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- In moments of crisis, the way we respond can mean the difference between chaos and care, confusion and clarity, trauma and healing.

Today on "Region Rising," we're exploring a powerful new approach to mental health response right here in Sacramento.

One that's changing lives, rebuilding trust, and delivering real help when people need it the most.

It is bold, collaborative effort between the Sacramento Police Department, the Sacramento Fire Department, and WellSpace Health.

Together, they are re-engineering how our region handles mental health emergencies and triaging needs through the 988 mental health crisis hotline.

And guess what?

It is working.

And today, we will learn how.

Joining us are Sacramento Police Chief Kathy Lester, Sacramento Fire Chief Chris Costamagna, and WellSpace Health CEO, psychologist as well, Dr. Jonathan Porteus.

It's great to see all of you here to take a closer look at this as we dive in.

And thank you so much for joining us here.

Welcome.

- Good morning.

- Good to be here.

- Thank you for joining us.

I just wanna start right now with this new model, and I'll start with you, Chief Lester.

Where did you just... Where did everyone come to the table and say, "We've gotta do something and we've got to find a way to approach this," because this has been all over the news about how mental health calls are being responded to.

But in the city of Sacramento, there's an approach, a collaborative approach.

What started this coming to the table?

- My first experience and really my thoughts about this happened long before I was the police chief.

And I remember looking at who we, as police, like were involved in violent encounters with, and lots of times, it was people in our community that were experiencing mental health crisis.

And a significant number of our officer involved shootings, for example, had that component.

And obviously, there's been very high-profile incidents around the country.

And I was actually at a conference a number of years ago and heard from Adam Palmer, who currently is the Chief of Vancouver, British Columbia, and was the chief at the time, he is a longstanding chief.

And they implemented a really interesting program where they had a Mental Health Response Unit to where they tried to provide services to people in their community that they had had prior contacts with and tried to get them into services before a mental health crisis actually happened.

And they were actually very successful.

So I thought, "Boy, we should really look at something like that in Sacramento."

And it actually took a couple of years, but we developed a Mental Health Response Team where we had dedicated officers that had quite a bit of extra training and would follow up on calls for service.

So one thing you should know about your police in California is we do have the ability to place a mental health hold on someone, but they have to meet certain criteria.

They literally have to be in crisis.

And I know Jonathan, Chris will talk about this, but there are so many other people that we encounter that aren't at that level of crisis but really need help.

And so you can imagine how frustrating that is when you only have one tool, and they have to be at a very high level of crisis before you can use that tool.

So we saw a lot of people in the community that needed this type of help.

So, the job of this team, with some support from the county, this is back in like 2018, '19, was to do outreach and response and make sure that people were checking in with their providers, that they were getting the help that they needed, that they were taking their medication.

And that's actually evolved over the years.

So, there's been a big push, as you know, from our community for alternate response and trying to get the right type of professionals to help individuals in need.

And certainly, the Police Department, I look at us as being like the emergency room, right?

Like, we're where you come when you're absolutely in crisis, but we're not primary care provider, right?

We don't do a ton of preventative work in this area.

That's not what we do.

And there are people that are better suited to help people in mental health crisis.

And so for the last number of years, we've been looking at different models and really working with our community-based partners.

Like, that's one thing I love about Sacramento.

Well, the many things, we have great community organizations that do amazing work.

And so whether it's on our violence prevention efforts or in this arena, trying to leverage those resources and experts has been really a game-changer.

I think that's what we're gonna talk about today.

- What we're sharing today is really good news.

What we're seeing happening in Sacramento is, in my opinion, this is national news.

Would you agree?

- Yeah, I mean, I think it's really important when you say re-engineering, it is a re-engineering.

But re-engineering doesn't mean brand new.

We're re-engineering.

There are pieces of this which are new, but really what we're doing is we're looking at who we are together in a partnership and saying, "How do we better address the issues?"

You know, we have been... WellSpace Health has been doing suicide prevention in the region since 1953.

That's kind of our original thing.

And we are now the suicide prevention provider for 32 counties across California out of 58, 32 counties.

But things changed.

988 was created.

It's now the national single three-digit number for not just suicide prevention, but mental health crisis.

And the question was: What is the opportunity that we have with that?

And the national model said, "Let's have sort of a 123 process.

Let's have a place to call, somewhere to call.

Let's have someone to respond and let's have a place to go."

And if you look at this as a science-based strategy, it became the 123 process that we're trying to do.

That is the re-engineering.

That is where crisis comes to 988 first.

If a call comes into 911 and it's not sort of a traditional call for law enforcement or EMS, we're saying, "Bring it over to 988," which is what's happening, they're interoperable, 988 and 911.

And what we're seeing is that 988 now, which is a nationally accredited crisis center with suicide prevention specialists answering every call.

We are able to say, "Is this a highly lethal situation?

Is this one that we can resolve?"

In fact, 95% of all the calls to 988 are resolved through the call to 988.

This is not a situation where we dispatch, even.

Let's put it in Sacramento terms.

- Okay.

- In December, 988, just in Sacramento, had 1,300 calls.

We do chat and text as well.

1,300 calls.

Of those 1,300 calls, 80 were considered needing some kind of dispatch.

And we have a Community Wellness and Response Team that is a Mobile Crisis Team, and we dispatch to that team.

Of those 1,300 calls, two of them needed law enforcement.

- Wow.

- So...

So, what happened to the other 1,220?

They were resolved within the 988 system, which is a system, it's progressive system where we start with lethality assessment.

And we move with someone through a process of discovery, calming, supporting, and then figuring out: What are the resources and follow up that someone needs?

So, you're not- - And the lethality assessment is for all parties involved.

It's for the person at risk, it's for the people near them, it's for possibly for law enforcement.

- Yeah, many of the calls are from family members, for example.

So I think it's just really important to say, "Yeah, that is the re-engineering."

Like, we are still partnering, but we're saying, "What do our partners in EMS and law enforcement, what is their job in terms of public safety and public health?

And what is our job?

What are we qualified to do?

What are they qualified to do?"

And frankly, there's been an unfair burden on other parts of the system.

We have an overreliance on law enforcement and EMS, which means we have an overreliance on jails and emergency departments when we have a crisis.

Now, most crises don't need an emergency department or a jail, but without another type of opportunity for people, that's where we've sent people.

And so as the chief said, we've had an abundance of mental health holds because that is the technique that we have for addressing mental health crisis in the community.

I'm not complaining about it.

I should point out that we have an overuse of them not because they're being misused, but because that's the only tool we've had in our tool belt.

Now, we have alternatives.

In fact, we even have a Triage Alternative Destination Model now, where Chief Costamagna's folks are able to put someone in an ambulance and take them somewhere other than an emergency room.

Until this year, it was not possible for them to put someone in a rig and take them anywhere but an emergency.

- That's huge.

That is huge.

- I'm not trying to minimize crisis.

When you take someone to an emergency room or an inpatient unit, you take away their ability to resolve their crisis.

And so much of the time, we see that if you give someone a chance to work it through in an alternative setting, they don't need that, so- - And I wanna be clear about something.

This entire conversation, for anyone who's watching, the reason everyone has come to the table on this is not to make anybody's jobs easier.

It's about caring for the citizens of Sacramento and the people who are in need.

It's not about lightening the load of each individual department or the emergency room.

It's about ultimately being patient-forward, crisis-forward, person-forward.

And if you are in need, do not wait.

Make that call to 988 if you are struggling.

Your life is worth it.

And everybody on this panel right here that you're watching is here to tell you that.

Chief Costamagna, tell me what you're seeing on your end with the Fire Department and how that role is bridging this gap.

- Okay, I'll talk a little bit about what we've seen over time.

And for us in the Fire Department, it goes back into the 2000s, and crisis is what we talk about a lot.

In emergency medicine and field medicine, people have all types of crisises and we've seen that change over time.

You talk about addiction, substance use.

So those are crisises that we deal with every day.

And some of those are medical in nature, some aren't.

There's a lot of calls that we've started dealing with that were not emergent calls, what a paramedic is trained for.

So we started looking into those types of calls and the different types of things that we could do.

And we were very limited for a long time 'cause we had protocols that we had to follow, that led us to an ER and overimpacting the ERs.

As we went through the pandemic, we saw more of that: people that were sick, people that were scared.

And that was a crisis for people.

And as we went through that, the opioid crisis was happening in the background at the same time.

And it wasn't in the background, it was the forefront in our country across the nation.

So, coming out of the pandemic, we were able to stand up first a team that was for substance use and triage in a very narrow field.

And then we were able to grow into the triage to an alternate destination for patients and getting them to the right space at the right time on the first try.

It wasn't getting them to an ER to be transferred.

A lot of cases, people get frustrated.

When you're in crisis, you're right on the edge and frustration is real.

So, trying to minimize that for them and get them to the right place for treatment the first time, a lot of times we have great success just being there for them, listening to them, that helps curtail the crisis.

But getting them to the right place the first time and not taking them to an ER, that can't help them all the way through their crisis or is going to have to transfer them to help them was not the best patient care for us.

It wasn't the best care for our community and our citizens.

So working with 988, working with the local EMS authority, our doctor and our Fire Department, Dr. Mackey has been greatly helpful in us changing these protocols so that we can Triage to Alternate Destinations and start making a real impact.

And then we've also brought on other units that we can bring on a Basic Life Support Unit that doesn't take... Like a heart attack, they're gonna take the call that is getting triaged to the proper destination.

They're going to help us with actually a culture of using 911 to solve problems in a household.

And not everything is an emergent problem or issue for them.

So, we've been able to slow down the use of 911.

We're definitely seeing an impact on it, and I think we still have work to do.

We have 20,000 calls a year.

It's about 54 calls a day in Sacramento that are falling into this triage-level call.

- Moments matter when someone calls, and especially when you're dealing with substance abuse, because a lot of times, people can, if they're going straight to the hospital, there's time to...

Moments matter, and- - Yeah.

- Those moments in the hospital can be moments where someone chooses to leave and not get help, or to say, "Enough is enough, I'm ready for change."

But I love the triage approach of, in many cases, being able to go from beginning to destination without having someone slip through the cracks.

And ultimately, that's what this is about.

Because that can happen to many people, by nobody's fault.

It just happens time and time again.

And by eliminating that middle step and going from crisis to where you're going to receive that compassionate care that you need is huge.

- And it's the city that funded the crisis receiving site in the first place.

They said, "What are we gonna do to have an alternative?"

And we co-developed this model, a crisis receiving site, which we call The Crib 'cause it's kind of a thing where it's sort of a rock-a-bye-baby metaphor or it's what a lot of our clients think of as a safe place.

We think of it as a front porch.

But in the first year or two, law enforcement was almost the exclusive client for us bringing people in.

And let me just linger on that for a moment.

Law enforcement brought in people to the crisis receiving site.

Again, 14,000 visits over three years.

They brought people in who basically would've gone to an emergency room.

We created a three-minute drop off.

Don't even need to know someone's name.

As long as you bring them to us, and you think, "Yeah, I can drop this person off."

Otherwise, they would go to the emergency room.

Of all of those people who got dropped off, we have referred 4% to the emergency room.

- Wow.

- So when we're talking about the re-engineering of a system, we're re-engineering the way people metabolize their crisis as well.

We're giving them a chance to resolve that crisis.

We're giving them a chance to, let's say go straight to detox.

You don't have that opportunity when an ambulance historically has picked you up.

You have to go to the emergency room, and then you go through a process, like you said, Rob.

Now, people are dropped off, and we will actually have someone drive over from the detox and take them.

And surprisingly, 10% of people who come in with an acute intoxication and a psychosis as well often, within four to six hours say, "I think I need a detox."

10%.

It's kind of remarkable.

I think that fits with what Chief Lester said about her collaboration with Vancouver as well 'cause these models like really pair.

And so I can't emphasize enough the incredible triangulation of efforts here.

And Rob, what you've done is you've put the triangle on the screen for everyone here with the service organization, with law enforcement, and with EMS.

- It is, I I love what you just said, Jonathan, about how the person you're trying to help is allowed to be in a place at the crisis receiving, Crib, you call it, where they feel like they can have a voice in this and say, "You know what?

I do need help."

And it takes a special place to be able to lean in to that language.

And it is clear that has been created and is working.

Chief Lester, I remember going to your swearing in, and you had your entire family up there: your husband, your children, your parents were there, who were just delightful.

And that stuck with me, because now, as I'm talking to the three of you, this feels very much like a family approach to dealing with a problem, and that everyone's coming to the table to try to solve something and help someone.

I've spoken to your officers on the street, they say that you take that role very much to heart as bringing in that familial touch to the Police Department.

And I believe that when you're responding to mental health, that that is such an important role because it's been something that has been separated many times.

Over the years, people have become ostracized for one reason or another from family members when this happens.

And it's nice for a fresh set of tools to come in that has the tools to help someone move forward.

And I see that in all of you.

I want to run to each of you and say you're on the air.

What do you want to say about this and what do you need?

- Ooh, that's a good question, right?

Okay.

Chris and I, our city manager, the former head of DCR, member of our Mayor's Office, we went to Albuquerque a couple of years ago because they have a organization, it's city-sponsored, but it's called Albuquerque Community Safety.

And it's to do a lot of...

It's to really formalize the work that WellSpace and Dr. Porteus does, which is to create the right response for the situation at hand.

You know, we do that here to a certain extent.

We have community service officers that take our sort of nonviolent calls to offer that service.

But these are trained professionals, and there are a lot of people in our community that want to serve our population in need.

They don't necessarily wanna become a police officer because that's such a different...

I mean, that's a very demanding job and really requires very unique skills, I would say.

But they still wanna help.

And so there's a lot of people that can do this type of work.

They can relieve the burden from fire, from PD, and they can give people the best response.

And Chris and I went on ride-alongs, actually, with this group, and I was so impressed at the community response and how the community really welcomed this group and the collaboration between Fire, the Police Department, and then our community providers.

And I think that we can get there.

We have to refocus, we have to fund that properly, and we have to make sure that every one of those agencies has the support that they need, track metrics, and be able to report back.

But in the future, I really am going to push for that, and I hope that's where we land.

- We've moved from a system of response that was 911, relying on emergency rooms and jails, essentially.

We've moved to a system that is not reliant as much on law enforcement and other first responders as the first responders.

And that has a different model that involves crisis receiving.

Again, step one, place to call, 988.

Step two, a response we dispatch out, the appropriate response.

And then step three, crisis receiving.

I should point out, when it comes to crisis receiving and that Triage to Alternative Destinations, it might be helpful for the viewers to understand that two people on this call, Chief Lester, Chief Costamagna, they are largely responsible for changing state law.

This is not, when we talk about re-engineering, when you say, "Oh, I'm gonna see if we can get an ambulance to go somewhere else," that is not legal.

So the law has to be changed.

So this is not being just a local vision.

This has been a vision that's required law to change across the state to allow us to do this.

And so- - And I'm talking long-standing laws.

I mean, this was major work.

- Yeah, so the front end user might say, "Gosh, I'm on the way to the right place," but we all should really realize that they're on the way to the right place because of a huge amount of work that's gone into having a vision for that and making it work.

And then I think we just really need to be clear that we are working together, that it's about the appropriate response for people and people having the opportunity to resolve a crisis.

95% of the calls to 988 get resolved within 988.

What you see predominantly is a move to community, to crisis, mobile crisis, and then a move to crisis receiving.

That is the re-engineering that is phenomenal.

And I'm honored to work with two people who is visionary and powerful in changing the system.

This is a drop in in not just a local bucket.

There are ripples here.

The Chief Lester here goes out and talks to police chiefs across the state, and they're all saying, "What are you doing?

What are you doing, right?"

The sheriff is doing the same thing, but there's a partner in Del Norte County, there's a sheriff who's thinking of doing exactly what Sheriff Cooper's been doing.

And the sheriff is engaging in conversations at the state level, and they're bringing us in, because guess what?

We're the 988 provider for that county as well.

And so best practice that saves lives is being promulgated out of Sacramento County by the very people you're talking to here, which is incredible.

So we're not just saving lives here, we're saving lives there.

And I think we're just gonna do better.

988 as a phenomenon only became real in 2023.

'22, sorry, the middle of 2022.

So we're seeing the growing of this re-engineering and it's going extremely well, but it's going extremely well because of the partnership and vision.

- I just have to say, I salute each of you for this.

This is such a big deal, and we are in such need as a society to hear good news and things that are working.

And as I look at each of you, I see it.

I mean, this is phenomenal.

Thank you, just from my heart, for doing everything you do to make this happen because it has not been an easy journey, but it has been worth it, and this is proof right here what we're looking at.

- Thank you for taking the time to cover a story like this in depth.

This typically would not get the attention or the coverage that I think it deserves.

So, really appreciate you for diving deep into these issues and sharing with the community... Kind of what we do and what we're trying to do and ask great questions.

And it's always great to work with you, so thank you, Rob.

- It is my honor and it is my privilege.

And you know what?

It's my job, and I take it seriously.

All right, thank you all so much.

- Thank you so much.

- Thank you for having us.

- It's so good to see each of you.

And thank you for joining us here on "Region Rising."

If you are in need, pick up the phone and call 988.

You do not have to wander this journey of mental health struggles or crisis alone.

There is somebody there to help you.

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You can watch when you want at robontheroad.org.

(bright music) (uplifting music) - [Announcer 1] Murphy Austin Adams Schoenfeld, LLP, focusing on business law and commercial litigation, is proud to support "Rob on the Road: Region Rising."

More information available at murphyaustin.com.

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