S.F. expands authority to impose mental health holds. Paramedics can now place people in confinement

San Francisco Chronicle, July 21, 2021

By Mallory Moench


San Francisco paramedics — not just police officers and doctors — can now order people to be held in confinement for up to 72 hours if they believe those people are experiencing a mental health crisis and are a danger to themselves or others.


A new law will give about three dozen paramedics the authority to impose mental health holds on people in crisis as the city turns to non-police responses to deal with crises often visible on the streets. The Board of Supervisors unanimously approved the legislation sponsored by Supervisor Ahsha Safaí on Tuesday.


“Currently firefighters and paramedics perform medical, behavior and social needs assessment but don’t have the ability to initiate temporary mental health holds when someone is in real crisis,” Safaí said during a committee meeting earlier this month.


The move fits with the city’s plan to shift mental health and homelessness 911 calls away from police and to community paramedics. Last year, the city launched the Street Crisis Response Team s — each a trio of public health professionals who respond to emergency calls about mental health crises. Those teams don’t have the capacity yet to handle all mental health-related calls and holds, but the city will expand the program this year.


The Police Department is the primary agency that orders mental health holds in response to emergency calls. Police initiated around eight holds a day between July 2019 and June 2020, according to a city report.


San Francisco Fire Department Capt. Simon Pang, who oversees the Street Crisis Response Teams, said police should keep the ability to order holds, but he thinks paramedics are better equipped for that job.


“This is an alternative to law enforcement. This is a replacement,” Pang said. “The presence of law enforcement increases the stigma of mental illness by creating the image that someone with mental illness has broken the law, and people with a history of mental illness ... can be triggered by the presence of law enforcement.”


Pang described examples — an elderly woman depressed and threatening suicide at home or a homeless man on Market Street smeared in feces — where paramedics could mandate mental health help. He predicted the number of holds will decrease because he thinks paramedics can help connect people in need with social services and treatment more effectively than police officers.


Doctors and mental health professionals can also initiate mental health holds. In total, the Department of Public Health tracked roughly 9,000 mental health holds placed between July 2019 and June 2020, said Angelica Almeida, a clinical psychologist with the department. An individual could be subject to more than one hold.

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