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Cities Aim To Remove Police From Most Psychiatric, Substance Abuse Calls


A lot of cities across this country responded to a summer of protest by talking of ways to reimagine their police departments. Doing that has proven to be difficult. But three cities, including San Francisco, are trying this. They want to remove police from most calls involving people in a psychiatric or substance abuse crisis. It's estimated that almost a quarter of fatal police encounters followed calls about disruptive behavior directly tied to a person's mental illness or substance abuse. NPR's Eric Westervelt has our story.


ERIC WESTERVELT, BYLINE: San Francisco Fire Captain Simon Pang and a colleague slow drive through the city's Tenderloin district, an area long challenged by homelessness and open-air drug abuse, when a call comes in for a man semi-conscious in the street behaving strangely.

UNIDENTIFIED PERSON #1: Going to be a white male, 30s, red sweater, black sweatpants.

SIMON PANG: It's in the marina.

WESTERVELT: Captain Pang, a section chief and veteran firefighter and paramedic, is skeptical this is an emergency medical call.

PANG: Typical call. This is what - why the fire department needs innovative techniques. Thirty to 40% of the entire fire department call volume is for people experiencing homelessness, exhibiting problem behavior, right? So this here, it's likely someone who's having behavioral or social issues, very unlikely they're having a medical problem.

WESTERVELT: It's the kind of time-suck call that can tie up paramedics and police, the kind that has prompted San Francisco, starting next month, to launch what will be the nation's largest urban experiment in diverting calls for people in a mental health or behavioral crisis away from the police.

PANG: They were handling these calls the best they can. I think the time is now to rethink the entire process so that we can get personnel that are better suited to help people having behavioral and social crises.

WESTERVELT: Those better suited will be the city's new street crisis response teams run by the city's fire and health departments. The mobile units will include a paramedic, a psychologist or social worker and a peer support specialist, someone with lived experience in addiction and recovery. San Francisco police get tens of thousands of 911 calls a year for people in a behavioral crisis, the vast majority are nonviolent.

These new non-police teams will at first take over the police calls for code 800, a broad catch-all that reads, report of a mentally disturbed person. The police here got nearly 17,000 of those code 800s last year. Of those, just 132 of them reported a potential for violence or a weapon. If these new units take over those calls, Captain Pang says, the hope is cops will have more time to focus on fighting crime. Still, if someone in mental distress is armed or threatening violence, Pang says, the police will still be sent first.

PANG: They want to make sure that we don't expect to be handling cases where someone might be violent or dangerous. I think they're concerned. They want to make sure that whatever takes their place is able to adequately do the job.

WESTERVELT: On paper, anyway, the police are supportive of replacing cops with medic teams for some calls. But there's deep skepticism among the rank and file, with caustic postings on social media. The San Francisco Police Department declined NPR's interview requests on the reform. Federal Bureau of Justice Statistics surveys show that 64% of those in jail and more than half of all prison inmates have a mental health problem, many of them undiagnosed.

And in many cities, a small group of people use emergency services almost daily, if not several times in a single day. Most of these 9/11 high users, as they're called, are people with dual mental and substance abuse problems who endlessly cycle in and out of shelters and emergency rooms, people such as Steve (ph).

STEVE: God bless them. God bless everybody.

WESTERVELT: Steve is one of the city's 911 frequent flyers. He's a semi-homeless alcoholic who, on average, uses the emergency system up to 20 times a month. Captain Pang has known him for years. A former heroin addict, Steve grew up in and out of foster homes. On this day, Steve's on the street, hammered on cheap vodka. He's nearly falling off a broken chair he's found wearing an ill-fitting plastic Joker hat discarded from a Halloween costume.

STEVE: See; these people are trying to help me out.

UNIDENTIFIED PERSON #2: We've got to get something real quick.

UNIDENTIFIED PERSON #3: Do you want help?


WESTERVELT: After much negotiation, Captain Pang offers to guide Steve back to his subsidized room in a supportive housing program.

PANG: And if you get there safely, I'd like to buy you a sandwich. Is that OK?

STEVE: I said, no.

PANG: You're just saying no. How about a cup of coffee?

STEVE: I said, no.

PANG: OK. So you want to stay here tonight? You want to stay here right now?

WESTERVELT: It's exactly the kind of daily dance - social work with a badge and emergency bag - that Captain Pang's EMT teams are used to. And it makes them well-suited to build the new crisis response teams around, teams that Pang hopes will better guide people to long-term supportive services and end the "Groundhog Day" cycle.

PANG: It's very, very difficult when you feel like you are doing nothing to help the problem. And so if you pick someone up over and over again that is clearly in distress and miserable, it's frustrating. There's no satisfaction because you're not helping anybody.

WESTERVELT: San Francisco's new teams are modeled on a program in Eugene, Ore., that has successfully diverted these kind of behavioral and mental crisis calls away from police for three decades.

TIMOTHY BLACK: It's our experience that, you know, folks in crisis just aren't dangerous.

WESTERVELT: Timothy Black is with the Eugene program called Crisis Assistance Helping Out On The Streets - or CAHOOTS

BLACK: It's really a misnomer to say that the only response for people in crisis can be a response that involves, you know, the tools of force like a badge, a gun, handcuffs.

WESTERVELT: Black says since the summer's protests, he's been flooded with calls from across the country from city officials looking to potentially copy the program. Even some who support scaling up non-police crisis teams caution they're no substitute for repairing America's long broken mental health care system. Christy Lopez directs the innovative policing program at Georgetown Law.

CHRISTY LOPEZ: This idea of waiting until these incidents become crises to deal with is just so - A, inefficient and, B, just doesn't take account of all the harm that we could prevent if we just provided people appropriate mental health care.

WESTERVELT: In Eugene, the numbers show that the CAHOOTS model is working to reduce the risk of violence and get people help. Denver and Portland, Ore., have launched pilot programs modeled on CAHOOTS. And San Francisco plans to get its first crisis response team up and running seven days a week by the end of November and be citywide by next March.

Eric Westervelt, NPR News, San Francisco.

(SOUNDBITE OF THRUPENCE'S "FOREST ON THE SUN") Transcript provided by NPR, Copyright NPR.

Eric Westervelt is a San Francisco-based correspondent for NPR's National Desk. He has reported on major events for the network from wars and revolutions in the Middle East and North Africa to historic wildfires and terrorist attacks in the U.S.