Marin County is planning to expand its mental health crisis intervention team and make clinicians available for calls round-the-clock to comply with a recent state mandate.
Created in 2016, the Marin County Mobile Crisis Team consists of licensed clinicians who are available to respond to incidents involving people experiencing a mental health crisis. The team and similar programs in other cities are meant to provide an alternative to law enforcement intervention in such crises.
The team has seven clinicians on staff who respond to calls from 8 a.m. to 9 p.m. Monday through Friday and from 11 a.m. to 9 p.m. on Saturdays. At least two clinicians are on duty at a time.
Todd Schirmer, director of Marin County Behavioral Health and Recovery Services, said the department plans to contract with three peer counselors and add five county substance use counselors to be part of the team. A counselor will accompany clinicians on response calls as needed.
“We’re trying to expand the scope of the team as well as have more people on duty so we can cover 24/7,” Schirmer said.
Schirmer said at least one clinician and one counselor will be on duty. Another two teams could be on duty during certain midday, afternoon and evening hours, with these teams focused on youth and school responses and following up on prior calls. One clinician will be working during the overnight shift.
California is requiring county mobile crisis teams to provide 24/7 coverage before the end of the year. The change comes as a result of the federal American Rescue Plan Act of 2021, which allowed these crisis intervention services to be covered under Medicaid through March 2027.
Schirmer said the proposal is to fund the expansion of the county’s crisis team through the state’s Mental Health Services Act, with no impact on the county’s general fund.
The number of calls the team received has increased through the years, rising from about 1,000 calls in 2016 to about 3,000 calls in 2022.
Schirmer said there have been significant challenges to fill clinician positions.
“There are certain calls that will go to voicemail,” Schirmer said.
Sometimes calls can be missed because clinicians are already responding to other incidents, Schirmer said. To address this, the county recently hired two full-time dispatchers who will perform triage over the phone and dispatch clinicians when needed, according to Schirmer.
Jeremy Portje, chair of the Marin County Human Rights Commission, said it has heard concerns from law enforcement that hotline service is unavailable or that calls go to voicemail.
“All too often someone who is in mental crisis or just a crisis finds themselves having broken no law but handcuffed in the back of a police car,” Portje said. “That’s traumatic and compounds the problem even though it’s offered as a solution. It’s not an intentional problem. It’s one of those unintended consequences of good policy.”
The commission voted last week to form a new committee to explore potential changes and improvements for the crisis team. Portje said he proposed the idea after an incident when he tried to help a friend who experienced a mental health crisis last year. The incident occurred on a Sunday, when the county crisis team is unavailable, and ultimately ended with his friend being handcuffed by police.
The new committee plans to meet with county staff and members of San Rafael’s recently formed crisis team, known as SAFE. Portje said what he envisions for the county is a team similar to the Crisis Assistance Helping Out on the Streets team run by the Eugene Police Department in Oregon. The team’s clinicians are dispatched by the police department service channels rather than having to call a hotline as is required for Marin’s team.
“It requires someone to have the crisis team’s number on hand and that can get confusing,” Portje said of the Marin team’s hotline. “I would like to see dispatch implemented into the existing 988 or 911 system.”
Portje said he was “thrilled” to learn the Marin crisis team will now be covered under MediCal — the name of California’s Medicaid program — but said funding might not be the only hurdle to improve interventions.
“If this staffing plan is not set by MediCal, I see an opportunity for the commission to work with the county, utilizing police data and other information, to advise on a more robust approach as this still seems thin to me,” Portje said of proposed clinician staffing levels. “A lot of staff but not in immediate response.”
Jason Sarris, a commission member who used to be homeless, supports expanding the team.
“From my experience living on the streets for as many years as I did, I’ve seen a lot of situations where somebody was having a mental health crisis and with police involvement and it’s ended up going bad,” said Sarris, who was sworn into the commission on Tuesday. “I think to have mental health liaisons dispatched to situations like that really helps the individual and definitely helps the police if they don’t have to respond to calls like that.”
More information about the Marin County Mobile Crisis Team can be found at marinhhs.org/mobile-crisis-team.