Responses to mental health crises are set to change in Santa Cruz County with a new 988 system as an alternative to 911. Non-police responses are expected to be dispatched through the system, and advocates say the 24-hour, non-police system is overdue. Santa Cruz Local’s Stephen Baxter talks to Assemblymember Mark Stone, advocate Jeffrey Arlt and others about the mental health crisis response in the county now and its shortcomings. Some potential solutions may come from Santa Cruz County’s Mobile Emergency Response Team at 1-800-952-2335 and Alameda County’s Community Assessment and Transport Team.Transcript below.

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Police Reform Series

Public Health Nurses Marie DelRosario, left, and Suzanne Samson of the Homeless Persons’ Health Project talk to a man during a visit to a homeless camp on Dakota Avenue in Santa Cruz in April. (Stephen Baxter — Santa Cruz Local file)

Transcript

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INTRO MUSIC

Stephen Baxter: I’m Stephen Baxter. This is Santa Cruz Local.

INTRO MUSIC FADE OUT

SB: This episode is part of Santa Cruz Local’s Police Reform Series. Today we’ll hear about a movement toward alternatives to 911 in mental health crisis response. It’s happening in Santa Cruz County and in other places in California. We’ll also learn about a potential new 988 phone number for mental health and suicide prevention that is supposed to supplement 911. 

In an episode last year, we looked at a program in Oregon called CAHOOTS. It offers a mobile, non-police response to mental health crises. If you haven’t heard that episode yet, check it out. It’s Episode 81 in your feed. 

In that episode we heard about the death of Sean Arlt. He was a Santa Cruz man who was killed by police in 2016. Sean suffered from bipolar disorder. One night he was having a mental health crisis. The police came. Sean advanced toward the police with a bow rake. And Sean was shot and killed. 

I recently spoke with Sean’s father, Jeffrey Arlt. He told me a little bit more about who Sean was.

JEFFREY ARLT: He grew up in Santa Cruz and was a bright young man. He was also an individual and would challenge his teachers and challenge us. But he was very logical and articulate. It wasn’t, you know, it wasn’t just this emotional angst that he had, he was engaging.

SB: Sean went to Santa Cruz High and graduated from an alternative school in town. At Sonoma State University, he double majored in psychology and philosophy. He graduated with honors. 

JEFFREY ARLT: So We did have several incidents where law enforcement showed up, they calmly spoke with Sean, and his episode settled and then they left. We did have incidents where he was lying on our floor moaning and screaming and two officers came in who were absolutely completely ill prepared for the situation, didn’t know what to do, and left.

He was someone who was demonstrating — just a minute — the potential to be someone who can make a positive contribution to its community. 

Our society, our nation as a whole is taking the wrong approach to responding to people in mental health crisis, which includes, you know, the stress, anxiety, depression, you know, being alienated in society. This isn’t something police officers should be expected to be the first responders for —  or even, you know, unless it becomes a criminal, a violent criminal activity. I can’t — it doesn’t make sense to have the police respond.

SB: Data from Santa Cruz police and the Santa Cruz County Sheriff’s Office shows that most mental health related calls happen during the day. And that’s a big reason why the law enforcement agencies have mental health liaisons during the day but not at night. The liaisons are basically county mental health clinicians who help defuse situations and offer care and resources. Jeffrey Arlt said those hours during the day, they’re not sufficient. 

JEFFREY ARLT: Well, a good question to ask our leaders would be, ‘Why don’t Would you be happy with a police response only from eight to six? Because most of our crimes, you know, happen in this window? Or, you know, we’re only going to have police at night, because most of our crimes happen then. We’re only going to have our fire department respond because the data shows that most fires occur on these particular days at these particular hours.

SB: Now, Jeffrey helps lead a group called Alternatives to 911. They’re looking for non-police responses to mental health crises.  Their focus is to change local policies.

SB: The problem is not just about police force — and sometimes deadly force — during 911 calls for mental health. Those incidents are rare. The problem is also with everyday calls to 911 that are for mental health problems and suicide prevention. 

  • Depending on when you call and where you are in the county, you may get a different response. Scotts Valley and Capitola police don’t have mental health liaisons, for example. So if you call from there, you’ll probably get a police officer. And police officers don’t have as much crisis training as mental health liaisons. 
  • Santa Cruz and Watsonville police departments do have mental health liaisons. So does the Sheriff’s Office if you’re calling from, say, Aptos, or Live Oak or San Lorenzo Valley. But the liaisons aren’t on duty at night. So at night you’ll get a police officer or a sheriff’s deputy 

Unhoused people in Santa Cruz come into contact with law enforcement and mental health specialists probably more than most.

Near San Lorenzo Park recently, I talked to Louie Ugarte. He’s 22. He was raised in Live Oak. And he lived in a tent in the park when I spoke to him.

LOUIE UGARTE: I definitely don’t trust the police to handle a suicide situation very well, only personally because they’re obviously very aggressive in the way that they handle most, if not all situations that they find themselves in. In my experience I’ve definitely had them help me mental health wise. It’s not like they don’t do their jobs whatsoever. I think that they just need to understand that their job is really to protect and serve. And not so much reprimand.

SB: Louie told me he had attempted suicide. Someone he knew called 911. Santa Cruz police arrived. Louie said the officers were compassionate.

LOUIE UGARTE: I tried to commit suicide, tried to hang myself four times in a row. And they were very, very understanding. It wasn’t officers that I had ever actually met other than that one single time. But it was a different experience than I usually always have. And I really feel like that moment, they were the most protective of me, and they did serve me in the way that I needed it at the moment that I needed it. And that is how I believe the job should be done.

SB: I also met Greg Bengston near San Lorenzo Park. He’s 55. He talked about mental health liaisons who accompany police to some of those mental health related calls. He told me he hasn’t dealt with them personally. But he’s seen them work.

GREG BENGSTON:  Um, no, I’ve seen them in action. I’ve seen her in action. She’s — but only  on a few things so I don’t want to generalize. But I haven’t seen her be that proactive and engaging more just like just standing off and observing. And there’s other times where she’s not here. and I know someone who actually called 911 on themselves … 

SB: Greg told me he saw somebody at the homeless camp one night. The man was drunk. He wanted help. So he called 911 on himself. Police arrived and eventually handcuffed the man and took him to the Santa Cruz Psychiatric Health Facility. Also known as Telecare. That’s the county’s crisis stabilization center on Soquel Avenue. He was back at the camp a few hours later, Greg told me. 

GREG BENGSTON: You know, I talked to him the next day and I was like this isn’t the way you’re— I understand that reaching out for help, desperation, and, um that’s a first step he had to do. But you know, two o’clock in the morning, wasted, it’s not the best way to introduce yourself into a crisis facility.

SB: Sometimes when police respond to mental health problems, it results in what’s called an involuntary psychiatric hold. It’s also known as a 5150 hold. The person can basically be taken to a mental health facility for up to 72 hours. The officer gives a test that’s supposed to determine whether the person is a danger to themselves or others. If they are, then they’re sent to the crisis stabilization facility on Soquel Avenue. If that’s full, then they’re sent out of county. Fifty-one fifty holds are one of the few tools that an officer has to deal with these situations. 

SB: In Alameda County in the East Bay, there was a problem with these 5150 holds. 

In 2015, Alameda County had the highest number of involuntary psychiatric holds of any county  in the state. On top of that, many of those held did not actually need psychiatric care. And the people who did not qualify for a hold received little — or in some cases — no care. They were not connected to mental health resources that would have benefited them. This is all according to Alameda County staff and documents.  

And, of course, for law enforcement officers there who respond to those calls, that’s time spent away from handling crime.

To address this problem, Alameda County leaders created a program. It’s called the Community Assessment and Transport Team. It’s also known as CATT with two Ts.

When you call 911 for problems related to mental health or drugs, CATT can be dispatched. CATT has s mental health clinician and an emergency medical technician. CATT started in July 2020. They have teams in Oakland, San Leandro and Hayward. The teams’ initial hours were 7 a.m. to 11 p.m. They hoped to expand those hours. 

  • CATT has a few aims. One is to reduce involuntary psychiatric holds by at least 25%. 
  • Another aim is to reduce hospital emergency department visits. That’s because county leaders found that too many people were inappropriately referred to emergency rooms.
  • A key part of the program is also Alameda County Care Connect. That’s basically a shared database. It coordinates and facilitates services for mental health, substance use disorders and other services. Care Connect is supposed to get everyone on the same page

CATT has been going for about a year. Its success is still not clear. Program leaders don’t yet know whether involuntary psychiatric holds have been reduced. 

  • We have data only for the first four months of the program. There were an average of 53 calls each month, according to county records. 
  • And they transported clients to what they called a “safe location” during about one-third of those calls. Other times the patient could not be located by the team, or sometimes the patient refused to be treated or transported. Or other times the patient was transported by another authority.

So for Santa Cruz County, a program like CATT could be on the horizon. State and federal leaders are pushing for a new emergency phone number for non-police responses. Instead of calling 911 for mental health crises, people could call 988. 

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Last year, a federal law was adopted to institute 988 as the National Suicide Prevention Lifeline. It had been 1-800-273-TALK. The 988 number will start in July of 2022.

The 988 system must be set up in each state. In the California legislature, there’s a bill called AB988. And as introduced, the bill would create a fee that’s tacked on to cell phone bills and landlines. It’s similar to the way some 911 services are funded. This new fee would help pay for 988 dispatchers and mental health crisis responses. The bill is winding its way through the state legislature and being tweaked. 

I talked to state Assemblymember Mark Stone recently. He represents Santa Cruz County and part of Monterey County. He’s a co-author of the AB988 bill. 

MARK STONE: Unfortunately, over the years, we’ve just relied on law enforcement too many times, and they’re not even — if you talk to the sheriff and the police chiefs — they’re not really wanting to respond to all of these calls. But they know they’re the only response that’s being called in. So if there’s another response that’s more appropriate to the situation, I think everybody sees that as a real win for the community and have the right people there to address whatever situation that is. So it’s a very appropriate step and I think a very healthy step from a community standpoint.

SB: I asked him how it could be implemented in Santa Cruz County. He basically said it would be up to county leaders. I also talked to Tara Gamboa-Eastman. She’s a lobbyist for the Sacramento-based Steinberg Institute. She’s been pushing legislators to adopt AB988.

TARA GAMBOA-EASTMAN: The federal legislation, the National Suicide Hotline Designation Act, allowed for the fee to cover the efficient and effective routing of calls, personnel, crisis outreach services, and crisis stabilization services. And so that includes mobile crisis teams. And the fee in the 988 legislation allows for the fee to be used to cover all of those things. So there will be funding for mobile crisis teams. But again, it’s only going to be used to supplement and not supplant other sources of funding. So voice customers aren’t going to be the backstop or kind of the fixer of all things in the mental health crisis system. But it is a really important piece of the funding scheme to make sure that the system operates well.

SB: The fee is expected to be adjustable. That covers part of the costs. The federal government is supposed to reimburse the counties for 85% of their costs related to 988. That’s for three years and it could be extended. I asked Tara what Santa Cruz County leaders can do to prepare for the 988 hotline.

TARA GAMBOA-EASTMAN: Yeah, I think they should be looking at doing an inventory of what crisis services they already have, what their anticipated need is, if they aren’t currently meeting demand, and thinking about how they can scale up their mobile crisis teams to really leverage the federal dollars. Taking a look at how they need to get to 24/7 mobile crisis teams because that’s what they have to do to take advantage of that 85% reimbursement. You can’t have it part-time mobile crisis, it has to be 24/7, so coming up with a plan for that would be the biggest thing that they could do.

SB: Let’s review what Santa Cruz County has now.

  • 911 gets you law enforcement from five major agencies in the county: the Santa Cruz County Sheriff’s Office and police in the cities of Santa Cruz, Watsonville, Capitola and Scotts Valley. All of the agencies have mental health liaisons that can respond to calls with officers or deputies — except Capitola and Scotts Valley. But all the liaisons are available during the day only, not at night.
  • Santa Cruz County also has non-police responses. They’re not connected to 911.  Many residents don’t know about them. If you call the county Access line at 1-800-952-2335, you get the county’s mental health services. It also gets you the Mobile Emergency Response Team. It’s also known as MERT. That’s a licensed clinician in a county vehicle. MERT’s hours are 8 a.m. to 5 p.m. That’s only on weekdays. 

The MERT team will go anywhere — homes, churches, schools, streets, wherever. And you don’t need to be o be a a county mental health patient to get MERT services. 

MERT responds to about 150 calls each month. For scale, the Santa Cruz County Sheriff’s Office responds to about 260 to 400 calls each month for “emotionally distressed persons.” That’s basically mental health calls. 

There are some key differences between MERT and the Alameda County program.

  • MERT is not dispatched through 911. Law enforcement rarely calls on MERT to handle situations.
  • MERT’s main focus is not transport to services or relieving law enforcement of calls. Its focus is providing services.
  • MERT’s hours also are only during weekdays and during the day. The Alameda County program has hours into the night. 

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SB: It’s possible MERT could be expanded to 24 hours. MERT could become the response team in Santa Cruz County for the 988 emergency line. That’s what Cassandra Eslami told me. She runs MERT. She works for Santa Cruz County Behavioral Health.

She told me she was engaged in a conversation about 988, but nothing is certain. She also told me she’s eager for information on the financial breakdown of how a 24-hour response could be done successfully in the county.

People I spoke to in the mental health services community told me that MERT has been effective. The problem is not enough people know about it. I talked to Sarah Leonard. She’s the executive director of the Mental Health Client Action Network. They offer peer support and many other services in midtown Santa Cruz.

SARAH LEONARD: It’s kind of like, something’s great if you use it. And MERT is great if it’s used. But some of the times when it’s most dearly needs to be used, it’s not. Sometimes the police act incredibly lovingly toward people with severe mental health, I mean, truly. And sometimes they are indifferent callous, even harassing towards certain individuals that they have deemed not a public benefit. But who may be absolutely wonderful redeemable individuals who actually might not have done anything wrong. Um, yeah, so MERT I do like immensely. But it needs to be called.

SB: MERT’s number again. 1-800-952-2335. The number’s in our show notes. Maybe put it in your phone. 

We have more resources on Santa Cruz Local’s Santa Cruz County Mental Health Crisis Resources page. Visit SantaCruzLocal.org/resources/crisis. The link is in the show notes.

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SB: This episode is part of Santa Cruz Local’s Police Reform Series. Funding for this series came in part from the Solutions Journalism Network and members of Santa Cruz Local. 

Thank you to our guardian level members: Debra Szeicei, Fran Goodwin, Patrick Reilly, Alixanne Baxter, Chris Neklason, Elena Cohen and Steve Ritz, and Elizabeth and David Doolin. 

Santa Cruz Local’s work is free. We believe everyone should have access to fair and accurate local information. It makes Santa Cruz County stronger.

Our work is supported by our Santa Cruz Local members. Become a member today. Visit SantaCruzLocal.org/membership.

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SB: Thanks to Trimpot for the music. I’m Stephen Baxter. Thanks for listening to Santa Cruz Local.

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Stephen Baxter is a co-founder and editor of Santa Cruz Local. He covers Santa Cruz County government.