[Content warning: This article includes mentions of mental health struggles, self-harm, and suicide.] 

During her time working as a mental health crisis responder in Santa Cruz County, Danielle Long has responded to a wide variety of situations. The transition from call to call can be jarring. 

“Crisis response is all about flexibility,” Long said. “You could have one call where you’re putting someone in a 5150. Then the next call is a mom who found their kid dead from suicide.”

“5150” is a California law code that refers to the practice of holding someone involuntarily for 72 hours while they’re suffering a mental health crisis. It’s meant to apply when the person is in danger of hurting themselves or others.

Regardless of the specifics, in every mental health crisis, there’s a person at risk of (or in the process of) hurting themselves or others due to mental distress. If someone suspects that a mental health crisis is taking place, they should seek help immediately.

The question is: from whom?

In the past, seeking help from a crisis service like 911 would almost always trigger a strictly police-centric response. But, after several years of increased awareness about police shootings — which frequently involve a mental health crisis — some counties around the U.S. have begun sending trained crisis counselors and clinicians to respond to mental health crises instead of law enforcement.

Santa Cruz County has been working on a similar program since 2015. On Sept. 28, they crossed a major milestone after the California Mental Health Services Oversight and Accountability Commission (MHSOAC) approved a program called Crisis Now that will put $5.1 million towards mental health crisis response over the next three years. This was the program’s final hurdle; the Santa Cruz County Board of Supervisors had already approved the program on June 29.

“The stars have aligned,” said Santa Cruz County Director of Access and Crisis Services James Russell. “We’re getting the funding, we’re getting the legislation. And I think this is what the community actually wants.”

The county’s Behavioral Health Division, which has always handled mental health crisis response, has been plagued by staffing shortages for years. In a 2022 report, the Santa Cruz County Grand Jury described the division as “underfunded, understaffed, and overworked.”

Crisis Now aims to solve that by hiring “peer responders”: care workers who have experience with mental health crises but aren’t licensed clinicians. Russell clarified that those responders will receive training and work in conjunction with licensed staff.

Russell also predicts that mental health crisis responders will be available 24/7 by July 1, 2024. He characterizes that change as a significant step towards separating crisis care and police response. 

“We want to make sure that if police don’t need to be involved, they’re not involved,” Russell said. “We need a behavioral health response for a behavioral health crisis.”

Crisis Now’s other goals include building a new short-term crisis care facility for people 18 and under, upgrading the existing care facility, and implementing a system whereby someone can call any emergency number (including 911 and 988) and be connected with a mental health crisis responder.

At the moment, the only way to access mental health crisis response directly is by calling their dispatch at 800-952-2335. The less than 2% of 988 calls that require intervention often result in a police response.

THE CURRENT SYSTEM

The Mobile Emergency Response Team (MERT) and the Mobile Emergency Response Team for Youth (MERTy) are currently active Monday through Friday from 8 a.m. to 5 p.m.

The county also runs a Mental Health Liaison (MHL) program that embeds mental health professionals with the Santa Cruz Police Department, the Santa Cruz County Sheriff, and the Watsonville Police Department. They work from 8 a.m. to 5 p.m. daily.

Members of the Santa Cruz community have been calling for an expansion of MERT and MERTy ever since two Santa Cruz locals were killed by police during separate mental health crises in 2016. On the national level, the Washington Post reports that 1 in 5 police shootings since 2015 involved a mental health crisis. A 2021 study by researchers from UC Berkeley and UC San Francisco also found that Black men are more likely than any other group to be killed by police during a mental health crisis.

Other problems with having law enforcement respond to mental health crises are subtler. In fall 2020, activist Laura Chatham witnessed multiple mental health crises while volunteering for Santa Cruz Food Not Bombs, a local meal distribution program that often serves food to the unhoused community.

“We’d call 911, but you’d always get the police and everybody would scatter,” Chatham said. “Someone would be having a psychotic episode, and there’d be nothing we could do. We couldn’t call anybody.”

Social worker Danielle Long has seen plenty of people react negatively to police presence while in crisis. But she pointed out that those reactions don’t follow hard and fast rules. Before becoming the manager of the county’s crisis care continuum in January, Long worked as a Mental Health Liaison (MHL).

“Crisis care continuum” refers to the organizational ties that connect dispatch, care workers, and patient intake facilities. The term is commonly used within the Behavioral Health Division.

Long has seen plenty of people react negatively to police presence while in crisis. But she pointed out that those reactions don’t follow hard and fast rules. Sometimes, according to Long, police officers get more positive responses than care workers — whether it’s because they’re already accustomed to dealing with law enforcement, feel protected by police, or simply recognize the uniform.

“Sometimes, the liaison will show up and [the person suffering a crisis] will be like, ‘I’m not talking to you,’” Long said. “It depends on the situation and the person.”

The county plans to have the MHL program work in tandem with MERT and MERTy for the foreseeable future. Likewise, MERT and MERTy will continue to collaborate with law enforcement in situations that might prove dangerous to care workers.

THE COMMUNITY RESPONSE

Crisis Now has been well-received by many — including Mike Beebe, the Board President of the Santa Cruz County chapter of the National Alliance on Mental Illness (NAMI). NAMI Santa Cruz partners with the county on a variety of programs.

“We’re completely in support of it,” Beebe said. “We’re going in the right direction.”

But Laura Chatham sees one key flaw within the program. She became a member of the Santa Cruz County Mental Health Advisory Board in 2021.

Chatham alleges that the Crisis Now program directs far too much money to consultants like Recovery Innovations International (RII). RII is a non-profit organization that specializes in designing crisis services; in the past, they helped Maricopa County in Arizona establish their crisis response system.

Chatham doesn’t think the county needs to study its developing system any more than it already has.

“We know what we need,” she said. “[The problems with our system] are clear. We should use the $5.1 million to circumvent those gaps.”

Russell disagreed. He insisted that hiring RII will ensure the county follows state mandates around crisis response systems that are critical for funding.

“[RII] is the first consulting group that has been able to speak to our entire crisis system in an authoritative and knowledgeable manner,” Russell said.

Ultimately, Russell feels that Crisis Now has put the Behavioral Health Department in a “comfortable” place. But he pointed out that Crisis Now is only meant to ramp up the county’s work. He and Long will be working with their team to secure more permanent funding over the course of the next 2 years.

For now, Russell hopes to learn from the community as much as possible.

“We have to use word of mouth,” Russell said. “We have to build trust. That’s going to be a multi-year thing — we’re not going to discover that tomorrow.”