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In November of last year, the Redwood City Police responded to reports of a person displaying “erratic behavior.” The 36-year-old man, who resisted arrest, was pinned down, beaten and detained by police, sparking debate about the involved officers’ use of force and, more broadly, law enforcement’s role in handling possible mental health crises.
Less than a month later, the city took a major step towards changing the way officials respond to crisis calls.
In early December, Redwood City announced that it would be joining three other cities in San Mateo County in a new, two-year Community Wellness and Crisis Response Team Pilot Project. The city, along with Daly City, San Mateo and South San Francisco, would pair a mental health professional, through nonprofit StarVista, with local law enforcement to better de-escalate emergency calls and provide appropriate care for non-violent people in crisis.
Patricia Baker, a licensed marriage and family therapist, recently joined forces with the Redwood City Police Department as their mental health clinician. She has extensive experience working with prison inmates, adolescents and homeless individuals and has worked on two other treatment pilot programs. In her new role, Baker is dispatched out to support the police in aiding people experiencing a crisis—sometimes up to three calls a day.
The Pulse spoke with Baker to get a behind-the-scenes peek into her new role.
What does it mean to be a community wellness and crisis response team mental health clinician?
I'm very excited to be part of the implementation—the Community Wellness and Crisis Response Team. And there are reasons for that. I just like data-driven programs. We don't know what we don't know. And we need data to learn what are the good alternatives.
What it means to me to participate in data-driven pilot programs is that we get to really learn things. So this current pilot project is working with the Gardner Center at Stanford. And it's going to be interesting as that data begins to emerge. Then the challenges will consist of analyzing that data, in order to better understand, for one thing, if the Crisis Response Teams are being implemented as they were planned, identify any gaps, any problems with any implementation. And it seems that all the stakeholders are very amenable and open to doing this and looking at the data—whatever it is that we need to do to achieve better outcomes.
What does a typical day look like for you?
Well, I go out a lot because I can have my radio on and sort of be doing follow-up, doing some case management. The priority, though, of my day is responding to any calls. So dispatch will receive a call and/or the officers may request me when out on a call, and I will go meet the officers. When they see that it's safe, I will go in, conduct an assessment, an evaluation, a mental health status examination and determine what the best course of action is.
So I'm assessing, does this person meet the criteria for a home? Are they gravely disabled? Are they a danger to themselves or others? Is it appropriate to write a safety plan? Are there alternatives to psychiatric emergency services? And then my clinician’s hat means that I'm examining symptoms, thinking about diagnoses. And I'm going to communicate those observations on the form, so that clients can receive the appropriate services when they get to psych emergency. And then maybe the following day or within the next couple of days, I look at what may have transpired in that psychiatric emergency hospitalization. I follow up telephone calls, I reach out to clients, I reach out to parents, sisters, some of my collateral sources.
And are you briefed about what you're going to arrive at, or do you assess when you get there?
I typically stand down until the officers communicate to me what's going on. They typically ensure my safety. And we as a team may talk to maybe the reporting party, maybe a case manager’s calling, maybe there is a marriage and family therapist or a psychologist calling who wants a client placed on a hold, or wants a little health and wellbeing check on a client. And officers will respond to those calls. And so I'll be briefed. And if it's deemed safe for me to go in, I'll then meet with the client.
If you arrive and someone is in the midst of a crisis, what’s the first thing you do?
‘Hi, I'm Patricia. What's going on?’ Might be something as simple as that. ‘What's happening? What's going on? What's really going on?’ You know, ‘Why do you think I'm here?’ I can open in any way. I am myself—I use myself to meet the client where they're at. And sometimes it works.
And sometimes it doesn't?
Sometimes maybe it’s less effective. People don't want to necessarily engage. People can feel a lot of different ways. Maybe someone can feel intruded upon by my questions. So I have to be aware of that. I have to read the cues, the social cues.
Sometimes it takes all day, or it can take two days. I have the benefit of very committed police officers. I have the community officer, Erik Ottersen, and we can outreach and say, ‘Hey, we'd like you to go to a shelter.’ We can discuss alternatives: ‘We don't want you getting arrested. We want the best outcome for this situation.’
How do you conduct that assessment?
A mental status examination consists of observing the general appearance, that appearance in relation to age, people’s psychomotor behaviors or mood and effect, the range of their effect, the stability of their effect, their attitude toward me during the encounter, specific moods or feelings that I observe or that somebody reports to me.
I'm assessing their attention, their concentration, short-term and long-term memory. I'm assessing how oriented somebody is to person, place, time—why am I here? Why are the officers here? Why were we called out, do you think? I might ask a question like that. I'm assessing thought patterns, how coherent or incoherent, confused the subject may be. Are they in touch with reality? Are they out of touch with reality? And I'm thinking about the content of whatever it is they're sharing, their level of consciousness.
The mental status examination is what serves as the basis of the sort of diagnosing and understanding whether or not somebody needs to be placed on a hold. Are they oriented to who I am? Do they know who they are? Are there substances onboard?
Once you've done this assessment, what role do you have in deciding what happens next?
I'm going to talk to the person, I'm going to try to relate to the person and find out what it is they believe they need. And I'm going to be pretty forthcoming. So my concern is whether you're a danger to yourself, a danger to others. I’m of course assessing if somebody’s gravely disabled, incapable of sheltering themselves, incapable of providing for their own needs, not eating.
People can be placed on hold, an ambulance can be called or a smart car can be called. So let's say I'm dispatched to a high school, where somebody may be experiencing suicidal ideation, or somebody may be self-harming. I will assess that situation. And instead of having an ambulance arrive at a high school or an elementary school, I can ask the officers, ‘Hey, is the smart car available?’ And the smart car can come, and it's a little more low-key.
How is working with your new team?
I always feel sort of supported by a team. The Redwood City police officers, to me, appear pretty sophisticated when it comes to crisis intervention. They're all CIT trained. Every last one of them. I’ve certainly been experiencing the Redwood City police officers as very capable in the field of crises. I'm currently learning a great deal from them. They've all been very welcoming, and they're very generous with the information. They are very often more familiar with our high-utilizers of emergency services. The officers know these clients well, and they can provide me with invaluable collateral information and history in order to inform my assessments.
They know some of my clients better than I do. They're familiar with, ‘Oh, this one person struggles with suicidality.’ Or somebody may have a history of acting aggressively or erratically. Police officers can be familiar with histories of trauma, PTSD. So they will see people when they're functioning well, and perhaps when they're functioning, not so well. I'm becoming, sort of, more familiar with some of the high utilizers of emergency services that they've been able to, you know, provide invaluable information for me.
In the last few months that you've been working in this capacity, are there any particular trends that you've noticed among those in distress?
I'm seeing children, I'm seeing adolescents and I'm seeing adults. I'm also seeing older adults, the elderly.
And then, of course, there are high utilizers of emergency service, there are the unhoused, there are often substances on board with some of the mental health issues that our unhoused experience.
Have you seen significant impacts from the pandemic?
It's been tough on our adolescents. It's been tough on our kids. And then getting back to school is a transition. One thing I have to do is to be aware of, is this client experiencing a transition, any kind of transition? What is that transition? We know that mental health hospitalizations in adolescents and children have been up 24%, I think, over the last year.
It's been tough on our elderly. And there's a lot of need out in the homeless encampments where our unhoused currently reside. I see the ongoing crises there.
As I'm listening to you talk about the work that you're doing in assessing and evaluating people’s needs in the time of a crisis, I just can't help but wonder what we did before you. Do you feel that you’re filling a big need in our city?
No system is perfect, right? There are still gaps, you know. I'm doing warm hand-offs, I’m doing referrals, I’m just reminding people of the resources that are there. They can access them, if they have access to the internet. San Mateo County has a lot of really very committed agencies and resources. Sometimes my job is just to remind people that those resources exist.
I hear officers telling people about some of these resources, but due to the number of calls, I don't know that [police officers] are meant to be our case managers out in the community. I don't know that time allows that.
I’m responding to these crises because it's my hope that people will be able to achieve optimal outcomes. I guess I'm more tuned in maybe than what we were doing before in that I'm thinking, ‘Well, what are the long-term case management needs of this person?’ And I can be idealistic about that.
Often people decline services. That doesn't mean I'm not going to continue trying. ‘Let me know when you're ready or when you think you might want to go to First Chance or the Sobering Station.’ You know, ‘Let me know when you think that a treatment episode at the Women's Recovery Association might be something you'd be interested in. Let me know when you want to do an assessment for housing.’ And again, in the interim, working relationally, just going and reaching out. ‘Hi, how are you doing?’ Today that meant bringing somebody an old pair of blue jeans. That's all it meant today. Stopping by and going, ‘Hey, you could use some jeans.’
Have you seen an impact so far?
I think that beginning to work relationally with high-utilizers of emergency services—so those subjects and those clients who repeatedly have arrests—just studying to be consistent, getting to know people by name, recognizing them, opening up a dialogue, I think that does have an impact.
And I'm not the only one doing it. You know, some of my officers are very effective. They know people by name. ‘Hi, how are you doing? How's it going today?’
We have a new officer and to see a little sixth grader really looking up, just light up because the officer’s talking to her. I'm talking to her. It's a team effort. It’s not just me. Sometimes for that little sixth-grader who’s subtly ideating or cutting, to have a strong female presence in the room, an officer just being super respectful and super caring—while I might be doing the assessment, that sort of caring and that magic is happening between the officer and that student.
This work sounds extremely emotionally draining and challenging. And I just wonder how do you cope? How do you take care of yourself?
That's a complex question.
It is challenging. It's challenging when people are not ready to avail themselves of the help. And I also realize that people have the right to self-determination, people have the right to do that—to decline services. I hold the hope, because I think I could be any of us. What kind of human society are we going to be? How do we take the best care of our most vulnerable members? What does that look like? I’ve grown up in the San Francisco Bay Area. Since the 80s, we've seen some of these complex issues become increasingly both more complex and just constant. We in the Bay Area, you know, things have changed.
What are your hopes for this new program?
This is a two-year pilot project. And then my position may become a County position, for instance. Or maybe they'll decide that they would rather go with a different model and not involve the police department. Maybe they'll decide that it's better to just have one police officer and one clinician working as a team. Maybe the data will indicate that it's more effective to have the clinician at the fire department.
We'll look at the data coming from other cities. These projects have been going on in Oregon, in Los Angeles, San Francisco's about to implement. So it's starting to happen. And we're all going to learn from each other about what is most effective. And every little city is going to be a little different. And there's going to be different cultures. And police departments have different cultures and fire and emergency responses.
So what works in San Mateo, does that work in Menlo Park? Does that work in Redwood City, San Francisco, Los Angeles? Do we know? Do we know yet? Not until we see the data.
If you, or anyone you know, is in need of emergency support, you can reach Patricia Baker at her 24/7 Crisis Hotline number: (650) 579-0350
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