behavioral health or mental health needs, homelessness, addiction or substance use, and/or incarceration
○ Emphasis on dual diagnosis (mental health and substance use) training, psychosomatic interactions, substance use management, and harm reduction ○ Identities reflective of those most harmed by the current system of care and/or those who are most likely to use or benefit from the SCU services ○ Multilingual
● Across these roles, the SCU mobile team will need to be trained on a variety of topics (for a full list, refer to recommendation #14). These may be desirable prerequisite skills, such as:
○ Disarming without the use of weapon
○ Motivational interviewing
○ Naloxone administration
○ Harm reduction
○ Trauma-informed care
Attachment 3
SCU Crisis Response Recommendations | 19
Recommendation #4
Equip the SCU mobile team with vans.
Based on the scope of services, the SCU mobile team will need a vehicle to arrive at each call, carry equipment and supplies, and transport clients to another location. A well -equipped van should be both welcoming and physically accessible to clients and easily maneuverable by staff.
SCU vans should include:
• Wheelchair accessible features
• Lights affixed to the top of the van,
allowing for sidewalk parking
• Locked supply cabinets
• Rear tinted windows for client privacy
• Rear doors not operable from the inside
• Power ports to charge laptops, tablets,
and phones
• Comfortable seating
• SCU logo on the side of the van so the
community can easily identify the team
SCU vans should not include:
• Sirens
• A plexiglass barrier between the front
and back seats
Why not use an ambulance?
There are a several reasons why an ambulance is not the appropriate vehicle for the SCU:
• Ambulances must transport to a receiving emergency department when transporting from th e field (a call for service from a community member), which may not always be the most appropriate end point for the level of care required (refer to recommendation #5). • Ambulances require a special license to drive and would require the inclusion of an EM T or paramedic on staff and would therefore increase the expense of the SCU. • Ambulances are more expensive to purchase and maintain than a van. • A van is potentially less stigmatizing and traumatizing for a person in crisis.
Why were these specific features chosen?
All van specifications are based on lessons learned from alternative crisis response programs in other cities and experiences and insight shared by the Berkeley Fire Department. Many van features, such as locked supply cabinets and locked rear doors, are designed to increase the safety of both crisis responders and a person in crisis. Other van features support the SCU mobile teams to provide a variety of services.
Why shouldn’t the van have sirens or a plexiglass barrier? Sirens can draw unnecessary public attention, thereby reducing privacy for a person in crisis , while both sirens and plexiglass barriers can exacerbate the stigmatization, traumatization, and criminalization of mental health and substance use crises.
Considerations for Implementation
The number of vans required will be based on the number of SCU mobile teams and shift structure/overlap (refer to recommendation #12).
Attachment 3
SCU Crisis Response Recommendations | 20
Recommendation #5
The SCU mobile team should provide transport to a variety of locations.
The SCU should provide a level of care appropriate to each specific crisis with the aim of de -escalating crises, preventing emergencies, and promoting well-being. The SCU will transport service utilizers in the SCU van (refer to recommendation #4) unless there is a medical need that requires the SCU to request an ambulance for transport.
The SCU will transport service utilizers to:
• Inpatient units of psychiatric emergency
departments
• Primary care providers, psychiatric facilities, or
urgent care
• Crisis stabilization units, detox centers, or
sobering centers
• Drop-in centers and other CBOs
• Shelter or housing sites
• Domestic violence service sites
• Long-term programs including residential
rehabilitation sites
• Requested public locations (e.g., parks)
• Requested private locations (e.g., home)
Considerations when deciding transport location:
• Transport can be voluntary or involuntary,
based on a 5150 assessment
• The SCU should be able to deny the request of
a person in crisis for transportation based on
their assessment of the appropriate level of
care
• The SCU will need to assess safety or liability
concerns for the service utilizer or other
bystanders based on transport location (e.g.,
not transporting an intoxicated person home
where another person is present at the home)
Why should the SCU transport service utilizers to so many different locations? The SCU model aims to support diversion of people experiencing crises away from jails and hospitals and into the appropriate community-based care and resources. Some crises can be resolved on scene, while others will require transport to another location. Even if a crisis is de-escalated on scene, service utilizers may benefit from being transported to another location for additional care or resources. Throughout this project, stakeholder participants emphasized that the level of need outweighs the available resources and providers in Berkeley and Alameda County. Providing transport to a variety of locations and resources allows the SCU to provide the level of care appropriate to each specific crisis and increases the possibility of providing care in an overwhelmed service network. Refer to Section V for long-term recommendations for addressing the needs of the service network.
Considerations for Implementation
• Established, trust-based relationships with community partners and warm handoff procedures will improve overall quality of care and can reduce the amount of time required when dropping off a client.
• Staff at emergency facilities will need to be familiar with the SCU, includi ng the van, logo, and uniforms, to be prepared to receive transported clients in a timely and responsive manner, reducing “wall time.”
• Triage criteria and workflows should support the SCU in assessing where and how to transport a person in crisis.
• Triage criteria and workflows for transport should address the safety implications for both the person in crisis and other community members.
Attachment 3
SCU Crisis Response Recommendations | 21
Recommendation #6
Equip the SCU mobile team with supplies to meet the array of clients’ needs.
The SCU will be responding to a variety of calls, each with their own specific needs. The supplies needed will vary depending on the call. Below is a suggested list of supplies the SCU should carry , generated from the input of stakeholders and other alternative crisis response programs. These supplies will facilitate a harm reduction approach and directly contribute to the health and well-being of the person in crisis.
Medical supplies
• First aid kit
• Personal protective equipment
• Wound care supplies
• Stethoscope
• Blood pressure armband
• Oxygen
• Intravenous bags
• Single-dose psychiatric medications
Client
engagement
items
• Food and water
• Clothing, blankets, and socks
• Transportation vouchers
• “Mercy beers” and cigarettes
• Tampons and hygiene packs
Community
health supplies
• Safe sex supplies and pregnancy tests
• Naloxone
• Clean needles and glassware
• Sharps disposal supplies
Technology
• Cell phones
• Data-enabled tablets
• Computer Aided Dispatch (CAD)
• Police radio
Uniforms • Casual dress: polo or sweatshirt with the SCU logo
Attachment 3
SCU Crisis Response Recommendations | 22
Why does the SCU need to carry client engagement items? These items can help initiate an interaction while also meeting the basic needs of clients while they are experiencing a crisis.
Why does the SCU need to carry community health supplies? These supplies can help address an underlying physical health need or provide harm reduction for substance use crises.
Why does the SCU need technology and uniforms?
The team needs cell phones and data-enabled tablets for mobile data entry. The tablets should be preloaded with an electronic health record (EHR) application so staff can access client history to provide more effective, tailored care. Wearing a casual uniform can help the team appear more approachable to clients and be easily identifiable. Uniforms that look more like traditional emergency response uniforms c an be triggering for clients who have had traumatic experiences with emergency responders.
Considerations for Implementation
• The need for basic provisions among service utilizers is often significant and therefore affects the model’s budget. To effectively plan for the program budget, San Francisco’s Street Crisis Response Team shared that they budgeted for $20 in supplies per client contact but quickly exceeded their $10,000 annual budget. Denver’s STAR program noted that these supplies were in high demand and the budget was supplemented with donations.
• Staff should track which supplies are used most often and which supplies are requested by clients that the SCU does not carry.
Attachment 3
SCU Crisis Response Recommendations | 23
Recommendation #7
Clearly distinguish the SCU from MCT.
Once the SCU model is implemented, there will be two teams responding to mental health crisis calls in the City of Berkeley: the Specialized Care Unit and the Mobile Crisis Team. It will be necessary to clearly distinguish the role of these two teams so that the proper response is deployed for each situation. The general public will also need to be informed regarding the two teams, how to access them, and why .
Suggested scenarios when MCT and Police should be deployed instead of the SCU:
• If there is a confirmed presence of a serious weapon during a mental health crisis, the police and MCT would be deployed.
• If the police request mental health support during a crisis, MCT will be deployed as a co-response. • If the SCU is on a call and needs backup or cannot successfully intervene, they would call for an MCT-police co-response.
If there’s an SCU, why should the MCT still exist?
When the police respond due to the presence of a weapon or other element outlined above , a joint response that includes clinical staff to support the intervention is a best practice and community asset, delivering a trauma-informed response focused on de-escalation. This is especially true for a person in crisis with past traumatic experiences with the police. The MCT remains an important resource that can reduce the negative impacts of police presence during situations where a mental health crisis intersects with issues of imminent public safety.
Why is it important to distinguish MCT from the SCU?
Trust & Acceptability of SCU: MCT responds to the majority of their calls with police backup. Because SCU is a non-police crisis response option, clearly distinguishing the two models will be essential in establishing and maintaining community trust to increase utilization of the SCU, particularly among groups most at risk of harm from police violence.
Logistics for Deploying the Right Team: Dispatch will need tools and training to clearly differentiate the teams’ roles to effectively deploy the right team for each mental health crisis call.
Considerations for Implementation
• All triage criteria and workflows need to be reflective of the differentiation between SCU and MCT.
This includes the triage criteria and workflows for Dispatch and/or the alternative phone line and Alameda County’s Crisis Support Services (CSS) (refer to recommendation #9). • The distinction between MCT and the SCU, particularly around availability and police involvement, should be emphasized in the public awareness campaign (refer to recommendation #24). • Tracking the acuity levels of calls, as well as whether MCT and police were called in for backup, can help refine the Dispatch process and ensure that the right team is deployed .
Attachment 3
SCU Crisis Response Recommendations | 24
Acc
essing the SCU Crisis Response: Dispatch &
Alternative Phone Number
Implementing the SCU as a 24/7 mental health and substance use crisis model requires that community members have reliable and equitable access to the team. By integrating the SCU crisis response into 911 and Dispatch’s processes, mental health crisis services will be elevated to the same level of importance as Fire and Police when calling for emergency services, thus promoting community access to specialized crisis care. To reach this goal, the SCU model, City of Berkeley leadership, and Dispatch will need to work together during assessment and planning processes.
The need to develop and implement the SCU model is urgent. Yet Dispatch is a complex, under-resourced, and overburdened system. To achieve structural change that ensures sustainability, significant planning and coordination is essential.
There are several possibilities for how to advance the SCU-911 integration aligned to the phased implementation approach. The following recommendations are aligned to best practices and emerging alternative models and responsive to the needs and concerns expressed by community stakeholder participants. Each recommendation should be further explored, assessed, and discussed across City of Berkeley leadership:
Key
Recommendations
8. Part
icipate in the Dispatch assessment and planning process to prepare for future integration.
9. Ensure the community has a 24/7 live phone line to access the SCU.
10. Plan for embedding a mental health or behavioral health clinician into Dispatch to support triage and SCU deployment.
Attachment 3
SCU Crisis Response Recommendations | 25
Recommendation #8
Participate in the Dispatch assessment and planning process to prepare for future integration.
Ultimately, the SCU should be integrated into 911 and Dispatch protocols. To reach this goal, the SCU model, City of Berkeley leadership, and Dispatch will need to work together during assessment and planning.
Dispatch, through the Berkeley Fire Department, has conducted a Request for Proposal process and selected a consulting firm to support enhancements to the deployment of Fire and EMS/Ambulance services. That assessment and planning process should integrate SCU implementation, preparing for the SCU to be a mental health emergency response on par with police and fire emergency calls.
If this is a non-police response model, why is Dispatch involved? An effective mental health crisis response that increases community safety, well -being, and health outcomes relies on the SCU actually being deployed to community members in cr isis. Dispatch has established infrastructure and technology that could effectively and safely deploy the SCU mobile team.
Moreover, 911 is a well-known resource to the general public, which many people do seek during crises. In 2017, Dispatch received 256,000 calls.
16 For these reasons, integration of the SCU into 911 and Dispatch’s processes is an important method for deploying the SCU team to people experiencing a mental health or substance use crisis.
Will another assessment and planning process delay the launch of the SCU? Dispatch’s expertise and experience are a critical asset to lead the assessment, planning, and implementation of revised 911 procedures that include the SCU. The Dispatch assessment and planning project is slated to begin in 2022; by incorporating assessment and planning for the SCU into an existing project, it will initiate the process several months sooner than if a separate and new project were to be initiated. Additionally, integrating both projects will ensure consistent and simu ltaneous efforts rather than disjointed efforts that require backtracking or undoing of work and decisions.
Considerations for Implementation
• A systems-change initiative of this magnitude will need identified shared aims and goals. • A systems-change initiative of this magnitude will need Dispatch leadership to champion the effort and communicate early, often, and positively about the upcoming changes. • By participating in Dispatch’s assessment and planning processes, the SCU model can identify opportunities early on that support the integration, such as using aligned terminology and data collection processes.
• A Dispatch representative should join the SCU Steering Committee (refer to recommendation #20).
• Dispatch leadership should join the model’s centralized coordinating body (refer to recommendation #19).
16 Berkeley City Auditor. (2019, April 25). 911 Dispatchers: Understaffing Leads to Excessive Overtime and Low Morale. https://www.cityofberkeley.info/uploadedFiles/Auditor/Level_3_-_General/Dispatch%20Workload_Fiscal%20Year%202018.pdf Attachment 3
SCU Crisis Response Recommendations | 26
Recommendation #9
Ensure the community has a 24/7 live phone line to access the SCU.
Implementing the SCU as a 24/7 mental health and substance use crisis model requires a 24/7 live phone line to ensure community members have reliable and equitable access to mental health crisis response.
The 24/7 availability is essential for community members to feel confident in the availability of the mental health crisis response, as stakeholders reported that MCT’s alternative phone number— which is not live and relies on voicemail and callbacks— does not feel like a reliable resource during crises.
The need to develop and implement the SCU model is urgent and at the same time must achieve structural change to ensure sustainability. Implementing a process for the short-term that must be undone would be an inefficient use of funds and may confuse the public and exacerbate distrust. For these reasons, the following three options should be further considered and assessed for how to most effectively ensure 24/7 live access to the SCU crisis response:
1. Option A: Use the existing 911 Communications Center (“Dispatch”) to deploy the SCU.
2. Option B: Contract to a CBO that can staff and implement an alternative number phone line as part of the SCU model.
3. Option C: Use the 988 National Suicide Prevention Lifeline to receive, triage, and assess all mental health crisis calls.
Table 1 below highlights several factors to consider related to timeline and staff capacity, funding, safety, system integration, and public awareness. Based on these factors, it appears that Option A (using the existing 911 Communications Center to deploy the SCU) would be the best option for the City of Berkeley.
However, these factors should be further discussed by City of Berkeley leadership across HHCS and Dispatch with careful consideration of the phased implementation approach and timeline .
Attachment 3
SCU Crisis Response Recommendations | 27
Table 1: Options and factors to assess when planning for the community to have 24/7 live phone line access to the SCU .
Opti
on A *Recommended Option*
Use 9
11 and existing Communications
Center (“Dispatch”) to deploy the SCU.
Opti
on B
Contract to a CBO that can staff and
implement an alternative number
phone line as part of the SCU model.
Opti
on C
Use the 988 national phone line to
receive, triage, and assess all
mental health crisis calls.17
Timeline & Staff
Capacity
Ass ess Dispatch’s ability to recruit, hire,
and train new staff on a timeline aligned
to the phased implementation
approach.
Cons
ider the amount of resources and
time required for Dispatch to train
existing staff on new protocols.
Cons
ider Dispatch’s capacity to support
the SCU adoption and integration in
addition to the current accreditation
process.
Ass
ess whether a CBO can realistically
implement both the SCU model and an
alternative phone number (i.e., call
center), including recruiting, hiring, and
training all new personnel.
Moni
tor the alignment of national,
state, and county timelines for 988
implementation.
Ass
ess whether the 988 call center
will be staffed appropriately for
the additional call volume brought
in by requests for SCU.
Fund
ing Est
imate the additional funds required
for Dispatch to recruit new personnel
(i.e., a recruitment team) and manage
the Human Resource capacity to
support additional staff.
Est
imate the cost to create and operate
an independent 24/7 live alternative
phone line.
Expl
ore the amount of funding and
resourcing available for 988 to
assess whether the funds
sufficiently support the 24/7 SCU.
17 Gold, J. (2021). How will California’s new 988 mental health line actually work? U.S. News. https://www.usnews.com/news/health-news/articles/2021-10-12/how-will-californias- new-mental-health-hotline-actually-work
Attachment 3
SCU Crisis Response Recommendations | 28
Safety Promotes
Safety
Evaluate and compare each option’s ability to establish protocols or infrastructure to support the safety of crisis responders and community members.
Dispatch already has established
protocols and technology to track the
crisis responder’s location/position
through CAD.
Dispatch already has established
protocols and technology to maintain
radio communication between
Dispatch and crisis responders,
especially during rapid changes in a
situation.
Dispatch already has established
protocols and technology to streamline
the handling and transfer of calls so
that a person in crisis does not have to
repeat their story multiple times,
thereby reducing the number of
dropped calls.
Assess the resources and timing
required for a CBO to ensure sufficient
training on the use of the CAD system
and radio communication.
Assess workflows and processes that
would affect the number of times a
caller must repeat triage/assessment;
estimate whether there will be an
increase in dropped calls.
Consider if a non-911 entity will more
effectively reduce police-community
interactions during mental health and
substance use crises.
Assess the ability for existing
Alameda CSS and 988 technology
to integrate with Dispatch’s CAD
system and radio communication.
Evaluate the effectiveness of
existing processes to transfer calls
between Alameda CSS and
Dispatch.
Consider if the 988 entity will more
effectively reduce police-
community interactions during
mental health and substance use
crises.
Risks t
o
Safety
Evaluate and compare the potential risks to the safety of crisis responders and community members across each option.
Consider whether Dispatch will be more
likely to deploy the police than the SCU
during initial model implementation.
Evaluate whether community members’
fear of a police response, will reduce the
utility, acceptability, and accessibility of
the SCU.
Consider whether alternative phone line
personnel will be more likely to deploy
the SCU than transferring calls to 911.
Evaluate whether community members
will be more likely to call an alternative
phone number than 911 if they are
experiencing a mental health or
substance use crisis.
Consider whether community
members will be confused about
988 and may believe it is only for
suicide prevention rather than the
full spectrum of mental health and
substance use crises, and therefore
be less likely to call 988.
Option A (Recommended) Option B Option C
Attachment 3
SCU Crisis Response Recommendations | 29
System
Integration
N/A
(
911 is already integrated with Berkeley
Fire, Falck, and Alameda County CSS)
Exp lore the process for a CBO to assess
and prepare callers if they need to
transfer the call to 911, such as if the
presence of weapons is confirmed.
Evaluate the effects, such as a slowed
response time or increased risk of a
dropped call.
Cons
ider whether the transfer of calls to
911 (i.e., calls ineligible for SCU) will
undermine community trust in the
alternative phone line.
Det
ermine the feasibility of integrating a
CBO’s technology to allow for the
transfer of calls between Alameda CSS
and Dispatch.
Det
ermine the feasibility of a CBO’s
technology to receive calls from Fire
and Falck if they request the SCU.
Det
ermine whether Alameda
County will be able to deploy a
Berkeley-specific team (the SCU)
for only Berkeley residents as a
component within the larger 988
model.
Ass
ess what will be required for a
county system to deploy a model
administered by a CBO, such as
additional contracts, MOUs, or staff
licensure requirements.
Publ
ic Awareness Cons
ider what will be required of a
public awareness campaign to build
community trust in 911 to deploy the SCU
as a non-police response.
Con
sider what will be required of a
public awareness campaign to inform
Berkeley residents both about the SCU
as a non-police crisis response and
promote an alternative phone number
to access the SCU.
Asse
ss the public awareness and
education planned for 988.
Ass
ess whether the Alameda
County 988 public awareness
campaign can be adjusted for
Berkeley to communicate the
availability of the SCU through 988.
Option A (Recommended) Option B Option C
Attachment 3
SCU Crisis Response Recommendations | 30
Why consider different options for phone access to the SCU? The numerous factors that should be assessed to determine the best option for phone access to the SCU will require a significant amount of collaboration and detailed planning across city leadership , which requires time throughout Phase 0. The general public is familiar with 911 as a crisis response resource. As a result, 911 could be an important method of ensuring mental health and substance use crises are routed to the SCU mobile team. However, stakeholders, especially residents of color and Black residents, consistently shared that the fear of physical violence, criminalization, or retaliation by police in response to mental health and substance use emergencies is a barrier to calling 911. Therefore, a non-911 option may support community members to feel confident in the SCU as a non-police mental health crisis response.
Considering and assessing the full array of options will ensure the best approach for a reliable and equitable access to 24/7 mental health crisis response.
Why is Option A elevated as the recommended option?
Overall, Option A is recommended because it appears to be a better fit for the SCU model. It will most likely be the more cost-effective option, will allow for the SCU mobile team to be launched soonest, and will align to the phased implementation approach and the future integration of the SCU into 911.
By pursuing Option A, preparation with Dispatch can begin sooner than the other options, thus allowing for additional time to plan and prepare. This additional planning time can be used to address concerns regarding safety, community trust, and public awareness. Integrating the SCU into 911 from the initial phases of implementation may also support a streamlined and efficient integration. In contrast, Option B will likely require significantly more funding to create an entirely new call center, which may become obsolete once 988 is implemented, nationally. The feasibility and expense of standing up an entirely new call center (option B) may be prohibitive. Option C will require significant coordination with Alameda County and has many implications that are outside of the control of the City of Berkeley, which could cause delays or challenges to the implementation of the SCU model.
Additionally, 911 has established technology and infrastructure for receiving and triaging phone calls, deploying crisis responders, tracking the crisis response to promote responder safety, and collecting data that is essential for monitoring, evaluation, and follow-up. Moreover, for the public awareness campaign, it may be easier to communicate the SCU as a non-police response through 911 than it is to both communicate the SCU as a non-police response and to publicize an alternative phone number.
Why might the model implement an alternative phone number? (Option B or Option C) First, due to existing community distrust of policing systems, it is important to establish the SCU response as a non-police response. By implementing the alternative phone number first, community members may be encouraged to utilize the SCU. Second, the existing Dispatch system is complex, overburdened, and underfunded. In order to have a successful integration of the SCU within 911, it may require more time for planning for a sustainable integration that ensures community safety. Third, lessons learned from other cities implementing alternative models may indicate this order would support SCU success. For example, the Portland Street Response team can be accessed through both 911 and a non- emergency phone number connected to Dispatch. However, they found that calls from 911 were prioritized rather than calls from the alternative line when deploying the team. Berkeley will need to establish clear prioritization and triage protocols so that the highest-acuity calls receive adequate responses, rather than the response being determined by the source of the call.
Attachment 3
SCU Crisis Response Recommendations | 31
Do other cities use multiple phone numbers?
From the reviewed models, at least seven use two or more lines for emergency crisis calls:
• Olympia, WA: Crisis Response Unit
• Sacramento, CA: Department of Community Response
• Austin, TX: Expanded Mobile Crisis Outreach Team (EMCOT) • Oakland, CA: Mobile Evaluation Team (MET)
• Portland, OR: Portland Street Response
• Eugene, OR: Crisis Assistance Helping Out on the Streets (CAHOOTS) • Denver, CO: Supported Team Assisted Response (STAR)
If the model uses an alternative phone line, what happens if people still call 911 when they are having a mental health crisis?
Dispatch should have the option to forward calls to the SCU alternative phone line, where those staff can triage the call and deploy the SCU. Establishing these protocols will be part of the assessment and planning process. It is also important that a public awareness campaign promotes access to the SCU team (refer to recommendation #24).
Additional Considerations for Implementation:
• The phone line will require dedicated office space and equipment to process calls and deploy the SCU.
• The phone line will need technology and protocols to ensure data collection and integrity to support monitoring and evaluation (refer to recommendations #22 and #23). • The phone line will require enough staff to maintain a 24/7 live response including staff to receive calls and supervisory staff. This team will need to be sufficiently staffed to account for shift overlap, sick leave, and vacation time.
• Additional data collection and planning will be required to determine the adequate number of call takers and fully implement the phone line.
• Option A may require that Dispatch makes more gradual changes to triage criteria, deploying the SCU to a more limited scope of call types with a gradual increase in SCU deployment through Phase 1 implementation.
• Either option B or option C would still require the phone line entity to collaborate with Dispatch to develop types of calls, triage criteria, and workflows to allow for future integration of SCU into Dispatch.
• The future structure of the 911 Communications Center within Berkeley Police Department should be evaluated (refer to Section V).
*Please note: Dispatch uses specific terminology that may not be accurately represented here. The language in these recommendations should be understood from a lay perspective rather than rigid technical language (e.g., call takers versus dispatchers, assessment versus triage versus decision-trees).
Attachment 3
SCU Crisis Response Recommendations | 32
Recommendation #10
Plan for embedding a mental health or behavioral health clinician into Dispatch to support triage and SCU deployment.
Embedding a mental or behavioral health clinician within the Dispatch represents a new process for Berkeley’s Dispatch and broadens Dispatch’s lens from being solely a Police entity to an entity that includes clinical specialists. Dispatch must be involved in planning for this additional team member.
Why should Dispatch have a clinician in the call center? Embedding a mental health clinician in emergency call centers is an emerging best practice, though only a few cities nationally report staffing their call centers with clinicians. The few cities that have included mental health clinicians in their call centers have found them to be a useful resource. Where implemented, clinicians provide specialized training for call takers to handle behavioral health crisis calls, receive transferred behavioral health crisis calls, and provide guidance.
18 How does having a clinician in Dispatch promote community or crisis responder safety? Berkeley Dispatch is deeply committed to the safety of crisis responders. In interviews for this project, Austin’s EMCOT program19 shared that embedding a clinician within their call center increased communication around safety and risk assessment during triage, including increased deployment of the crisis response team. They also shared that this integration improved handoffs for telehealth conducted by the clinician. Berkeley should plan for embedding a clinician in Dispatch to support with de-escalation and determinations because it could promote safety.
Why does the clinician need to be part of planning in Phase 0 if implementation is in Phase 1? This change represents a structural shift for Dispatch, incorporates new roles for a specialized skillset, and changes several workflows. As a result, having a clinician participate in planning in Phase 0 will support successful implementation in future phases. Additionally, given the current significant understaffing and under-resourcing of Dispatch, the clinician can augment staff capacity without Dispatch having to acquire a new, specialized skillset.
Considerations for Implementation:
● Calls that do not require an in-person response should continue to be sent to Alameda County CSS for phone support.
● Staffing structures will need to be adapted, such as determining which roles supervise the clinician and which roles the clinician supervises.
● The clinician may be able to provide training and ongoing professional development to support call takers to identify and address mental health calls.
● There may be a need for multiple clinicians depending on their role and the call volume. ● This recommendation will need to be adapted based on how recommendations #8 and #9 are implemented.
18 Velazquez, T & Clark-Moorman, K. (2021). New research suggests 911 call centers lack resources to handle behavioral health crises.
ResearchGate.
https://www.researchgate.net/publication/355684339_New_Research_Suggests_911_Call_Centers_Lack_Resources_to_Handl e_Behavioral_Health_Crises
19 Read more about the EMCOT program here: http://www.austintexas.gov/edims/pio/document.cfm?id=348966
Attachment 3
SCU Crisis Response Recommendations | 33
Implement a Comprehensive 24/7 Mental Health
Crisis Response Model
There are many considerations for realizing the full implementation of a 24/7 model including hiring personnel, establishing clear roles, and providing office space and required materials. Staffing a comprehensive model should seek to address the perceived challenges of existing crisis response systems throughout Berkeley, such as not having 24/7 availability or sufficient staff capacity.
The following recommendations are designed to leverage the lessons learned from other cities implementing non-police crisis response models and be responsive to the needs and concerns expressed by community stakeholder participants. Each recommendation should be further explored as launch and implementation progresses:
Key Recommendations
11. Fully staff a comprehensive model to ensure the success of the SCU mobile team, including supervisory and administrative support.
12. Operate one SCU mobile team per shift for three 10-hour shifts.
13. SCU staff and Dispatch personnel travel to alternative crisis programs for in -person observation and training.
14. Prepare the SCU mobile team with training.
Attachment 3
SCU Crisis Response Recommendations | 34
Recommendation #11
Fully staff a comprehensive model to ensure the success of the SCU mobile team, including supervisory and administrative support.
In addition to the three-person SCU mobile team (recommendation #3), the 24/7 live phone line (recommendation #9), and the clinician in Dispatch (recommendation #10), the SCU will require supervisory and administrative support roles. These roles will support the day -to-day services and operations of the SCU mobile team. They also will participate in case management meetings (recommendation #18), rapid assessment and monitoring (recommendation #22), and model evaluation (recommendation #23).
Recommended Personnel Roles & Types of Responsibilities20:
Program Manager
• Review data from implementation, lead rapid assessment process, support changes and iteration to model
• Liaise with city, Dispatch, and central leadership around implementation, rapid assessment, and coordination
• Manage contract and budget
• Manage scheduling and shifts
Clinical Supervisors
• Oversee and support SCU mobile team, provide consultation for medical and mental health services
• Plan and lead training and professional development for SCU mobile team • Collaborate with peer specialist supervisor on how to best support SCU mobile team • Share client and staff feedback to program manager for rapid assessment and monitoring Peer Specialist Supervisor
• Oversee and support peer specialists on SCU mobile team with an emphasis on emotional support for peers
• Plan and lead training and professional development for SCU mobile team, with an emphasis on utilizing peer specialists and other forms of team communication and support (e.g., advocacy, equal value, communication)
• Collaborate with clinical supervisor
Call Takers / Call Center (pending implementation of recommendations #8-10) • Receive calls from the 24/7 live phone line; triage calls and deploy SCU mobile team, as required • Receive calls from Dispatch
• Transfer calls that do not require in-person services to Alameda County CSS • Participate in case management care coordination meetings, as relevant 20 Refer to Appendix B for the number of personnel, availability, shifts, and a sample shift structure Attachment 3
SCU Crisis Response Recommendations | 35
Considerations for Implementation
Availability or shift structure for roles:
• The program manager and peer specialist supervisor roles should be available during traditional business hours.
• The clinical supervisor role should be available 24/7 and will require redundancy in hiring. • The call center will need to be staffed to ensure a 24/7 live phone line. I f Option B is pursued (refer to recommendation #9), the call center should be situated within the SCU model rather than a separate CBO. This could promote morale and team identity and will increase the quality and efficiency of communication.
Office & Equipment Needs:
• The SCU model will need an office space that accommodates all personnel and their roles, such as daily huddles, desks, and equipment.21
• Stak
eholders suggested that the SCU would benefit from developing relationships with service utilizers and their families. If these opportunities are pursued as part of the SCU’s function, then office space could also accommodate service utilizer and family consultations and/or open “office hours” for relationship building.
21 Refer to Appendix C for the budget and additional office equipment needs, such as computers, phones, printers, etc.
Attachment 3
SCU Crisis Response Recommendations | 36
Recommendation #12
Operate one SCU mobile team per shift for three 10-hour shifts.
In order to staff a crisis response model that operates 24/7, the SCU should staff one mobile team per shift for three 10-hour shifts. We estimate that the SCU would respond to three to six incidents per 10-hour shift, with each incident requiring 20 to 120 minutes for response and closure. This should generally be manageable by one SCU mobile team.22
Why 10-hour shifts?
Based on feedback from those operating similar models as well as from community stakeholders, 10-hour shifts are common in residential settings and tend to work well for clinical and mental health staff. There are often labor union protections for shifts longer than 10 hours. Three 10-hour shifts would provide 24/7 coverage while allowing for some overlap before and after each shift.
Why should shifts overlap?
The SCU mobile team shifts should overlap so that the team can conclude engagement with a person in crisis before their shift ends. The next shift would be able to respond to a crisis call that comes in towards the end of the preceding team’s shift. The overlap also supports team huddles for care coordination. The shift structure and overlap should include time for the required paperwork at the end of the shift so that there is not an expectation that paperwork is completed during off hours.
Will one SCU mobile team be sufficient?
This estimate is comparable to the call and incident volume reported by Denver’s STAR pilot, Portland’s Street Response pilot, and Eugene’s CAHOOTS program. Though the city population of Denver and Portland are 5.8 and 5.3 times larger than Berkeley’s population, respectively, their pilots are restricted to smaller geographic units of the city; Denver and Portland both operate only 1 mobile crisis response team per shift.
Eugene’s city population is 1.4 times the population of Berkeley, and Eugene operates 1 crisis team per shift, with an additional team during peak hours of 10am-12pm and 5pm-10pm. 23 Considerations for Implementation
● Staffing structure will require redundancy to allow for personnel to take vacation and sick days, and in anticipation of periodic vacancies.24
● Staffing structure may need to plan for on-call or floater shifts.
22 Estimates for SCU call volume are based on analysis of call and service volume by MCT from 2015 to 2019, the Auditor’s Report and analysis of Berkeley Police Department’s call and service volume from 2015 to 2019, and analysis of Berkeley Fire’s and Falck’s transport volume and time on task from 2019 to 2021. Please refer to Appendix D for more specific analysis and estimates. 23 The City of Eugene (2019-03240). https://www.eugene-or.gov/DocumentCenter/View/56579/2019-03240-White-Bird-CAHOOTS- Services---SIGNED
24 Refer to Appendix B for the number of personnel, availability, and a sample shift structure.
Attachment 3
SCU Crisis Response Recommendations | 37
Recommendation #13
SCU staff and Dispatch personnel should travel to alternative crisis programs for in-person observation and training.
Although Berkeley’s SCU model will be uniquely designed and tailored for the Berkeley community, there are many opportunities to learn from successes and challenges of other models that have implemented non - police mental health crisis response programs. For example, the Denver STAR team shared that their Dispatch team benefited greatly from traveling to Eugene, OR to observe and learn about the CAHOOTS model and plan their deployment protocols.
Options for city programs to visit:
• CAHOOTS: Eugene, OR
• STAR: Denver, CO
• EMCOT: Austin, TX
Recommended personnel to attend:
• Dispatch: Supervisor
• SCU: Clinical Supervisor and Program Manager
• Phone line staff, as relevant (refer to recommendation #9) Potential program components to observe during site visit:
• Triage criteria and workflows
• Assessing for risk and safety
• Working with the mental health clinicians embedded in Dispatch • Coordinating and prioritizing calls between 911 and an alternative phone number • SCU mobile team services and team coordination
• Role clarification
Why should Dispatch and SCU staff travel to these sites together? This training opportunity would support the collaboration between the SCU and Dispatch in planning for the phased integration. By traveling to the sites together, SCU and Dispatch will not only hear the same questions and answers but can ideate and collaborate on adaptations for the Berkeley SCU model. F inally, this is an important opportunity for relationship building between SCU staff and Dispatch, which is essential to this systems-change initiative.
Considerations for Implementation
● Travel costs will need to be included in the initial budget; estimates for consulting fees from the sites are already included.25
25 Refer to Appendix C for the estimated SCU model budget.
Attachment 3
SCU Crisis Response Recommendations | 38
Recommendation #14
Prepare the SCU mobile team with training.
The SCU will require training in a set of specific skill areas to be best equipped to provide mental health crisis response. The personnel hired should already have demonstrated their specialized skill set in previous employment settings; training will therefore support the team to align on how to implement their skills.
Training also supports teams to work together and with other entities effectively, such as Dispatch, which is essential in crisis response.
The SCU mobile team should be trained in the following topics:
• General de-escalation techniques
• Disarming without use of weapon
• Substance use management
• Naloxone administration
• Harm reduction theory and practice
• First aid
• Situational awareness and self-defense
• Radio communication
• Motivational interviewing
• Implicit bias, cultural competency, and racial equity • Trauma-informed care
• Training on data collection protocols and data integrity (refer to recommendations #17 and #18) • Compliance with confidentiality and HIPAA when interacting with Police and/or Dispatch How long will it take to train staff?
Eugene’s CAHOOTS program includes at least 40 hours of classroom training and 500 to 600 hours of field training for all new staff.26 This equates to 12.5 to 15 weeks of training when calculated on a full-time basis.
What informed these suggested training topics?
These training topics were generated from a variety of alternative model program recommendations and input from Berkeley service providers and community stakeholders.
Considerations for Implementation:
● The phased approach timeline incorporates an estimate aligned to CAHOOTS’ model, with room for adaptation.
● Training should be provided to all new SCU staff as they are added to the team, regardless of start date.
● Additional training topics may be identified by the SCU team. 26 Beck, J., Reuland, M., & Pope L. (2020). Case Study: CAHOOTS. Vera. https://www.vera.org/behavioral-health-crisis- alternatives/cahoots
Attachment 3
SCU Crisis Response Recommendations | 39
Adm
inistration and Evaluation
There are many considerations for effectively administering and monitoring implementation of a new, 24/7 mental health crisis response model. Effective implementation includes ongoing collaboration and decision-making at both the structural and provider levels.
At a structural level, the SCU model will require cross-system coordination for implementing new processes and therefore will require leadership across the City of Berkeley and SCU to collaborate around ongoing program monitoring, data review and transparency, and system integration. At a provider level, the SCU model will require collaboration and communication to support care coordination and case management for people that have experienced crisis as well as to elevate emerging challenges and successes.
Moreover, the community can— and must— provide essential advisory capacities. The community should be actively engaged to provide input and feedback throughout the planning and implementation of the SCU, including through the SCU Steering Committee and ongoing opportunities for the general public.
The following recommendations were informed by the lessons learned from other cities implementing alternative crisis models and aim to be reflective of the perspectives shared by the project’s stakeholder participants. Each recommendation should be a starting point to promote cross -sector collaboration, adjusting to accommodate the evolution of the SCU:
Key
Recommendations
15. Contract the SCU model to a CBO.
16. Integrate the SCU into existing data systems.
17. Collect and publish mental health crisis response data publicly on Berkeley’s Open Data Portal.
18. Implement care coordination case management meetings for crisis service providers.
19. Implement centralized coordination and leadership across city agencies to support the success of mental health crisis response.
20. Continue the existing SCU Steering Committee as an advisory body.
21. Solicit ongoing community input and feedback.
22. Adopt a Rapid Monitoring, Assessment, and Learning process.
23. Conduct a formal annual evaluation.
Attachment 3
SCU Crisis Response Recommendations | 40
Recommendation #15
Contract the SCU model to a CBO.
The administrative structure of crisis response systems across the country varies significantly. Some are administered by government agencies, some are run in collaboration between a government agency and CBO, and some are entirely operated by CBOs. There are several reasons why the SCU model should be contracted to a CBO, at least through Phase 2 of the phased implementation approach.
The SCU crisis response model would benefit from being contracted to a CBO for several reasons:
• Supports a quick launch: CBOs are often able to move more nimbly than government agencies, especially as it relates to hiring; adequately staffing the SCU mobile crisis team is a critical element in timely implementation.
Given the urgent need, the ability to launch the SCU quickly and provide non-police mental health crisis response services is critical.
• Established relationships with community members: Stakeholders made it clear that CBOs have developed strong relationships with service utilizers accessing mental health support, homelessness resources, street medicine, and system navigation and referrals. CBOs in Berkeley have expertise in the community that can be leveraged
to advance the SCU’s crisis response efforts.
• Referral networks and partnerships: A CBO with established networks and partnerships would be well positioned to support service utilizers with referrals as well as transport to community-based resources.
Additionally, these relationships can support warm handoffs at transport locations.
Considerations for Implementation
● To contract with a CBO, the City of Berkeley will have to issue a Request for Proposals (RFP). The RFP process will need to evaluate a CBO’s capacity to develop and implement a model of this size on this timeline. ● The City should identify a backup plan if no qualified CBOs respond to the RFP. ● The CBO’s practices should align to the values and principles of the SCU. The City may need to use contracts and MOU specifications to require:
○ Adequate and equitable wages for all SCU staff and crisis responders, especially peer specialists and peer specialist supervisors.
○ A representative and equitable hiring process that prioritizes staff who are reflective of those most marginalized and harmed by existing crisis response options and the criminal legal system. ○ Necessary data and metrics to collect and report as well as ensuring sufficient technological systems to meet these needs.
● CBOs may face challenges inherent in the contract structure, which should be evaluated and protected against as these challenges can undermine sustainability and longevity. ○ Short-term funding: only funding the SCU in one-year increments can reduce staff retention and inhibit investments in operations (refer to Section V).
○ Overhead costs: allocate enough funds for overhead costs (e.g., salary, training, and office equipment), which are critical to SCU success.
○ Contract monitoring: data collection, monitoring, and evaluation are essential to the success and iteration of the SCU but should not be prohibitive to the work. ● There may be additional needs or considerations around data and system integration (refer to recommendation #16) and the collaboration across administration and leadership if a CBO implements the SCU; these may need to be included in the contract.
● All recommendations are written with a contracted CBO in mind; additional implications may arise during planning and Phase 0.
Attachment 3
SCU Crisis Response Recommendations | 41
Recommendation #16
Integrate the SCU into existing data systems.
Having access to patient data will support the SCU to provide tailored, informed, and equitable services for those experiencing mental health and substance use crises. Access to existing data systems, such as an EHR, will not only ensure that the SCU has access to relevant patient information, but also that other providers are aware when, how, and why their client might be interacting with crisis response. Finally, integrating the SCU into existing data systems will ensure aligned and consistent data collection, which is essential for the rapid assessment monitoring (refer to recommendation #22) and evaluation (refer to recommendation #23).
There are many factors outside of the purview of the SCU, HHCS, or even that City of Berke ley that affect whether data and system integration can be achieved. These factors include patient privacy and legal protections (i.e., HIPAA), technological capabilities, available funding, logistics across private and government entities, and more. As a result, this recommendation is included as an aspiration that should be planned for in future phases and may not be realized during Phase 1 of implementation. • Bidirectional, live data feeds should be integrated between the SCU and other data sources, including but not limited to:
o EHRs used by major medical systems and Federally Qualified Health Centers (FQHC) o Alameda County’s Community Health Record (CHR)
o Alameda County’s YellowFin
Why does the SCU need to access service utilizers’ records, such as EHRs? Access to an EHR allows crisis responders to make informed decisions based on a service utilizer’s health history. This access also enables crisis responders to communicate directly with a service utilizer’s existing support team, such as psychiatrists or case managers, when providing crisis response or referring the service utilizer for follow-up care.
Is it common for crisis responders and clinicians to have access to service utilizer records? Many other crisis response programs enable access to these sources of data. For example, the Alameda County Community Assessment and Transport Team (CATT) has access to the county’s CHR. Providers at FQHCs, including programs like Lifelong’s Street Medicine Team, have access to an integrated EHR. Berkeley Mental Health (BMH) is already integrated with the county’s YellowFin reporting system. Other city models, such as Denver STAR, enable their crisis responders to access existing data systems.
Why should the data feeds be bidirectional?
Not only do crisis responders need to access service utilizer medical history, but the data they collect during a crisis response should be entered into the centralized data systems so that a service utilizer’s existing support team has an updated and complete case history. The county’s CHR has live data feeds from many providers and so the SCU’s data should also have bidirectional capabilities when possible.
Attachment 3
SCU Crisis Response Recommendations | 42
Considerations for Implementation
● The Berkeley City Attorney and IT have signed onto the county’s CHR, and many CBOs and medical providers have also already signed onto the CHR, which could facilitate the SCU’s integration into this system.
● The SCU will need access to EHRs and the CHR to participate in client case management meetings (refer to recommendation #18).
● SCU team members will need training and support to accurately enter data into these platforms, which is essential to data integrity.
● Legal protections for confidentiality and consent will have to be carefully assessed to determine the feasibility of this recommendation and implementation approach. ● Many health conditions can be criminalized and prosecuted. The SCU data must be separate from Dispatch and CAD data because Dispatch is situated within Berkeley Police Department . Presently, Dispatch does not have access to EHRs or the CHR, and in the future, this separation should continue.
Attachment 3
SCU Crisis Response Recommendations | 43
Recommendation #17
Collect and publish mental health crisis response data publicly on Berkeley’s Open Data Portal
Data collection is essential to monitoring and evaluation and spans across the SCU mobile team and supporting personnel, Dispatch and/or the alternative phone line, and central leadership. Given how many different personnel and agencies will be collecting and reviewing data, it is essential that data collection be planned for early in Phase 0 to ensure alignment, accuracy, and data integrity. • Types of data that should be collected and published:
o Call volume
o Time of calls received
o Service areas
o Response times
o Speed of deployment
o Determinations and dispositions of Dispatch (including specific coding for violence , weapons, and emergency)
o All determinations and deployed teams from Dispatch
o Percentage of calls responded to by SCU of all calls sent to SCU o Type or level of service needed compared to the initial determination at the point of Dispatch o Service utilizer outcomes
o Number of 5150 assessments conducted
o Number of 5150s confirmed and involuntary holds placed o Number of transports conducted
o Location of transport destinations
o Type of referrals made
o Priority needs of clients served (housing, mental health) o Number of requests for police involvement
o Racial demographics of service utilizers
o Other relevant characteristics of service utilizers, such as homelessness status or dementia Note: not an exhaustive list.
• Examples of public data dashboards from alternative crisis models:
o Portland’s Street Response data dashboards
o NYC’s B-HEARD monthly data reports
Attachment 3
SCU Crisis Response Recommendations | 44
How does data collection promote community safety and health? Nationally, many emergency call centers lack consistent data collection and internal sharing and r eview, suggesting city administrators and leaders are unable to effectively use data to understand the scope of behavioral crisis and response in their communities. 27 Collecting data in a way that can be used among program administrators will be essential in supporting the success of the SCU and positive outcomes for the community. Moreover, during this project, it was impossible for RDA to conduct an “apples-to-apples” analysis between data from any of the contributing agencies (Police, Fire and Falck, MCT , Dispatch/Auditor’s Report) because the data entry practices across each agency are inconsistent. Specifically, the variables that each agency records for each call response are not the same. In instances where there were similarities in the types of variables used between agencies, the values that they each used to enter or code their data were not comparable.
Why does publishing data publicly matter?
Publishing data through Berkeley’s Open Data Portal could promote transparency around crisis response services, address community stakeholders’ distrust of the system, and keep the community informed about the SCU and the city’s crisis response services.
Considerations for Implementation
● Multiple agencies are likely to engage in data collection that contributes to the SCU model. All data variables and definitions should be aligned to ensure system integration and data integrity, including:
○ CAD data
○ Additional 911 and Dispatch data (as applicable)
○ Alternative phone number data (as applicable)
○ SCU mobile team data
○ EHR data
○ CHR data
● Personnel will need ample training on data collection, including variable definitions and data entry processes, to ensure a high degree of data integrity.
● Staff will need adequate technology to collect and report on data (refer to recommendation #6).
27 Velazquez, T & Clark-Moorman, K. (2021). New research suggests 911 call centers lack resources to handle behavioral health crises.
ResearchGate.
https://www.researchgate.net/publication/355684339_New_Research_Suggests_911_Call_Centers_Lack_Resources_to_Handl e_Behavioral_Health_Crises
Attachment 3
SCU Crisis Response Recommendations | 45
Recommendation #18
Implement care coordination case management meetings for crisis service providers.
Service utilizers often receive care across multiple agencies and individual service providers, but transparency and visibility of service utilizers that move in and out of these agencies is a challenge. Regular case management coordination meetings across organizations and providers could help to address the perceived lack of coordination across different services and to improve the care coordination for service utilizers, such as those discharged from inpatient facilities.
Who should participate:
• SCU mobile team
• Service providers and case
managers identified through CHR
and EHRs
• Partners and those receiving referrals
at CBOs
• A designated meeting coordinator
(e.g., SCU program manager, city
staff)
What the meetings should achieve:
• Discuss care for shared service
utilizers
• Discuss needs of high service
utilizers, services provided
• Discuss successes or challenges with
warm handoffs and referral
pathways
How is care coordination relevant to crisis response?
Care coordination supports providers in making informed decisions about the services to provide and can prevent future crisis. Throughout the project’s qualitative data collection, service providers in Berkeley commonly provided the idea of care coordination meetings between the SCU and providers; they expressed that if their clients access SCU crisis services, they would benefit from collaborating with the SCU.
The REACH Edmonton program also shared that meetings for frontline workers to discuss shared clients increased positive client outcomes. Finally, Berkeley’s Transitional Outreach Team (TOT) shared challenges they have encountered when providing follow-up care after MCT responds to an incident, especially communicating with the many external providers that interact with a single service utilizer.
Why is there a coordinator role in these meetings? Who is that? Based on the lessons learned from other cities implementing alternative crisis response models, such as the REACH Edmonton and Denver STAR programs, care coordination meetings will require a centralized coordinator or leader from the SCU. Frontline workers do not have the capacity to manage these meetings, which includes scheduling, note taking, preparing data, following up on items as necessary, and other duties. The care coordinator may be an administrative staff member of the SCU, such as the program manager, or a staff member from the City of Berkeley who oversees many of the relevant contracted providers (beyond the SCU).
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SCU Crisis Response Recommendations | 46
Considerations for Implementation:
● These meetings will require a clear owner to manage meeting topics, prepare data, identify non - urgent items for follow-up, and ensure equitable power and time talking, especially for peer specialists. The SCU program manager may be best poised for this role. ● Integrated data systems that allow for sharing data and reviewing case history across providers would enhance care coordination and case management (refer to recommendation #16). ● There may be a benefit to call takers joining these meetings if they identify and document who is in crisis.
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SCU Crisis Response Recommendations | 47
Recommendation #19
Implement centralized coordination and leadership across city agencies to support the success of mental health crisis response.
Overall, programs benefit from ensuring there are one or more people responsible for coordinating the program at a birds-eye view. As a new mental health crisis response initiative, the SCU model will require cross-system coordination for implementing new processes, training, monitoring, and evaluation. Moreover, because these initiatives span across Dispatch and/or an alternative phone number, the SCU mobile team, and other referral entities like Fire, Police, MCT, TOT, and mental health and social service providers, a centralized coordinating body will be essential to the success of this far-reaching initiative.
Why is the Berkeley Police Department involved in this leadership body if the SCU is a non-police response? Because the police currently respond to all mental health calls received through 911, any decision about shifting specific call and service types from police to SCU will require BPD buy-in, communication, and planning. Moreover, Dispatch is currently situated within BPD, and therefore, BPD leadership will be required to assess and approve changes to Dispatch.
For instance, to ensure that all SCU data is kept confidential and separate from police, BPD will need to support planning for CAD data to integrate with SCU in a compliant manner. Finally, police may be able to request SCU deployment, so these types of protocols will need BPD’s input.
Considerations for Implementation:
● These meetings will need a clear owner to schedule meeting times, prioritize agenda topics, prepare data, identify non-urgent items for follow-up, and coordinate follow-up communication to relevant stakeholders. ● A data dashboard will support data review and rapid assessment processes. ● Some agencies may have strong bargaining presence or positional power, such as BPD. It is important that these meetings uphold equitable power and weight in making decisions. ● Throughout Phase 0 and Phase 1, this group may need to meet on a weekly basis. ● Additional stakeholders may need to be added to this group (permanently or ad hoc for specific topics), such as representatives from emergency departments, John George Psychiatric Hospital, or other city or county stakeholders.
● As the model progresses, this group may discuss opportunities to improve the mental health crisis system at a broader scale, beyond the scope of the SCU’s crisis response, such as more inter-county and inter-city coordination on systemic issues related to housing.
Who should participate:
• Berkeley Dispatch
• Berkeley Department of Public
Health
• Berkeley Mental Health (BMH)
• Berkeley Health, Housing &
Community Services
Department (HHCS)
• SCU Program Manager
• Berkeley Fire Department
• Berkeley Police Department
• Other relevant parties as the
project evolves
What the meetings should achieve:
• Progress along the phases of
implementation
• Lead the rapid assessment processes
and regularly review data
• Review SCU Steering Committee
feedback
• Review service utilizer and stakeholder
feedback
• Prioritize issues
• Make decisions
Additional outcomes:
• Increase open communication
across city agencies
• Build trust across crisis
responders and city
departments
• Align all partners on shared
values for increasing
community health and well-
being
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SCU Crisis Response Recommendations | 48
Recommendation #20
Continue the existing SCU Steering Committee as an advisory body.
Presently, the SCU Steering Committee has representatives with ties to community groups and stakeholders. The SCU Steering Committee should continue as an advisory body to incorporate into decision-making spaces the perspectives that may otherwise be negle cted in government spaces.
The SCU Steering Committee should continue to advocate for marginalized communities in the SCU model design and delivery by taking on an advisory role through Phase 0 and Phase 1 of implementation, at a minimum.
The current participants should remain, if
they choose, including:
• Berkeley Community Safety Coalition
• Representatives from the Mental
Health Commission
• HHCS staff
• BMH staff
• Berkeley Fire
Addi
tional participants should be added,
including:
• Relevant staff from the SCU or
administrative CBO, such as the
program manager or clinical
supervisor
• Dispatch personnel, particularly
someone in a leadership position
who can both promote change and
holds expertise relevant to
implementation
Considerations for Implementation
● HHCS staff should maintain the role of coordinating the SCU Steering Committee, even if a contracted CBO leads the SCU, because HHCS will lead other aspects of oversight including contract management.
● Additional participants may be added to the SCU Steering Committee at different times. For example, Dispatch personnel should join earlier in Phase 0 of implementation, while SCU personnel will join once that team is fully staffed in Phase 1.
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SCU Crisis Response Recommendations | 49
Recommendation #21
Solicit ongoing community input and feedback.
Governments often face barriers in hearing from community members that are the most structurally marginalized. However, engaging existing coalitions and networks designed to represent marginalized service users’ perspectives can support more equitable engagement. Intentional outreach for these opportunities is essential because, historically, government institutions and other structures have prevent ed the full and meaningful engagement of Black people, Indigenous people, people of color, working class and low-income people, immigrants and undocumented people, people with disabilities, unhoused people, people who use drugs, people who are neurodivergent, LGBTQ+ people, and other structurally marginalized people. Prioritizing the engagement, participation, and recommendations of the community members most harmed by existing institutions, including those most harmed by police violence, will ensure that systems of inequity are not reproduced by a crisis response model.
Instead, community engagement can support the SCU to address structural inequities. In addition to the SCU Steering Committee, ongoing opportunities for the community to provide input to decisions as well as feedback about their experiences will be valuable to the SCU model throughout Phase 1.
Suggested methods to receive community
input and feedback:
• Focus groups
• Town halls or community forums
• On-site outreach
• Questionnaire
• Online feedback “box”
Encourage participation among:
• Service utilizers
• Community members with mental
health and behavioral health needs who
have not yet engaged with the SCU
• Service providers at CBOs, especially
those receiving SCU transports and
referrals
Modalities should ensure equitable access to
participation:
• Online and in person
• Large groups, small groups, and one-
on-one
• Anonymous
• Written and verbal
• Translation and interpretation
Address structural barriers to participation by:
• Using convenient, accessible, and
geographically diverse locations
• Offering events at varying times to
accommodate different schedules
• Providing financial compensation
• Providing childcare
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SCU Crisis Response Recommendations | 50
Why is more community engagement needed if community input informed the model? The robust community engagement that contributed significantly to the development of this model demonstrates the valuable perspective and knowledge held by community members about the types of services needed and how to make them more accessible and acceptable. Soliciting ongoing feedback once the SCU is launched will provide insight to how well the model is meeting community members’ needs and where barriers to crisis care persist, servicing both quality improvement and evaluative needs.
Why should ongoing community engagement be conducted?
Community input and feedback should not be limited to the end of Phase 1 as part of a summative evaluation, but instead be ongoing to account for the changing landscape of SCU model implementation and the needs of both service utilizers and the broader community. It will also support ongoing iteration of the SCU throughout Phase 1, while planning for more complex modifications in Phase 2.
Considerations for Implementation
● The opportunities for community input and feedback should be held regularly, such as monthly, or quarterly.
● Frequent service utilizers, perhaps identified during the SCU’s first three months of implementation, could be the primary recruitment base for feedback.
● Address barriers to equitable participation in feedback, such as by providing childcare, transportation vouchers, or financial compensation for time. ● Community feedback should be evaluated as essential data points that directly inform the rapid assessment processes (refer to recommendation #22).
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SCU Crisis Response Recommendations | 51
Recommendation #22
Adopt a rapid monitoring, assessment, and learning process.
Many crisis response programs use data to monitor their ongoing progress and successes, modify and expand program pilots, and measure outcomes and impact to inform ongoing quality improvement efforts.
Data collection, data system integration, centralized coordination across city leadership, the SCU Steering Committee, and ongoing input and feedback from community members and service utilizers (recommendations #16, #17, #19, #20, and #21) should all contribute to the monitoring that supports ongoing implementation, assessment, and iteration.
A rapid assessment process will likely need to:
• Develop a shared vision for the SCU model.
• Develop goals for the SCU model.
• Create assessment questions to guide the monitoring and learning process .* • Define indicators or measures.
• Use a mixed-methods approach, including quantitative programmatic data and feedback from service utilizers, staff, and other stakeholders.
All model components will benefit from assessment, including:
• Availability of the team, accessibility of Dispatch and/or alternative phone line, response time
• Services provided, expertise of mobile team, training • Equipment, vehicles, and supplies
• Transport, service linkages and handoffs, partnerships with CBOs • Case management meetings and centralized leadership coordination • Data collection, data integration, data integrity, and data transparency • Public awareness campaign
Consider using the Results-Based Accountability (RBA) framework 28 to assess SCU
performance aligned to:
• Quantity of SCU services
• Quality of SCU services
• The impact or outcome of SCU services
*From the shared vision, create assessment questions to use throughout the duration of Phase 1, such as:
● Is there a need to scale and increase services?
● Are resources being used efficiently in the pilot? Will they be used efficiently with an increase in services? ● How effective is the current approach? Will it be effective with an increase in services? ● Is the current approach appropriately tailored to the Berkeley community? Is it appropriate for the Berkeley community?
28 The City of Berkeley is using RBA for performance monitoring efforts and therefore may benefit from using RBA for the SCU model too.
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SCU Crisis Response Recommendations | 52
Figure 4: Rapid Monitoring, Assessment, and Learning Process
A rapid monitoring, assessment, and learning process can happen in multiple venues. Some questions may be assessed on a quarterly basis, while others can happen on a monthly or weekly basis.
Considerations for Implementation:
● The rapid assessment process will need to establish clear roles for leading the meetings and decision-making, especially between the SCU program manager and central coordinating leadership.
● The rapid assessment process will benefit from clear timelines and processes for reviewing data, discussing changes and adaptations, and sharing findings across relevant stakeholders . ● The rapid assessment process may have multiple processes or venues based on specific data points or meeting frequencies. Clarify who should be attending, such as Dispatch, the alternative phone number (if applicable), the SCU mobile team, HHCS leadership, and others.
Establish
Advisory
Group
Assessment
Planning
Data
Collection
Regular
Monitoring
Meeting
Update
Model
Goals, Questions,
Measures
Successes,
Challenges,
Lessons
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SCU Crisis Response Recommendations | 53
Recommendation #23
Conduct a formal annual evaluation.
Several components of the SCU - including the model’s services, the SCU mobile team’s training, the deployment determinations of Dispatch and/or the alternative phone line, and impacts and outcomes for service utilizers - offer potential for demonstrating the success of the model through formal evaluation. The evaluation should measure whether the SCU model is progressing towards the intended outcomes, as well as suggest opportunities for modifications and expansion. Design of a formal, annual evaluation is best done early in program planning.
Evaluation may define:
• A Theory of Change or Logic Model
• Short-term and medium-term goals
Evaluation could measure:
• Fiscal analysis, especially evaluation of progress towards the City’s aim of reducing BPD’s budget by 50% • Systems change effectiveness, including evaluation of progress towards City’s goal of reducing the footprint of BPD to criminal and imminent threats
• Program efficacy/effectiveness, quality of service
• Service utilizer outcomes
• Ongoing barriers and challenges that Phase 2 can address • Effectiveness of public awareness campaign, whether community members know about it • Impacts aligned to a Racial Equity Impact Assessment
29 Eva
luation should include:
• Qualitative and quantitative data
• Perspectives from SCU personnel
• Perspectives from service utilizers
• Perspectives from adjacent organizations, staff, and SCU Steering Committee How is the proposed evaluation different than rapid monitoring? Evaluation and rapid monitoring, or quality improvement, are complementary and should inform each other.
Rapid monitoring is intended for more immediate quality improvement and occurs on more frequent cycles to guide iterative implementation of specific model elements. Evaluation asks broader questions from a greater degree of distance to guide adjustments to the model that will support ongoing effectiveness and sustainability.
Staff are typically central to rapid monitoring to facilitate ongoing improvements, but an evaluation is generally conducted by an outside team that has some distance from day-to-day operations.
Considerations for Implementation
• If the City of Berkeley intends to contract out the evaluation, then the RFP and contracting process should be initiated early in Phase 0 to allow for adequate planning. 29 To learn more about Racial Equity Impact Assessments, visit:
https://www.raceforward.org/sites/default/files/RacialJusticeImpactAssessment_v5.pdf Attachment 3
SCU Crisis Response Recommendations | 54
Promo
ting Public Awareness
Promoting public awareness of the SCU and its aims will be essential to the SCU’s success. Public education efforts should be advanced through a variety of methods, including a far -reaching campaign and targeted outreach. These efforts should emphasize that the SCU is a non-police crisis response service and promote how to access the SCU (i.e., which phone number to call). Overall, promoting public awareness is essential to building trust and addressing fears or reluctance that might inhibit people to call for support during a mental health or substance use crisis.
Promoting awareness and establishing relationships with other providers in the response network is also important, especially staff at emergency facilities who may interact with the SCU during the transport of a person who has experienced a mental health or substance use crisis. This type of relationship -building and education can streamline processes to promote positive outcomes for people in crisis.
The following recommendations should be adapted and implemented to advance public education and awareness about the SCU model:
Key Re
commendations
24. Launch a public awareness campaign to promote community awareness and education about the SCU.
25. The SCU mobile team should conduct outreach and build relationships with potential service utilizers.
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SCU Crisis Response Recommendations | 55
Recommendation #24
Launch a public awareness campaign to promote community awareness and education about the SCU.
For the community to be able to call for an SCU response, they must know that it exists. Stakeholder input throughout this project has indicated that community members must trust that the SCU provides a crisis response without the use of law enforcement for the SCU to be a viable and sought -after crisis response option. For these reasons, promoting public awareness of the SCU and its aims will be essential to the SCU’s success.
Aims of the campaign:
• Emphasize the SCU as a non-police mental health and crisis response option • Distinguish the roles and responses of SCU, MCT, and police • Promote how to access the SCU (i.e., through 911, an alternative number, or 988) • Describe when SCU will not respond (e.g., social monitoring, weapons) and when it will (e.g., types of services).
• Emphasize the community engagement that informed the model • Share the availability of Berkeley Open Data
• Promote opportunities for ongoing stakeholder input and feedback Why is it important to launch a public awareness campaign? To inform the community of this new resource and to distinguish the SCU as a non-police response.
Stakeholder input throughout this project has indicated that community members must trust that the SCU provides a crisis response without the use of law enforcement for the SCU to be a viable and sought -after crisis response option.
How do other cities promote their crisis response model? Other cities provided examples of promoting awareness outside of mass media. For example, Portland’s Street Response team contracts with street ambassadors with lived experience (via a separate contract with a local CBO) who perform direct outreach to communities and work to explain the team’s services and ultimately increase trust with potential service utilizers.
Considerations for Implementation
● The methods of the campaign may need to be tailored to the targeted stakeholder groups and may include:
○ Mass media, billboards, advertisements on public transportation, radio announcements, local newspaper announcements, updates to the city’s social media and websites, updates to service providers’ and CBOs’ social media.
○ Business cards with contact information for potential service utilizers. ○ “Meet-and-greets” that the SCU mobile team hosts with service providers at CBOs and emergency facilities.
● The public awareness campaign may have multiple phases, such as first promoting awareness of th
e SCU and how to access it, and then promoting opportunities for stakeholder feedback.
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SCU Crisis Response Recommendations | 56
Recommendation #25
The SCU mobile team should conduct outreach and build
relationships with potential service utilizers.
In addition to a public awareness campaign that promotes the SCU as a community resource, shares how to access the SCU, and emphasizes the non-police design, many service utilizers may still be reluctant to engage with a new entity. As a result, to most equitably meet the needs of potential service utilizers and especially substance users, the SCU may need to conduct in-person outreach. This outreach should be targeted to specific groups who are most likely to call the SCU with the aim of establishing trusting relationships and sharing more about their harm reduction approaches.
Targeted sites for relationship building with potential service utilizers:
• Encampments
• Safe parking RV lots
• Drop-in centers
• Downtown Berkeley
• People’s Park
• Emergency department waiting rooms
Why might service utilizers be reluctant to engage in services with the SCU? Many community members have personally experienced the criminalization of substance use and mental health emergencies, whether through their own experiences or having witnessed the experiences of family, friends, or community members. Such carceral approaches include involuntary psychiatrist holds and unnecessary transport to hospitals. In particular, unsheltered residents and substance users may be more distrustful of a new team and be less likely to call during a crisis. In interviews, unsheltered residents shared that not all of their substance use management are being adequately addressed by current crisis responders and they experience high rates of transport to emergency departments. Many also shared that they fear police retaliation for their substance use. In general, there are several reasons why community members may be hesitant about engaging crisis responders, which could be addressed by individual, relational outreach.
Why would relationship building improve utilization of the SCU? Despite many service utilizers reporting overall distrust of first responders, they also shared that EMTs have developed trusting relationships and strong rapport for handling overdoses. Because of this relationship, service utilizers are more willing to call for an EMT to respond to an overdose. Similarly, h aving strong relationships built on trust will be key to the success of the SCU.
Considerations for Implementation
● If there are periods of low call volume, the SCU may use those times as opportunities to build relationships in communities of potential service utilizers and proactively provide services . ● This outreach may also be implemented based on data and findings or in preparation for Phase 2 expansion and changes.
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SCU Crisis Response Recommendations | 57
Syste
m-Level Recommendations
The development of a mental health crisis response model as a component of the City of Berkeley’s emergency services should be understood as a systems-change initiative of great magnitude. There are several critical factors that must be attended to in order to realize the full implementation of the SCU and to progress towards its intended outcomes.
Addressing the Needs of Dispatch
There is an urgent need for a 24/7 mental health and substance use crisis response model that does not rely on law enforcement to provide specialized mental health care.
To provide this service, crisis responders must be connected to those in crisis. Thus, the role of Dispatch is essential.
Dispatch needs a full assessment and planning process to address the complexity of the 911 response system. This assessment and planning, though urgent, cannot be done hastily. The SCU will benefit if Dispatch is able to:
• Address the understaffing, under-resourcing, and identified training needs of call takers.
• Plan for a sustainable integration.
• Plan for a variety of scenarios to ensure crisis responder and community safety. • Participate in the SCU phased-implementation approach and ongoing collaboration with SCU leadership.
• Establish trusting relationships and rapport with the SCU so that call takers are confident in deploying the SCU for scenarios they previously would have deployed MCT or Police.
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SCU Crisis Response Recommendations | 58
A Sufficient Investment of Resources
A lack of sufficient resources is not only a challenge for Dispatch, but is a common challenge expressed by service providers in Berkeley and in other locales. Within the City of Berkeley, both TOT and MCT have challenges meeting the needs of community members because their hours of operation are limited, and they do not have enough staffing and resources to provide 24/7 services. This results in the perception of slow or delayed response times and can decrease the likelihood that callers continue to seek that service. Efforts in other cities, such as the Mental Health First and MACRO initiatives in Oakland and the Street Crisis Response Team in San Francisco, have also had to restrict their hours of availability and services due to a lack of sufficient funding.
Mental health crisis response could be essential in promoting health equity in the City of Berkeley. However, if it is not sufficiently resourced to provide 24/7 crisis response without long wait times, it will not achieve trust, and will become utilized less often and will therefore not achieve the desired systems-change results. This resourcing includes not only the SCU mobile crisis team, but the entirety of the model and related infrastructure, from the call center to program manager. Sufficient resourcing also includes dedicated time by city leadership to support coordination, collaboration, and problem -solving.
The Role of Trust
Trust was one of the most discussed factors across stakeholder engagement and will be a critical ingredient to the success of this system-wide change initiative. The public awareness campaign and all Phase 0 planning processes must address the concerns and doubts that could undermine trust across community stakeholders, the service provider network, and city leadership.
Trust will shape whether community members utilize the SCU. Community members must trust that the SCU:
• Is a non-police crisis response.
• Is accessible and available 24/7.
• Is responsive to emerging needs and ongoing community input and feedback. • Provides competent harm reduction and non-carceral approaches to mental health and substance use crisis intervention.
Trusting relationships affect the quality of referrals, warm handoffs, and service linkages across the service provider network. Service providers emphasized that trust plays a role in:
• Whether they will refer a client to another provider. • The amount and type of information they disclose about a shared client. • Whether systems will choose to share and integrate data.
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SCU Crisis Response Recommendations | 59
• The quality of collaboration and communication during warm handoffs, care coordination, or at client discharge.
Trusting relationships are essential to centralized coordination and collaboration among city leadership. The SCU model will require a variety of agencies and departments to work together in new ways and toward new ends. Other cities implementing alternative crisis models shared that trust was enhanced across leadership by:
• Aligning on shared values and commitment to improving health outcomes for people in crisis.
• Recognizing and adapting to the varied cultures of city departments, agencies, and CBOs.
• Ensuring decision-making power is allocated in alignment with the aims of the crisis model, such as ensuring that law enforcement does not have an unaligned or inequitable of voice or power in making decisions.
• Reviewing data to promote accountability and celebrate successful outcomes. • Planning for sufficient time to prepare and participate in collaboration.
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SCU Crisis Response Recommendations | 60
Con
clusion: Next Steps &
Future Considerations
This report presents recommendations for a model that is responsive to community needs. Still, there were numerous questions, issues, needs, and considerations that surfaced that were beyond the scope of the project. Decisions around those factors could significantly shape the types of services the SCU provides as well as how it is coordinated and administered across agencies. Such considerations are pertinent to the future of the SCU, crisis response, and the mental health service system in Berkeley, and therefore should continue to be discussed by city leadership and those implementing the SCU.
Long-Term Sustainable Funding
The SCU model requires long-term sustainable funding. A sound fiscal strategy must recognize the robustness of costs associated with the SCU and plan for institutionalizing and sustaining those costs. There are a number of potential funding sources for the SCU model, including Medi-Cal reimbursement, Medi-Cal opportunities through CalAIM, and DHCS grants. However, these funding streams are unlikely to sustain a crisis response model on their own. Other funding and resources may need to be braided in to the SCU to effectively implement this model.
While braiding allows for maximizing funding resources, it also requires clear and separate tracking of services based on funding sources and requirements. With multiple funding streams, the target populations, reporting requirements, eligibility criteria, and performance measures can vary greatly. A braided funding model, therefore, requires knowledgeable administrators as well as dedicated time to manage. This can be especially resource-intensive for a CBO implementing the SCU. The SCU model will need to be very clear about the funding requirements and develop an appropriate syst em for ongoing tracking and reporting.
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SCU Crisis Response Recommendations | 61
Different financing mechanisms provide varying levels of sustainability and predictability, considerations which should inform the development of a fiscal strategy for the SCU model. Unfortunately, these recommendations may not be fully realized if there is not a long-term sustainable fiscal strategy. Modifications to the SCU model could negatively impact the quality of service delivery or lessen the population impact .
Across the country, some cities have used a sales tax to fund their alternative crisis response models while others have redirected funds away from police departments.
Rather than identifying new or short-term grant awards, a primary consideration for the City of Berkeley should be to look to dollars that can be reinvested from the Berkeley Police Department, in alignment with the Reimagining Public Safety initiative, to develop a sustainable and comprehensive SCU model.
Continue Planning for 24/7 Live Phone Access to the SCU Significant planning will be required to fully realize the 24/7 live phone access to the SCU (refer to recommendations #8, 9, and 10). Reaching out to existing call centers— such as Alameda County CSS— or to other cities implementing similar crisis models could support the development of the phone access to the SCU. Additional planning is needed to determine, at a minimum:
• Equipment and technology needs
• Staffing requirements for the estimated call volume
• Recruitment, hiring, and training
• Workflow and protocol development
• Cost and funding availability
The Location of 911 Dispatch Within the Berkeley Police Department
The 911 Communications Center is currently operated by the Berkeley Police Department.
This structure affects how Dispatch is funded and who makes decisions. As the role of Dispatch is broadened to coordinate a greater variety of responses to emergencies, there may be advantages to moving Dispatch outside of the Berkeley Police Department, such as improved communication and coordination across relevant agencies. For instance, it has been expressed that Dispatch call takers are currently more comfortable deploying the police than other crisis responders given their long tenure and rapport wi th police officers, so call takers’ ability to establish rapport with the SCU team is needed for them to be comfortable deploying the SCU. Structural changes like this may also align to several of the Reimagining Public Safety initiative’s aims. This consideration can be explored as part of the assessment and planning processes of the phased implementation approach.
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SCU Crisis Response Recommendations | 62
Preventing Social Monitoring: Clarifying the SCU’s
Guiding Principles
The SCU model is designed to ensure that mental health specialists respo nd to people experiencing mental health crises. However, there is significant and justified concern that the SCU could be co-opted to support the social monitoring and enforcement of unsheltered residents. Clarifying the SCU’s guiding principles could support in reifying the intentions of the model to ensure that all practices are aligned with those principles.
There are several elements within the model design where data, ongoing conversation, and service utilizer feedback can ensure that the SCU lives out its intention. One such example is whether and how the SCU would be deployed with the police and/or how the SCU is distinguished from MCT. For example, if a caller reports an unsheltered neighbor is residing on their sidewalk or driveway, this may not qualify for an SCU response. However, if that call is deployed to the police, then the response effectively criminalizes unsheltered Berkeley residents. Such scenarios should be explored as the SCU model is implemented, refined, and expanded.
Address the Full Spectrum of Mental Health and
Substance Use Crisis Needs
Mental health and substance use crises vary in severity along a spectrum. A crisis can present as someone in immediate danger to themselves or others, someone who needs regular support to address their basic needs, or someone who is generally able to manage their needs but needs occasional support to prevent a future crisis.
Throughout this project, many stakeholders expressed that in order to effectively address the challenges of the current system, solutions and changes must engage with the nuances and spectrum of mental health crises:
• Some forms of crisis are readily visible while others are not. • Some forms of neurodivergence are reported as a mental illness or crisis, but they are not.
• Some forms of crisis occur because the person is unable to access services to meet their needs.
• Some forms of emergency service utilization stem from ongoing unmet basic needs such as food and affordable housing.
Stakeholder participants urged that the concept and definition of a mental health crisis and crisis services be expanded to not only support crisis intervention but also prevention, diversion, and follow-up. The following two considerations should be further explored because they may support the SCU model. Both considerations represent a form of Attachment 3
SCU Crisis Response Recommendations | 63
reimagined public safety and may be realized with additional resources, such as funds divested from Berkeley Police Department:
Expand the SCU Model to Include a Follow-up Care and
Coordination Team
There will likely be a need for a team to receive referrals from the SCU mobile team and connect with service utilizers for follow-up care. Follow-up care could include referrals, system navigation, and case management support. This team may also need to conduct outreach to make contact with service utilizers and address barriers to care as needed. For example, some service utilizers may be unable to follow through with a referral if they do not have reliable access to transportation or experience challenges maintaining scheduled appointments. This team could potentially be funded by the 988 funding allocated to dedicated follow-up teams deployed from 988 crisis call centers.
30 There are many lessons that should be learned from the existing Transitional Outreach Team (TOT), such as challenges they face with adequate staffing and funding or constraints and limitations with who they can serve. Any initiatives around follow-up care should augment rather than duplicate the TOT.
Increase the Number of Sites for Non-emergency Care for Berkeley Residents
Throughout this project, stakeholder participants emphasized the need for sites for non-emergency care, such as drop-in centers, day centers, sobering sites, and respite centers. These services are important for harm reduction and crisis prevention, and as such would support the outcomes of the SCU model. There may be opportunities in Phase 0 or Phase 1 to reserve beds at a shelter or similar care facility as a temporary measure, ensuring persons in crisis have access to these beds after engaging with the SCU. However, increasing the overall number of sites for non-emergency care would require a longer-term investment
30 Santos, M (2021). New suicide prevention hotline aims to divert callers from police. Crosscut. https://crosscut.com/politics/2021/07/new-suicide-prevention-hotline-aims-divert-callers-police Attachment 3
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Appendix
Attachment 3
Appendix A: Launch Timeline & Phased Implementation Approach Nov 2021 - May 2022
System-Level: Planning, Launch, Implementation HHCS
Steering
Committee
Dispatch
Contracted
CBO
Engage community on feedback to SCU Model recommendations x x Engage community on SCU RFP requirements x
Dispatch leadership communicates and champions (internally) the SCU change-initiative
x
Plan for Dispatch assessment (e.g., determine if RFP needed) x x Jan Make decisions about 24/7, live phone line to SCU (option A, B, C) x x x Issue RFP for SCU x
Issue RFP for SCU alternative phone line (TBD) x
RFP Deadline
Review all RFPs x x
Select awardee for SCU x x
Begin planning for site visits x x x
Apr Contract process for SCU x
Hire SCU personnel (mobile team, supportive and administrative roles, Dispatch/phone staff)
x
Hire mental health clinician to support Dispatch assessment & planning x x Build relationships across all new personnel x x x x
June - Aug
Plan & Implement Recommendations: Refer to Phase 0 Implementation Approach
Phase 0 - Launch Timeline
Dec
Feb
Mar
May
Attachment 3
Phased Implementation Approach
Implementation Planning for Phase 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+ SCU Mobile Team Recommendations
1 The SCU should respond to mental health crises and substance use emergencies without a police co-response
Clarify specific factors and codes for all suggested
SCU call types
Develop triage criteria and workflows across all SCU
call-types and services.
Coordinate with other entities (BPD, MCT, UCPD) for
differentiation and/or collaboration.
SCU mobile team goes live,
providing services
Consider additional types of calls for service that
they can respond to where armed police officers
are not needed or aligned to a reimagined
definition of public safety, such as:
- Completing documentation while providing
crisis services where a traditional “police report” is
needed, such as in cases of sexual assault, sexual
harassment, and rape
- Petty theft
- Nonviolent conflicts, such as neighbor disputes
or youth behavioral issues
- Minor assaults, with no weapons present
- Proactive support at events that may trigger a
crisis (e.g., during an encampment sweep)
Integrate other SCU model
elements (e.g., follow-up care
team [Report Section V])
2 The SCU should operate 24/7
3 Staff a 3-person SCU mobile team to respond to mental health and substance use emergencies
4 Equip the SCU Mobile Team with vans Procure vans
5 The SCU Mobile Team should provide transport to a variety of locations Introduce SCU to emergency facility staff at all
transport destinations
6 Equip the SCU mobile team with supplies to meet the array of clients' needs
Procure supplies
7 Clearly distinguish the SCU from MCT
Develop clear roles and parameters for SCU and MCT
teams by collaborating across Dispatch, the SCU
Steering Committee, the current MCT team, and other
relevant leadership
Note: These decisions are essential for developing
triage criteria and workflows and for communicating
to the general public in a public awareness
campaign.
Evaluate the role of MCT and the
efficacy of having both teams.
Make recommendations for Phase
2, such as changes to each team’s
scope or processes.
Communicate to general public and relevant
service providers about changes relevant to the
distinguished roles of MCT and SCU
Phase 1 Future, Beyond Phase
2 Phase 0 Phase 2
Attachment 3
Phased Implementation Approach
Implementation Planning for Phase 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+ Phase 1 Future, Beyond Phase
2 Phase 0 Phase 2
Accessing the SCU Crisis Response
8 Participate in the Dispatch assessment and planning process to prepare for future integration
Decide the most effective method for 24/7, live phone
access to the SCU (Option A, B, C)
Dispatch makes investments in staffing and
technologies, as needed
SCU model discusses with Dispatch the necessary
data (variables, definitions, timelines, privacy, etc.) to be collected during each Phase of implementation
Dispatch begins planning for changes to CAD or
other data systems
Dispatch makes investments in
staffing and technologies, as
needed
Dispatch implements Phase 1
protocols, as determined by Phase
0 planning (Option A, B, C)
Implement new triage criteria and
workflows
9 Ensure the community has a 24/7 live phone line to access the SCU Implement and adapt 24/7, live phone line access to
SCU (Option A, B, C)
Adapt protocols for other Berkeley crisis responders
(Fire, EMS/Falck, MCT, Police) to request SCU support
through the alternative phone number
Dispatch and HHCS/SCU identify opportunities for
Phase 1 implementation (based on Option A, B, C),
such as:
- Phase 1 call types for SCU deployment OR
preliminary calls that Dispatch will transfer to the
alternative phone line in early Phase 1 (e.g., welfare
checks)
- Dispatch supports alternative phone line to develop
aligned triage criteria and workflows to support
future integration
If Option B or C:
Plan for how calls will be triaged
and prioritized from the two
separate sources (alternative
number and 911) in deploying the
SCU mobile teams in Phase 2
Determine if the SCU should
respond to crises by sight
("proactive" deployment and
intervention)
Determine if the SCU should self-
deploy by listening to the police
radio (based on other models:
Eugene's CAHOOTS, Denver's STAR,
and San Francisco's Street Crisis
Response Team)
If Option B or C:
Integrate SCU into 911
10 Plan for embedding a mental health or behavioral health clinician(s) into Dispatch to support triage and SCU deployment
Dispatch hires one clinician to support the Dispatch
assessment process and to support triage criteria
and workflow development for calls routed to SCU
Clinician attends trainings and site observations with
Dispatch and SCU
Clinician(s) supports planning for triage criteria, call- types, etc. (as relevant: Option A, B, C may affect
timing of this)
If Option A:
Dispatch prepares for fully embedding clinician(s),
including clarifying their roles and supervision
structure
If Option B or C: implement this in Phase 2
Clinician(s) support Dispatch
based on the assessment findings
and next steps, such as:
- supervises call-takers triaging
mental health crisis calls
- provides trainings to call-takers
based on 2019 Auditor's Report and
ongoing assessment
Assess whether clinician(s) can
provide services beyond SCU
deployment, including basic
telemedicine and psychiatric
screenings or psychiatric crisis
assessment
Attachment 3
Phased Implementation Approach
Implementation Planning for Phase 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+ Phase 1 Future, Beyond Phase
2 Phase 0 Phase 2
Implement a Comprehensive, 24/7 Mental Health Crisis Response Model 11 Fully staff a comprehensive model to ensure the success of the SCU mobile team, including supervisory and administrative support roles for SCU
12 Operate one SCU mobile team per shift for three 10-hour shifts 13 SCU staff and Dispatch personnel should travel to alternative crisis programs for in-person observation and training
Incorporate into RFP and hiring timelines to allow for
these periods of travel and training.
Note: City of Berkeley and/or the contracted CBO
may need to reach out to the other cities and
programs to solidify travel and training plans prior to the hiring of any individual personnel.
Allot time after the site visit(s) for debriefing,
reflecting on lessons learned, and discussing how to
integrate key takeaways into the SCU model.
Include in debrief and planning conversations
personnel that traveled for site observations, HHCS
staff, additional Dispatch leadership, and Steering
Committee members, as needed
14 Prepare the SCU mobile team with training, informed by community needs
Plan the training schedule based on community
needs, ongoing assessment and planning, and
prerequisite skills and experiences of hired personnel
Attachment 3
Phased Implementation Approach
Implementation Planning for Phase 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+ Phase 1 Future, Beyond Phase
2 Phase 0 Phase 2
Administration and Evaluation
15 Contract the SCU Model to a CBO
Extend contract and provide
funding for Phase 2, as applicable
Determine if the SCU can be
administered through the City of
Berkeley, elevating it to the status
of Police and Fire as an essential
citywide emergency service and
ensuring long-term sustainability
16 Integrate SCU into existing data systems
Assess feasibility of data integration across various
systems and sources: assess system capacity needs
to realize integration, seek consultation on legal
issues surrounding patient protections and sharing
health data across providers
Evaluate implications for Recommendation 18 (care
coordination case management meetings) based on
feasibility and adaptations from this
recommendation (Recommendation 16)
Maintain and strengthen data privacy before SCU is
integrated with Dispatch (given that Dispatch is
situated within Berkeley Police and that many health
conditions can be criminalized and prosecuted)
Continue: Assess feasibility of data
integration across various systems
and sources: assess system
capacity needs to realize
integration, seek consultation on
legal issues surrounding patient
protections and sharing health
data across providers
Coordinate with Alameda County
Care Connect to plan for bi-
directional data feeds with the
Community Health Record (CHR)
Plan for access to EHRs and other
relevant data systems
17 Collect and publish mental health crisis response data publicly on Berkeley’s Open Data Portal
Coordinate with City of Berkeley to add new data to
Portal
Plan for how regularly data will be refreshed/updated
on Portal
Publish data regularly
18 Implement care coordination case management meetings for crisis service providers
Involve all relevant agencies in planning to define,
align, and adjust data definitions, variables, and
collection practices. (e.g., 911-Dispatch, MCT, BPD, BFD, Falck, HHCS, SCU, etc.)
Engage potential participates to plan for Phase 1
implementation of care coordination case
management meetings (identify and confirm
participants, confirm meeting intervals, set meeting
times, etc.)
Convene and implement care
coordination meetings
19 Implement centralized coordination and leadership across city agencies to support the success of mental health crisis response Engage potential participates to plan for Phase 1
implementation of centralized coordination and
leadership meetings (identify and confirm
participants, confirm meeting intervals, set meeting
times, etc.)
Convene and implement
centralized coordination and
leadership meetings
Attachment 3
Phased Implementation Approach
Implementation Planning for Phase 2
Nov 2021 - Aug 2022 Sept 2022 - Aug 2023 Sept 2023 - Feb 2024 Feb 2024+ Phase 1 Future, Beyond Phase
2 Phase 0 Phase 2
Administration and Evaluation (continued)
20 Continue the existing SCU Steering Committee as an advisory body Identify additional Steering Committee members
Invite and engage new members
Adapt processes, group norms and agreements,
and/or meeting schedules, as relevant
Hold regular meetings of SCU
Steering Committee; incorporate
decision-making processes across
other Recommendations
21 Solicit ongoing community input and feedback
Decide on methods and intervals for collecting
community input and feedback during Phase 1
Develop a plan to communicate the opportunities for
community and feedback; incorporate into public
awareness campaign
Solicit ongoing community input
and feedback; incorporate
decision-making processes across
other Recommendations
22 Adopt a rapid monitoring, assessment, and learning process 23 Conduct a formal, annual evaluation
Plan for the evaluation and rapid assessment
processes to use overlapping data and be mutually-
supportive and streamlined
Plan for all data definitions and collection processes
to be aligned across rapid assessment and
evaluation aims.
Ensure that the evaluation findings
are available for the latter six-
months of Phase 1 to support
planning for Phase 2
Review evaluation findings
Plan for Phase 2
24 Launch a public awareness campaign to promote community awareness and education about the SCU
Plan for public awareness campaign, including
targeted modalities, targeted audiences, and/or
phased timing
Launch public awareness campaign
Continue public awareness
campaign, as necessary
25 The SCU mobile team should conduct outreach and build relationships with potential service utilizers
Conduct targeted outreach and establish trusting
relationships between SCU and community
members, promoting utilization of SCU
Continue targeted outreach and
build relationships as necessary
Attachment 3
SCU Crisis Response Recommendations | 66
Appendix B: Sample Shift Structure & Redundancy Needs
Model
Compo
nent
Phase
Staffin
g
Needs
Shift
Type M T W Th F Sa Su
No.
of
shift
s
(wee
k 1)
No.
of
shift
s
(wee
k 2)
No.
of
staf
f
per
unit
No.
of
unit
s
No.
of
FTE
need
ed
Notes
SCU Phase 1 Shift 1 10-hour
shift
mobile
unit A
mobile
unit A
mobile
unit A
mobile
unit B
mobile
unit E
mobile
unit E
mobile
unit E
mobile
unit a
3 4 3 6 18 Assumes
one
mobile
unit per
shift
Shift 2 10-hour
shift
mobile
unit B
mobile
unit B
mobile
unit B
mobile
unit C
mobile
unit F
mobile
unit F
mobile
unit F
mobile
unit b
4 3 3 Assumes a
three-
person
mobile
unit
Shift 3 10-hour
shift
mobile
unit C
mobile
unit C
mobile
unit C
mobile
unit D
mobile
unit D
mobile
unit D
mobile
unit D
mobile
unit c
4 3 3 Six
clinicians,
six peers,
six
therapists
mobile
unit d
4 3 3
mobile
unit e
3 4 3
mobile
unit f
3 4 3
SCU Phase 1 Shift 1 10-hour
shift
clinical
supervi
sor A
clinical
supervi
sor A
clinical
supervi
sor A
clinical
supervi
sor B
clinical
supervi
sor E
clinical
supervi
sor E
clinical
supervi
sor E
clinical
supervi
sor A
3 4 1 6 6
Shift 2 10-hour
shift
clinical
supervi
sor B
clinical
supervi
sor B
clinical
supervi
sor B
clinical
supervi
sor C
clinical
supervi
sor F
clinical
supervi
sor F
clinical
supervi
sor F
clinical
supervi
sor B
4 3 1
Shift 3 10-hour
shift
clinical
supervi
sor C
clinical
supervi
sor C
clinical
supervi
sor C
clinical
supervi
sor D
clinical
supervi
sor D
clinical
supervi
sor D
clinical
supervi
sor D
clinical
supervi
sor C
4 3 1
clinical
supervi
sor D
4 3 1
clinical
supervi
sor E
3 4 1
clinical
supervi
sor F
3 4 1
Attachment 3
SCU Crisis Response Recommendations | 67
SCU Phase 1 shift
busine
ss
8-hour
shift
progra
m
manag
er
progra
m
manag
er
progra
m
manag
er
progra
m
manag
er
progra
m
manag
er
- -
progra
m
manag
er
5 n/a 1 1 1 Assumes
mobile
unit peers
are
supervised
by clinical
supervisor
during
shift; this
specialist
is for other
profession
al
supports
for Peer
Specialists
shift
busine
ss
8-hour
shift
peer
supervi
sor
peer
supervi
sor
peer
supervi
sor
peer
supervi
sor
peer
supervi
sor
- -
peer
supervi
sor
5 n/a 1 1 1
Alternati
ve
Phone
Line
Phase 1 Shift 1 12-hour
shift
call
team A
call
team A
call
team A
call
team B
call
team D
call
team D
call
team D
call
team a
3 4 2 4 8 Assumes
two call
receptioni
sts per
shift
Shift 2 12-hour
shift
call
team B
call
team B
call
team B
call
team C
call
team C
call
team C
call
team C
call
team b
4 3 2
call
team c
4 3 2
call
team d
3 3 2
Dispatc
h
Phase
0 shift
busine
ss
8-hour
shift
BH/MH
triage
clinicia
n
BH/MH
triage
clinicia
n
BH/MH
triage
clinicia
n
BH/MH
triage
clinicia
n
BH/MH
triage
clinicia
n
- -
BH/MH
triage
clinicia
n
5 n/a 1 1 1
Phase 1 Shift 1 12-hour
shift
BH/MH
triage
clinicia
n A
BH/MH
triage
clinicia
n A
BH/MH
triage
clinicia
n A
BH/MH
triage
clinicia
n A
BH/MH
triage
clinicia
n C
BH/MH
triage
clinicia
n C
BH/MH
triage
clinicia
n C
BH/MH
triage
clinicia
n A
4 3 1 4
Assumes
one
clinician
per
dispatch
shift
Attachment 3
SCU Crisis Response Recommendations | 68
Shift 2 12-hour
shift
BH/MH
triage
clinicia
n B
BH/MH
triage
clinicia
n B
BH/MH
triage
clinicia
n B
BH/MH
triage
clinicia
n B
BH/MH
triage
clinicia
n D
BH/MH
triage
clinicia
n D
BH/MH
triage
clinicia
n D
BH/MH
triage
clinicia
n B
4 3 1
BH/MH
triage
clinicia
n C
3 4 1
BH/MH
triage
clinicia
n D
3 4 1
Attachment 3
SCU Crisis Response Recommendations | 69
Appendix C: Budget
Salaries, wages, benefits FTE Salary Cost/Year Notes Source BH Licensed Clinician / Psych-NP 6 $ 178,000.00 $ 1,068,000.00 JobsEQ "Nurse Practitioner" JobsEQ Mean Annual Wages for
San Francisco-Oakland-Bay Area
Mental Health Peer Specialist 6 $ 77,500.00 $ 465,000.00 JobsEQ "Health Education Specialists" JobsEQ Mean Annual Wages for
San Francisco-Oakland-Bay Area
BH Licensed Therapist / LCSW 6 $ 85,800.00 $ 514,800.00 JobsEQ "Mental Health and Substance
Abuse Social Worker"
JobsEQ Mean Annual Wages for
San Francisco-Oakland-Bay Area
Clinical Supervisor 6 $ 178,000.00 $ 1,068,000.00 JobsEQ "Nurse Practitioner"; unable to
find accurate salaries for a supervisory
position
Peer Specialist Supervisor 1 $ 85,800.00 $ 85,800.00 unable to find accurate salary range;
using LCSW range
Program Manager 1 $ 105,000.00 $ 105,000.00 Phase 0 Dispatch MH/BH
Clinician 1 $ 105,782.00 $ 105,782.00 "SUPERV PUBLIC SFTY DISP" https://www.cityofberkeley.info/u
ploadedFiles/Human_Resources/
Level_3_-
__General/ClassificationAndSala
ryListingByTitle.pdf
Subtotal $ 3,412,382.00 Total FTE Salary
Subtotal $ 853,095.50 Fringe Benefits, 25% Total Salary + Benefits $ 4,265,477.50
Ongoing materials and services Cost/Year Notes
Evaluation $ 185,000.00
Used cost of RDA feasibility study as
estimate
Vehicle maintenance 4 $ 20,000.00 $ 80,000.00 Estimate provided by Berkeley Fire Advertisement & PR 12 $ 2,000.00 $ 24,000.00 Includes community education
workshops, advertising, outreach and
engagement
Small equipment & supplies 1200 $ 20.00 $ 24,000.00 Wound care, hygiene, harm reduction, meals, transportation vouchers,
Attachment 3
SCU Crisis Response Recommendations | 70
clothing, blankets, etc.
Based on SF SCRT data, assumes 100
contacts with clients per month, $20 per
client contact; SF SCRT budgeted 10k
and said they needed more
Office supplies and postage 12 $ 200.00 $ 2,400.00 Communications 12 $ 600.00 $ 7,200.00 Printing and copying 12 $ 100.00 $ 1,200.00 Travel and transportation 12 $ 100.00 $ 1,200.00 Local travel for care coordination &
meetings
Training and meetings 12 $ 1,000.00 $ 12,000.00 Equity, team dynamics, and other
ongoing training
Licenses/fees/subscriptions 12 $ 50.00 $ 600.00 Insurance $ -
Contract services $ -
Legal services $ -
Audit and consulting $ - Utilities $ -
Facilities $ -
Subtotal $ 337,600.00 ongoing materials and services Subtotal: Personnel and non-
personnel recurring subtotal $ 4,603,077.50
Administrative overhead $ 276,184.65 6% for all recurring costs Total recurring cost $ 4,879,262.15
One time cost Cost/Year Notes
Vehicle 5 $ 60,000.00 $ 300,000.00
Assume 60k per van with wheelchair
capacity
Recruitment 27 $ 4,000.00 $ 108,000.00
Median national average of recruiting
new employee
Attachment 3
SCU Crisis Response Recommendations | 71
Training (SCU staff and
Dispatch) $ 75,000.00
Assume training for all Dispatch, BPD,
Fire, MCT, & SCU staff; both program
onboarding and emerging best
practices related to crisis response
Technology (computers, phones,
etc.) $ 25,000.00
Laptop/tablets, cell phones for all staff,
MiFi, portable chargers
Rapid assessment $ 40,000.00
Evaluation planning meetings, data
request development, community-input
meetings
Community outreach and
education (including materials
development) $ 25,000.00
Curriculum development, materials,
advertisement, outreach (SF SCRT hired
consultant to do this work)
Subtotal $ 573,000.00
Administrative overhead $ 34,380.00 6% for all one-time costs Total one-time cost $ 607,380.00
Recommendations Cost/Year Notes
Signing bonus 7 $ 5,000.00 $ 35,000.00 Signing bonus recommended for
licensed clinical staff
Technical Assistance $ 15,000.00
Consultation from existing similar
alternative models
Total additional
recommendations $ 50,000.00
Total cost with
recommendations $ 5,536,642.15
Estimated cost for program and
recommendations
Attachment 3
SCU Crisis Response Recommendations | 72
Appendix D: Anticipated Incident Volume
Potential Daily Incidents
for SCU (Average)
Potential Incidents per
shift for SCU (Average)
Average daily BMH-Crisis incidents (FY15-19)
MCT, TOT, CAT
10.73 incidents 19.82 6.61
Average daily BPD MH Incidents (FY14-20) 28.91 incidents Average time on task for transports BFD & Falck 101.48 minutes
Denver31
6 months, 1 team, not
citywide, not 24/7
Portland32
6 months, 1 team, not
citywide, not 24/7
CAHOOTS33
Annual, 1-2 teams, 24/7
Average incidents per shift 5.75 3 (Per hour) 1.81
% incidents that resulted in a transport 14.30% 6.27% 23.38% % transports that were to the hospital 16.82% 58.33%
Average minutes on task 24.65 19.33
Reduction of BPD calls 2.75% 4.60% 5-8%
31 STAR Program Evaluation (2021, January 08). https://wp-denverite.s3.amazonaws.com/wp- content/uploads/sites/4/2021/02/STAR_Pilot_6_Month_Evaluation_FINAL-REPORT.pdf 32 City of Portland
Bureau of Fire and Rescue (2021, October). Portland street response: Six-month evaluation. https://www.portland.gov/sites/default/files/2021/psu-portland- street-response-six-month-evaluation-final.pdf
33 Eugene Police Department Crim Analysis Unit (2020, August 21). CAHOOTS program analysis. https://www.eugene- or.gov/DocumentCenter/View/56717/CAHOOTS-Program-Analysis Attachment 3
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 2 TABLE OF CONTENTS
Introduction ...................................................................................................................................................................3 R
eport Infographic Summary .................................................................................................. ...................................4
Background ....................................................................................................................................................................5
NICJR R
eports .................................................................................................. .......................................................... 10 Implementation Plan ................................................................................................................................................. 13 C
onclusion ................................................................................................................................................................... 38 A
ppendices .................................................................................................................................................................. 39
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 3 INTRODUCTION
On July 14, 2020, the Berkeley City Council (Council) made a historic commitment to reimagine the City’s approach to public safety with the passage of an omnibus package of referrals, resolutions, and directives known as The George Floyd Community Safety Act. Central to the proposal was a commitment to achieve a “new and transformative model of positive, equitable, and community centered safety for Berkeley.” 1 Direction was given to the City Manager to collaborate with the Mayor and select Councilmembers to inform City of Berkeley (City) investments and reallocations to be incorporated into future Budget processes and to contract with independent subject matter experts to analyze the scope of work and community needs addressed by the Berkeley Police Department (BPD), to identify a more limited role for law enforcement, and to identify elements of police work that could be achieved through alternative programs, policies, systems, and community investments.
The National Institute for Criminal Justice Reform (NICJR) was selected through a Request for Proposal process to conduct this work in partnership with Bright Research Group, which led the community engagement; Renne Public Law Group, who has provided guidance on policy recommendations; Pastor Michael Smith, who supported the community engagement and outreach; and Jorge Camacho, the Policy Director of the Justice Collaboratory at Yale Law School.
This Final Report and Implementation Plan is the culmination of NICJR efforts over the past 10 months, a body of work reflected in the following deliverables:
1. Ne
w and Emerging Models of Community Safety and Policing report;
2. Berk
eley Calls for Service Analysis;
3. Alt
ernative Responses report;
4. Community
Engagement report; and
5. A pr
oject website.
1 https:/ /www.cityofberkeley.info/RIPST.aspx
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 4 The City of Berkeley’s George
Floyd Act referenced NICJR’s
reform model of Reduce
— Improve — Reinvest.
This report is also primarily
organized in those sections:
Reduce the footprint of law
enforcement; Improve the
quality of law enforcement
and public safety; and Reinvest
into community and services.
Some of the recommendations
in this report are programs
or policies that have been
tried in other jurisdictions
and have a track record of
effectiveness or promise, other
recommendations are new
ideas, aligned with the goal of
Reimagining!
The body of this report is
already 40 pages for a total
of 272 pages, including the
appendices, therefore the
below graphic provides
a quick overview of the
detailed recommendations
included in this report
instead of repeating the
narrative.
REPORT INFOGRAPHIC
SUMMARY
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 5 BACKGROUND
Berkeley City Council George Floyd Act
In response to the national outcry for police reform, and in line with the City’s long history of progressive policy making, the Berkeley City Council formally adopted the George Floyd Community Safety Act which included the following package of referrals, resolutions, and directions:
1. Ha
ve the City’s elected Auditor perform an analysis of the City’s emergency 9-1-1 calls-for-service and responses, as well as analysis of the Berkeley Police Department’s (BPD) budget.
2. Cr
eate plans and protocols for calls for service to be routed and assigned to alternative preferred responding entities and consider placing dispatch in the Fire Department or elsewhere outside the Police Department.
3. Analyz
e and develop a pilot program to re-assign non-criminal police service calls to a Specialized Care Unit. This Specialized Care Unit (SCU) consists of trained crisis-response field workers who would respond to calls that the Public Safety Communications Center operator evaluated as non-criminal and that posed no imminent threat to the safety of community members and/or Police Department or Fire Department personnel.
4. Ev
aluate initiatives and reforms that reduce the footprint of the Berkeley Police Department and limit the Police Department’s scope of work primarily to violent and criminal matters. This work should include an evaluation of programs and services currently provided by the Police Department that could be better served by trained non-sworn city staff or community partners.
5. Aspire t
o reduce the Police Department’s budget by 50% to generate resources to fund the following priorities:
• Youth pr
ograms;
• Violence pr
evention and restorative justice programs;
• Domestic
violence prevention;
• Housing and homeless servic
es;
• Food S
ecurity;
• Public health and M
ental Health services including a specialized care unit; • Healthcar
e;
• Ne
w city jobs;
• Expanded partnerships
with community organizations, and
• Establishing a ne
w Department of Transportation to administer parking regulations and traffic laws
6. Engaging
a qualified firm(s) or individual(s) to lead a robust, inclusive, and transparent community engagement process with the goal of achieving a new and transformative model of positive, equitable and community-centered safety for Berkeley.
7. Pur
sue the creation of a Berkeley Department of Transportation to ensure a racial justice lens in traffic enforcement and the development of transportation policy, programs and infrastructure, and identify and
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 6 implement approaches to reduce and/or eliminate the practice of pretextual stops based on minor traffic violations.
8. Analy
sis of litigation outcomes and exposure for city departments in order to guide the creation of city policy to reduce the impact of settlements on the General Fund.
Recent History of Problems with Policing in Berkeley
Although immediately inspired by the
events of 2020, the Council’s George
Floyd Act came on the heels of a period
of challenges with the BPD:
February 12, 2013: Death of Kayla
Moore, Black transgender woman in
mental health distress
Kayla Moore, a Black transgender
woman with schizophrenia, died in her
apartment on Allston Way while BPD
officers were responding to a call for a
“wellness check.” During the incident,
half a dozen police officers forcibly held
her down. The family of Kayla Moore
filed a lawsuit in 2014 against the City
of Berkeley, however, the City contended that minimal and appropriate force was used and sought a dismissal of the lawsuit in federal court, which was ultimately granted.
December 6, 2015: Use of Force at Black Lives Matter protests During a Black Lives Matter protest in Berkeley on December 6, BPD was accused of beating peaceful protesters and journalists, and using excessive amounts of teargas without justification. 2 In 2017, the City of Berkeley reached a settlement with several plaintiffs who sued the City and BPD for the attack. Seven plaintiffs received $125,000 and BPD agreed to amend its use of force policy. 3 March 26, 2018: Black child falsely accused, chased, and run over by car On March 26, 2018, on Telegraph and Stuart, a Black child in the 7th grade was chased and grabbed by a white man, who mistook the Black child roughhousing with a white female classmate on the sidewalk as an assault.
The boy was then struck with a car by another man as he ran in fear of his safety. The family was told by a white police sergeant that nothing unlawful actually happened, and determined that the man chasing the child did not commit any crime, rather he was lawfully attempting to make a citizen’s arrest. In addition, the child’s grandmother, who is his legal guardian, reported that she was told by BPD that she had no right to any written reports or documentation of the incident without a court order. 4 2 https:/ /www.kqed.org/news/10402266/berkeleys-police-chief-on-protests-tear-gas-use 3 https:/ /www.dailycal.org/2017/02/05/city-berkeley-reaches-conditional-settlement-lawsuit-regarding-police-use-force/ 4 https:/ /www.berkeleyside.org/2018/05/18/opinion-the-willard-school-community-wants-answers-fromberkeley-police-about-a- troubling-incident
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 7 May 2018: Report Reveals Racial Disparities in BPD Stops and Searches An analysis by the nationally renowned Center for Police Equity published in May 2018 found the stops and searches conducted by BPD were racially disproportionate. The report states:
“Our analysis of BPD vehicle and pedestrian stops found that Black and Hispanic persons were more likely than White persons to be stopped by BPD. Black persons in Berkeley were about 6.5 times more likely per capita than White persons to be stopped while driving, and 4.5 times more likely to be stopped on foot. Hispanic persons were about twice as likely, per capita, as White persons to be stopped while driving, and slightly less likely to be stopped on foot. In addition to their much higher stop rates, Black and Hispanic drivers (and pedestrians) were also searched at much higher rates. Once stopped, Black drivers were searched at a rate four times higher than their White counterparts (20% compared to 5%), while Hispanic drivers were searched at three times the White rate (15%).” March 14, 2020: Less-lethal shooting of unarmed Black man, Ashby & Sacramento St., A BPD officer used a less-lethal weapon to shoot William Dean Brown, a Black man kneeling on the ground with his empty hands in the air. He was shot within a distance of 12 feet and was hit in the torso, and quickly handcuffed and tackled by three officers as soon as he hit the ground.
June 9, 2020: BPD Chief mentions shooting protesters at City Council Meeting Just after a march organized by The Way church protesting the killing of George Floyd, then BPD Chief Andrew Greenwood made a comment during a Council meeting to discuss whether to permanently ban the use of tear gas as a method of crowd control. City Councilmember Susan Wengraf asked Greenwood what kind of alternative tools would be best to use if a crowd turned violent and police could not use tear gas, to which Greenwood replied “Firearms. We can shoot people.” His statement immediately prompted a call from the community for his resignation.
5 June 30, 2020: Officer shooting at Black man and minors in vehicle, North Berkeley BPD Officer Cheri Miller fired her gun at three teenagers accused of shoplifting at CVS. Miller got out of her vehicle with her gun drawn, and, within less than a minute of her arrival, she had ordered the driver, 19-year- old Brandon Owens of Concord, a young Black man, to get into his car and put his keys on the roof. When Brandon got back into his vehicle, he began to drive away from the officer who then shot at the moving vehicle three times. There were two minors in the car with Brandon. Miller was found not to have committed any crime, but was found in violation of BPD’s deadly force policy and was fired.
December 17, 2020: Use of force Parker and Mathews St., Southwest Berkeley 55-year-old David Frazier and an unnamed passenger were pulled over for multiple vehicle code violations.
The initial call was categorized as a routine traffic stop. When Frazier finally stopped after multiple attempts from BPD, two officers approached Frazier’s vehicle and began to forcefully attempt to pull Frazier out of the front seat, punching and pulling on him. The three officers were unsuccessful in gaining control over Frazier and then stepped back and pulled out their batons and began to beat Frazier while he sat in the front seat. Two more officers then approached the passenger side of the vehicle with their guns drawn, broke the passenger window, pulled the passenger out, handcuffed him and dragged him away. Frazier was dragged out of the car and tackled by five or six officers, handcuffed, and forced to sit upright on the hood of a police vehicle.
5 https:/ /www.berkeleyside.org/2020/06/13/marchers-in-berkeley-demand-resignation-of-police-chief
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 8 January 2, 2021: Use of force on unhoused Black man with mental illness, Shattuck Ave., Downtown Berkeley Bryant, a 50-year-old unhoused Black man who suffers from mental illness, tried to purchase a sandwich, bag of chips, and a bag of candy from Walgreens with $1.00 in coins. He attempted to walk out of the store without paying for the remaining amount owed, but security locked the doors on him. Bryant then pulled out a bike chain from his backpack which prompted security to open the doors and let Bryant leave the store.
Dispatch categorized the initial call as a possible 5150 (mental health hold) based on employees’ description of the event. The arriving officer shot Bryant in the face, shattering his jaw, within 20 seconds of arriving on the scene.
Reimagining Public Safety Task Force
As part of the George Floyd Act, the City created the Reimagining Public Safety Task Force (RPSTF), which was charged with making recommendations to the consultant (NICJR) and city staff on structures and initiatives to outline a new, community-centered safety paradigm as a foundation for deep and lasting change, grounded in the principles of Reduce, Improve and Reinvest as proposed by the NICJR, considering, among other things:
•
The
social determinants of health and changes required to deliver a holistic approach to community- centered safety;
• De
fining an appropriate response to calls-for-service including size, scope of operation and powers and duties of a well-trained police force;
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 9 • Limiting militarized weaponry and equipment; and
• Iden
tifying alternatives to policing and enforcement to reduce conflict, harm, and institutionalization, introduce restorative and transformative justice models, and reduce or eliminate use of fines and incarceration. Options to reduce police contacts, stops, arrests, tickets, fines, and incarceration and replace these, to the greatest extent possible, with educational, community serving, restorative, and other positive programs, policies, and systems.
The Task Force is comprised of:
•
One (1) r
epresentative appointed by each member of the City Council and Mayor, • One
(1) representative appointed from the Mental Health Commission, Youth Commission and Police Review Commission,
• One
(1) representative appointed by the Associated Students of the University of California (ASUC) External Affairs Vice President,
• One
(1) representative appointed by the Berkeley Community Safety Coalition (BCSC) Steering Committee, and
• Thr
ee (3) additional members appointed “At-Large” by the Task Force.
District 1 - Margaret Fine Youth Commission - Nina Thompson District 2 - Sarah Abigail Ejigu Police Review Commission - Nathan Mizell District 3 - boona cheema Mental Health Commission - Edward Opton District 4 - Jamie Crook Berkeley Community Safety Coalition - Jamaica Moon District 5 - Dan Lindheim Associated Students of U. California - Alecia Harger District 6 - La Dell Dangerfield At-Large - Vacant
District 7 - Barnali Ghosh At-Large - Liza Lutzker
District 8 - Pamela Hyde At-Large - Frances Ho
Mayor - Hector Malvido
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 10 NICJR REPORTS
NICJR produced drafts of the following series of reports then received feedback from the RPSTF and City staff and made necessary edits and additions then finalized:
1. Ne
w and Emerging Models of Community Safety and Policing Report
2. Berk
eley Calls For Service Analysis Report
3. Alt
ernative Responses Report
4. Community
Engagement Report
Included below is a brief description and summary of each of those reports. Links to the full reports are included below and the reports are appendices G through J.
New and Emerging Models of Community Safety and Policing Report The New and Emerging Models of Community Safety and Policing report includes detailed overviews of a variety of examples of Emerging Non-Enforcement Models of Community Response; Non-Law Enforcement Crime Reduction Strategies; Community Driven Violence Reduction Strategies; and Policing Strategies. Highlighted below are some of the programs included in that report that informed NICJR’s final recommendations for the City’s reimagining work:
Emerging Non-Enforcement Models of Community Response include the Crisis Response Unit (CRU) and Street Crisis Response Team (SCRT).
The City of Olympia, Washington implemented the CRU in April of 2019 to serve as an option to respond to behavioral health calls for service. CRU teams consist of mental health professionals that provide support such as mediation, housing assistance, and referrals to additional services to their clients. 6 Calls for service for the
CRU originate from community-based service providers, the City’s 911 hub, and law enforcement personnel. 7 The SCRT is a pilot program launched in November 2020 and administered by the Fire Department in San Francisco, California. The program targets individuals experiencing behavioral health crises. SCRTs consist of a behavioral health specialist, a peer interventionist, and a first responder. 911 calls that are determined to be appropriate for a SCRT are routed accordingly by dispatch. A team responds to calls in an average of 15 minutes.
8 Non-Law Enforcement Crime Reduction Strategies include the Mayor’s Action Plan (MAP) in New York City, NY.
Launched in 2014 in fifteen New York City Housing Authority properties, MAP was designed to foster productive dialogue between local residents and law enforcement agencies, address physical disorganization, and bolster pro-social community bonds. MAP’s focal point is NeighborhoodStat, a process that allows residents to have a say in the way NYC allocates its public safety resources. 9 Early evaluations show a reduction in various crimes
as well as increased perception of healthier neighborhoods.10 6 https:/ /olympiawa.gov/city-services/police-department/Crisis-Response-Peer-Navigator.aspx 7 https:/ /www.vera.org/behavioral-health-crisis-alternatives/cru-and-familiar-faces 8 https:/ /sfmayor.org/article/san-franciscos-new-street-crisis-response-team-launches-today 9 https:/ /www.americanprogress.org/issues/criminal-justice/reports/2019/10/02/475220/neighborhoodstat-strengthening- public-safety-community-empowerment/
10 https:/ /johnjayrec.nyc/wp-content/uploads/2020/10/MAP_EvalUpdate06.pdf
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 11 Calls for Service Analysis
The Berkeley City Auditor conducted an extensive report on BPD Calls For Service (CFS or events) which was published in July of 2021. NICJR conducted a complementary Calls for Service Analysis as part of its work on the City’s remaining effort.
The three primary objectives for the NICJR CFS report were to 1) provide an analysis of BPD CFS according to NICJR’s crime categories; 2) map NICJR’s crime categories to NICJR’s proposed Tiered Dispatch model; and 3) identify which CFS should be responded to by a non-BPD alternative.
The proposed Tiered Dispatch model and Community Emergency Response Network (CERN) reduce the burden on police to respond to certain calls for service and improve outcomes through community response to lower level and non-criminal incidents. The CERN will use community safety and problem solving responders who have expertise in community engagement, crisis response, de-escalation, and conflict mediation and resolution skills. Implementing the Tiered Dispatch and CERN can serve to increase public safety by refocusing law enforcement officers on the most serious crimes, applying a more appropriate response to public health and quality of life CFS, and more effectively utilizing public dollars and resources.
A review of over 358,000 CFS over the 5-year study period (2015-2019) found that over 81 percent of BPD CFS were for non-criminal events. Only 7.4 percent of CFS were for felonies of any kind. NICJR’s assessment of viable alternative responses indicated that 50 percent of CFS can be responded to with no BPD involvement, with another 18 percent of CFS requiring BPD to be present, but to serve in a support, rather than a lead role.
As a result of an assessment of the CFS and the narrative of the actual incidents, NICJR recommended that alternative response options be developed for the 50 percent of CFS that were determined to not require a law enforcement response.
Alternative Response Report
The Alternate Responses Report expands upon the Calls for Service analysis, providing a detailed overview of NICJR’s Tiered Dispatch model, the CERN, and describes how specific call types are assigned to the four tiers:
• Tier 1
: Non-Criminal: 911 calls and other CFS that are not crimes, like noise complaints or suspicious persons
• Tier
2: Misdemeanors
• Tier
3: Non-violent felonies
• Tier
4: Serious and violent felonies
Eventually, all Tier 1 and some Tier 2 CFS should be able to be responded to by the CERN or other non-police responders.
The report concludes with an overview of a framework for the City’s alternative response model, drawing upon both existing and planned City resources.
A description and implementation plan utilizing Tiered Dispatch and the CERN model are outlined in detail in the Implementation Plan below.
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 12 Community Engagement Report
Berkeley’s Reimagining Public Safety process has included comprehensive outreach and engagement of local community members in an effort to develop a community safety model that reflects the needs of the community and creates increased safety for all. In collaboration with the City of Berkeley’s RPSTF and the City Manager’s Office, Bright Research Group (BRG) developed and conducted a community survey to gather residents’ experiences with and perceptions of BPD and crisis response; and their perspectives on and priorities for reimagining public safety. More than 2,700 people responded to the survey. NICJR and its partners, as well as RPSTF members, held 14 listening sessions to hear from community members, especially hard to reach community members and those not well represented in the survey, including: the unhoused residents, formerly incarcerated, youth, Black residents and Latinix residents. Details of the survey responses and listening session feedback are contained in the Community Engagement Report.
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 13 IMPLEMENTATION PLAN
Based on the extensive research that was conducted by NICJR and partners, input from the community engagement process, feedback from the Task Force and other stakeholders, NICJR provides the following detailed recommendations to the City of Berkeley categorized in the Reduce — Improve — Reinvest framework.
REDUCE
To achieve the goal of a smaller law enforcement footprint and to reallocate a portion of the BPD budget towards more community supports, NICJR recommends the following measures:
•
Implemen
tation of the Tiered Dispatch/CERN model
• End pr
etextual stops
• Implemen
tation of BerkDOT, which should further reduce the size of BPD Tiered Dispatch/Emergency Response Network
The graph below depicts the response to certain 911 and other calls for service based on the Tiered Dispatch model, which contemplates a tiered response to CFS based on the nature of the call as reflected below:
Remaining Public Safety in Berkeley: Final Report and Implementation Plan 14 As reflected in the CFS Analysis, 81 percent of the 358,000 calls for service to BPD between 2015 -2019 were for non-criminal events. While some of these calls were determined not to be appropriate for non-police response based on an analysis of call narratives, NICJR recommends that 50 percent of these non-criminal calls be handled by a non-police response.
With BPD freed up to focus its efforts and attention on serious and violent crime, community-based responders can focus on the variety of needs that fall into the identified 50 percent of non-police calls. In addition to being available twenty-four hours a day, seven days a week, the CERN would be designed to build on the professional skills and expertise of non-sworn staff and to utilize collaborative community partnerships and the other necessary resources to appropriately and holistically respond to individuals in need. Some examples of this in practice include:
•
The
Albuquerque Community Safety Department provides a third option when individuals call 911, instead of only having the option of police or fire department services. Community Safety responders are dispatched with and without other first responders (Police and Fire). Community Safety responders may have backgrounds as social workers, peer to peer support, clinicians, counselors, or other similar fields.
11 • The Durham Community Safety Department dispatches trained, unarmed responders that may include lic
ensed clinical social workers and mental health clinicians paired with paramedics to calls involving mental or behavioral health needs, minor traffic accidents, quality of life issues (trespassing, loitering, panhandling, etc), and calls for general assistance.
12 • New York City B-HEARD (Behavioral Health Emergency Assistance Response Division) Program focuses on
using a mental-health centered response to 911 mental health calls. The B-HEARD teams have the expertise to respond to a range of behavioral health problems, such as suicide ideation, substance misuse, and mental illness, including serious mental illness, as well as physical health problems, which can be exacerbated by or mask mental health problems.
13 A national poll conducted in June of 2021 found that 70 percent of likely voters support a non-police response for 911 calls about mental health crises, and 68 percent support the creation of non-police emergency response programs.
14 In many jurisdictions, police are the first to respond to 911 calls about people experiencing issues related to mental health, homelessness, and substance use. However, police officers report not having the proper training or expertise to appropriately respond to those situations and often resort to their training and treat non-criminal situations as crimes.
Chief Eric Hawkins of the Albany, NY police department said, “Fundamentally I don’t have a problem with the basic premise to defund the police, and that is police officers should be doing police work and not social work.
Police officers shouldn’t be the point of contact for individuals with mental health issues, substance abuse issues, or unhealthy family structural issues.”
11 https:/ /www.cabq.gov/acs
12 https:/ /durhamnc.gov/4576/Community-Safety
13 https:/ /www1.nyc.gov/assets/nypd/downloads/pdf/public_information/b-heard-public-faqs-5-27-2021.pdf 14 https:/ /theappeal.org/the-lab/polling-memos/likely-voters-support-non-police-emergency-response/