Improving outcomes of street crisis response in San Francisco

Expanded alternatives to police response

San Francisco is a national leader in finding alternatives to law enforcement. The Coordinated Street Response Program allows us to substitute police response with specialized street response teams.

Better Coordinated Response

The Coordinated Street Response Program connects our specialized “crisis response” teams, including: 

  • Clinicians
  • Specialized community paramedics
  • Peer counselors who provide compassionate care to those in need on the street

Extra Trainings

The City of San Francisco is providing new training to 911 dispatchers and 311 agents. The trainings review what services or responders are most appropriate for each situation.

 

Street response teams receive extensive training on:

  • De-escalation
  • Trauma-informed care
  • Cultural competency
  • Motivational interviewing

How the street response teams work together

In this video

See how the City’s street response teams provide compassionate care to people on the streets.

The SF Street Response Program includes the following teams:

Emergency Response (Call 911)

Emergency Response (Call 911)

Street Crisis Response Teams (SCRT)

All teams operate citywide, 7 days a week, 24 hours a day. SCRT provides rapid, trauma-informed emergency care to people in acute crisis. SCRT teams address urgent behavioral health and wellness issues. They provide access to critical resources like: 

  • Urgent care
  • Emergency shelter
  • Substance-abuse treatment
  • Mental health and medical clinics
  • Residential programs

SCRT units include:

  • Community Paramedic
  • Emergency Medical Technician (EMT) or second paramedic
  • Either a Peer Counselor or a Homeless Outreach Team (HOT) specialist

Behavioral health clinicians are also a core part of SCRT. They provide follow-up support through the expanded City's Office of Coordinated Care (OCC). They follow-up with people who got a response from an SCRT unit. Follow-up includes care coordination and connections to critical resources.

Street Overdose Response Team/Post Overdose Engagement Team (SORT/POET)

SORT and POET connect with people in the critical moments after an overdose. Community paramedics can start medication-assisted treatments to help people with substance use disorders. SORT also provides: 

  • Rescue kits
  • Educational materials
  • Support to get into substance use treatment and shelter.

Follow-up teams include:

  • Street medicine specialist from the Department of Public Health
  • Peer specialists
  • Behavioral health clinicians

Non Emergency Response (Call 311)

Non Emergency Response (Call 311)

Homeless Engagement Assistance Response Team (HEART) 

HEART provides rapid responses to targeted, non-medical, non-emergency 911 and 311 calls. These calls are for people who are experiencing homelessness when there is no sign of: 

  • Crime
  • Violence
  • Threats
  • Mental health or medical need 

Examples include blocked sidewalks or a person loitering in the lobby of a building.  

HEART is a community based team that serves as an alternative to law enforcement. The HEART pilot project is currently funded for one year. 

Homeless Outreach Team (HOT) 

HOT provides support and connections to shelter and housing for people experiencing homelessness. The team works in neighborhoods 7 days a week throughout the City. Teams with expertise on issues that are barriers to stability provide these services.  

Some individuals may not be ready to accept help. In this case, HOT continues outreach so that services are available when needed. HOT coordinates with BEST and Street Medicine teams to ensure people have access to care. 

Teams are not dispatched through 911. People experiencing homelessness can contact 311 and ask how to connect to HOT. HOT only takes requests from people experiencing homelessness. It does not respond to third-party requests. First-person calls or planned outreach have proven more effective than third-party requests.

Referral Based

Referral Based

Bridge and Engagement Services Team (BEST) Neighborhoods 

BEST provides rapid and trauma-informed behavioral health assessment, engagement, and community-based therapeutic interventions. It promotes healing, wellness, and positive community participation.  

BEST Neighborhoods works in assigned neighborhoods 7 days a week. It provides time-limited, focused, and phased interventions to help clients shift to ongoing care and support. BEST is not dispatched through 911. BEST Neighborhoods responds to referrals from street teams including:

  • Street Crises Response Team
  • Healthy Streets Operations Center
  • SF Homeless Outreach Team
  • Hospitals
  • Jail health
  • Street Medicine

The team also assists unhoused people with behavioral health needs in neighborhood "hot spots."

EMS 6 

Works with people who need emergency services the most. Many are experiencing homelessness and face substance use and/or mental health disorders. EMS monitors 911 calls and gets calls from caseworkers to respond to people who need help. They provide urgent care and transport people to the hospital or to shelter.  

The City’s EMS 6 team focuses on people who frequently use the 911 system. It provides intensive, wrap-around care. The goal is to break the cycle of people who rotate from the street to the emergency room and back to the street.

Street Medicine Team 

Serves people experiencing homelessness with medical, mental health, and substance use needs. It focuses on people who are not connected to care. Services include:

  • Transitional primary care
  • Low barrier buprenorphine

Coordination with other street outreach teams to assess the need for acute medical conditions.

The City of San Francisco is streamlining and improving its response to people experiencing a mental health or substance use crisis on the streets.

Frequently Asked Questions

What is a “street crisis”?

What is a “street crisis”?

A “street crisis” is challenging to define. It includes someone experiencing a mental health or substance use crisis on the street. They could be:

  • Unconscious 
  • Not breathing
  • Threatening themselves or others

These are medical emergency situations that impact life safety.

A “street crisis” also includes non-emergency urgent situations. This includes:

  • Someone with obvious wounds
  • People who are lying down or sleeping
  • Someone who is inadequately clothed for the weather

Together we can help people experiencing a mental health or substance use crisis on the street. If you are experiencing an emergency or worried about someone’s safety on the street, call 911. For non-emergencies, call 311.

Why should I call 911 if I see a street crisis?

Why should I call 911 if I see a street crisis?

Calling 911 is the fastest way to send lifesaving help. You can help by calling. Call 911 if you see someone:

  • Someone Experiencing a mental health or substance use crisis
  • Unconscious 
  • Not breathing
  • Threatening themselves or others

 A highly trained emergency dispatcher will send the appropriate help. 

 The dispatcher will ask you where the emergency is and what is happening. You can say “I don’t know” if you do not know the answer. For best outcomes, if you feel safe stay at the scene so you can provide updates to the dispatcher. If you need to go, you can leave the scene after you make the call.

 Calling 911 does not mean the police will respond. San Francisco’s 911 has invested in alternatives to law enforcement. This helps reduce police response to behavioral health crises.

For non-emergencies, call 311.

How often do street crisis calls result in police response?

How often do street crisis calls result in police response?

There is no easy answer because different situations require different responses. Many factors play into each call. The Coordinated Street Response Program allows us to substitute police response with specialized street response teams. 

Street response teams reduce police responses to people experiencing mental health emergencies. In 2022, less than 3% of calls involving the street response teams required a police response.

How long do 911 calls typically last for the caller?

How long do 911 calls typically last for the caller?

Calls will last anywhere from 2 to 10 minutes, depending on the emergency. When you call 911, a trained emergency dispatcher will find out what’s happening. Then they will send the appropriate help. The dispatcher will ask you where the emergency is and what is happening. You can say “I don’t know” if you do not know the answer.

Do you have to stay on the scene if you call 911?

Do you have to stay on the scene if you call 911?

For best outcomes, stay at the scene so you can provide updates to the dispatcher. Stay calm and answer all questions as best you can. Answering questions will not delay response times. If you need to go, you can leave the scene after you make the call.

What is the City’s response time for non-life-threatening crises?

What is the City’s response time for non-life-threatening crises?

Situations range in urgency and associated response times. Response times vary based on the 911 dispatcher’s assessment of a situation. For example, for a medical emergency call, the City aims for an ambulance to arrive in under 10 minutes. For a mental health or substance use call, the City aims for a response time under 15 minutes.

What if someone refuses care?

What if someone refuses care?

We never give up on someone, even if they refuse care. It may take many interactions before we can help a person in crisis. All offers are voluntary unless someone is a threat to themselves or others. Each contact is a chance for us to:

  • Build trust
  • Understand the person
  • Offer more services and support

What is the process for dealing with people who need help multiple times?

What is the process for dealing with people who need help multiple times?

It depends on the situation. Individuals seen multiple times by street response teams are prioritized for follow-up care. It may take many interactions before we can help a person in crisis. Each contact is a chance to build trust and form therapeutic alliances.

Street response teams respond to 911 calls. Highly trained dispatchers send the most appropriate response team for each situation. If you are experiencing an emergency or worried about someone’s safety on the street, call 911. For non-emergencies, call 311.

Downloadable materials for printing

Spread the word about the Coordinated Street Response Program. Share our posters, postcards, and one-pagers for events and communal spaces.

Downloadable resources

Meet Jamie

I was living on the streets when I met Erika and Claudia, clinicians on the City’s street response teams. They got me into a shelter and my whole life has changed for the better.

San Francisco’s street response teams are trained in trauma-informed care and de-escalation. They reduce police response to people experiencing mental health or substance use crises.

Street response teams respond to 911 calls. Then, dispatchers send the most appropriate response team for someone like me.

About

The Coordinated Street Response Program is a multi-agency effort to provide specialized resources. Our goal is to offer compassionate care to people experiencing a crisis on the streets. San Francisco’s Coordinated Street Response Program is a multi-agency effort to bring together specialized resources to provide compassionate care to people experiencing a crisis on the streets.