He goes to police calls in a Prius. It is part of a new approach to mental health emergencies

Briana Fair, a mental health specialist with the San Mateo Police Department, received voicemails from a depressed caller one weekend this month. He knew the word. It was his client, who said a celebrity was hacking his phone, that he needed help moving to another apartment and why was the process taking so long?

“Normally, he won’t call like this unless he’s in trouble,” said Fair.

If Fair keeps him nearby, it will ensure he’s connected to the services he needs and prevent him from calling 911 dispatch, reducing the chance of a full-blown crisis involving officers or unnecessary hospitalization.

“I’m filling in the gaps,” Fair said. “It’s just a matter of getting him the right support.”

It works, according to a new study of San Mateo County efforts from Stanford’s John W. Gardner Center for Youth and Their Communities, which found that pairing law enforcement officers with mental health therapists reduces the likelihood of cost-effective interventions and interventions.

Fair was hired four years ago as part of a pilot program for this approach, also known as the “collaborative response model,” in all four of San Mateo County’s largest cities – Daly City, San Mateo, Redwood City and South San Francisco. The idea was to free up the police and provide alternatives to detention and hospital emergencies for people with mental health problems. Since then, this image has spread to police departments in almost every city in the region.

Researchers behind the Stanford study found that the respondent model reduced automatic psychiatric arrests by about 17% and reduced the likelihood of future 911 mental health calls among the four test cities. Seizure allows the hospital to hold a person for up to 72 hours to determine if they are a danger to themselves or others. Given the reduction of about 370 psychiatric cases over two years, researchers Tom Dee and Jaymes Pyne estimated annual cost savings of about $300,000 to $800,000.

“We have to look at alternatives and really understand that the police are not the best equipped to deal with serious mental health situations,” said San Mateo County Sheriff Mike Callagy, who proposed the pilot after seeing cases that led to police use of force and charges.

During each visit with her client, Fair tries to help her check something off her list of concerns. Today, they sit next to each other as they call the California Department of Social Services to inquire about home care. They are stopped and five minutes later, his client is breathing heavily.

“I know, it’s a lot,” Fair said. “That’s why I’m here.”

As the first mental health clinician for the San Mateo Police Department, Briana Fair connects people experiencing mental health issues with services to help prevent unnecessary hospitalizations or police involvement.

(Manuel Orbegozo / For CalMatters)

As jazz music plays behind the phone, Fair picks up a bottle of dry shampoo from the desk, reads the label aloud and asks her how she likes it. He brought the product during their last visit – a Band-Aid solution that he invented because his client was having trouble washing herself.

“Have you tried it yet?” he asks. “Do you want me to blow them for you?

Her client pulls her hair out of her ponytail, brushes it with her fingers and runs her hands through the part. Fair gets up from her chair, shakes the bottle and puts it on her head.

“Are you feeling better?” he asks.

“Yes, but you blew it in my mouth,” said his client, laughing loudly. “It feels fresh.”

An increasing number of mental health calls

Stanford’s research adds to the growing body of evidence about the positive impact of other first-responder programs, which have proliferated across the country amid calls for police reform after the 2020 killing of George Floyd. Those changes are still so small that not much is known about them, Dee said, and his study is one of the few that provides a reliable test.

“This is a general change that holds great promise,” he said. “That being said, it’s not a cut and paste type of thing. There are critical design and performance details that are critical to realizing the promise of these types of systems.”

Some of those details include buy-in from the police, training dispatchers on how to intercept calls, and integrating mental health workers.

Briana Fair assists a client in a San Mateo apartment on Dec. 15.

(Manuel Orbegozo / For CalMatters)

San Mateo Police Chief Ed Barberini said it was a “risky proposition” when his agency decided to participate in the pilot program, worried that its officers would push back. But mental health calls were increasing, he said, and without clinical expertise, police were being put in a difficult position. That view is shared by law enforcement agencies across the country, some of which have recently distanced themselves from mental health calls.

“We realized that we were starting problems and finding short-term solutions,” Barberini said. “I’m amazed at how things have turned out.”

Mariela Ruiz-Angel, director of Alternative Response Initiatives at Georgetown Law’s Center for Innovations in Community Safety, said the responders’ model is impressive — but it’s just the beginning of what a progressive city looks like.

“This is about transitioning to a level where we don’t have to send the police or shoot to call for basic needs,” he said. “The idea was never to take the police out of the equation completely. The idea was that we shouldn’t put them as the primary response to 911. We don’t have to protect the public about the police. Public safety is about the right response.”

To remove the family feud

The pilot program cost about $1.5 million over two years, split between the county and the four participating cities. When it was over, the San Mateo Police Department — an agency comprised of 116 sworn officers — transitioned Fair’s role to a permanent position as the agency’s first-ever psychiatrist. The city uses grant money to hire another mental health doctor on an occasional basis. All other participating cities have found a way to support their program.

On Monday morning, Fair responds to emails from police asking him to follow up on people he contacted over the weekend. This time of year has been busy, Fair said, because the holidays can be lonely. In the past week alone, he has had to respond to a variety of problems: evaluating a child who had a botched suicide attempt and responding to a transgender youth who wanted to stab himself.

The radio sits next to his desk. He pauses to listen carefully as the dispatcher relays information about someone he thinks is being followed by a federal agent. A family member came in to report the episode. A few minutes later, Fair throws her backpack over her arm, puts the radio in her pocket and quickly walks through the hallway to the garage. In the back seat of his district car – a white Toyota Prius – is a bulletproof vest, which he says he rarely uses.

Outside the apartment, Fair pulls over and turns on his lights. This process, also called “staging,” is where they park two blocks away so that the police, once they arrive, can check the scene to make sure it’s safe when they arrive.

A few minutes later, he opened the car door and ran in his black Nikes and black pants. The policeman introduces him to the family and from there, Fair’s career continues. He goes back and forth between the family and their lover, who is sitting across the street on a bench, as he gathers information from both sides: Is there a history of mental health? What kind of things have they used before? Are they currently receiving treatment? Have they been hospitalized before? Are there any threats they make? What do you want to see happen today?

After 10 minutes, Fair pulls one of the officers aside to let him know that the man does not need to be hospitalized. “Let’s plan for safety,” he told her. That’s what the agency does when it receives a call that doesn’t automatically rise to the level of a psychiatric hold. At that time, officials say, “they are just playing peacemaker.”

It was good to gather around the family to explain that this situation is no longer a police issue or a mental health issue, but a family issue. Still, he doesn’t want to leave them alone. They created a “security system” that everyone could ride on so that, as he later explained, “We don’t get another call in 10 minutes because they’re arguing on the street.”

“We get calls like this – when it sounds like it’s going to be bad – and we get here and it’s a family affair,” he said. “It’s happening.”

Mihalovich writes for CalMatters.