‘People don’t think clearly in crisis:’ California police tap mental health clinicians on toughest 911 calls
California law enforcement agencies are embracing new approaches to mental health crisis calls. But some activists still want a solution without police, including volunteers in Nevada County who came together after a fatal shooting.
The man sat silently on a cluster of boulders when the Nevada County Sheriff’s Office mobile crisis team pulled up. His phone, an open can of Dr. Pepper and a colorful glass marijuana pipe splayed out beside him as he looked out on the wooded valley below.
Minutes before, siren blaring, sheriff’s Deputy Galen Spittler raced his patrol truck through the winding Penn Valley roads to respond to a report of a 33-year-male — one they had placed on a psychiatric hold last fall — assaulting his mother. Now the man stood calmly, barely responsive, as Spittler checked him for weapons.
Up the dirt road, his mother sobbed. The man was not taking his medication for bipolar disorder since he got home from his latest hospital stint a few weeks ago, she said. When she tried to call the local behavioral health agency for an appointment, she said he threatened to kill her and threw a baseball bat at her.
“It’s been hell every day here. It’s been hell every day here,” she wailed. “It’s not a normal life.”
Clinician Ernesto Alvarado led the woman through breathing exercises to calm her down. He joined Spittler on patrol a year and a half ago when Nevada County created its mobile crisis team — a partnership between the sheriff’s office and the behavioral health department meant to defuse volatile situations and funnel more people into services rather than the criminal justice system.
“It changes how your body reacts to things,” Alvarado told the woman. He offered to take her to the county crisis stabilization unit if she was feeling overwhelmed by the confrontation with her son.
“I just want him to get help,” the woman said. “He needs medication. He needs something. I can’t take it no more. I’m at my wit’s end.”
Alvarado assured her they would place her son on another 72-hour hold at the local emergency room for evaluation, and that he would recommend the man be transferred to a facility for longer-term treatment.
“We don’t really have the final say,” Alvarado said. “But I also work there, so I’ll make sure, when they ask me, ‘What do you think?,’ I’m definitely going to tell them.”
The Nevada County Sheriff’s Office is among the wave of law enforcement agencies across California and the country rethinking how they handle mental health-related calls.
As the national reckoning over use of excessive force and the death of unarmed civilians gained steam during the past decade, demands also grew for communities to reconsider their approach to the personal crises — severe mental illness, homelessness, substance abuse — underlying so many 911 calls, arrests and, sometimes, fatal encounters with police. The debate was supercharged in the summer of 2020, following the murder of George Floyd and mass protests over policing practices, with many activists urging that law enforcement be removed from non-emergency response altogether.
Since then, new programs pairing law enforcement officers with behavioral health clinicians as patrol teams have popped up throughout California, including in San Mateo County, Pleasanton, Palo Alto, Santa Maria, Sacramento County, Humboldt County and Modesto. The Los Angeles Police Department expanded its decades-old mental health unit and moved it from a secondary to frontline response.
Supporters have promoted this strategy as a way to bring more sensitivity and care to some of the toughest, most time-consuming 911 calls, while freeing up officers to focus on their primary crime prevention duties.
To succeed, however, these efforts will need to rebuild trust between law enforcement and residents who led the push for change, often skeptical that the solution could come from police.
That is the case even in a place like Nevada County — overwhelmingly white, politically moderate, where law enforcement officials say they feel strong support. Pockets of anger and doubt linger over the February 2021 killing of Sage Crawford. Sheriff’s deputies shot Crawford, who was walking down a road with her two young children, after she accused the officers of trying to take her kids and charged one with a knife. The mobile crisis team was off-duty at the time.
A community group formed last year following Crawford’s death. It’s now working to establish a volunteer-run hotline that could supplement and potentially provide an alternative to the sheriff’s team for mental health crises and homeless people in distress, situations that its leaders argue are exacerbated when someone shows up with a badge and a gun.
“It will just automatically escalate the situation,” said Libby Woods, an educator in Nevada City who spearheaded the project. “It’s all hands on deck to save people’s lives.”
‘People don’t think clearly in crisis’
Though the mobile crisis team launched just a few months after nationwide protests over police brutality reached all the way to tiny Nevada City, the county seat, Sheriff Shannan Moon said she developed the program entirely separate from the social justice movement.
Her interest began while working in crisis negotiations, which proved to her the value of taking time to talk to people in distress, according to Moon, a 32-year veteran of the department.
She led the investigation of the 2001 shooting spree in which a Nevada County man — who was unhappy with the services he received through the behavioral health department — killed three people, including 19-year-old receptionist Laura Wilcox. Her death prompted the Legislature to pass Laura’s Law the following year, allowing for court-ordered outpatient treatment in Nevada and about two dozen other counties that have since adopted the measure.
After she was elected the county’s first female sheriff in 2018, Moon drew inspiration from a team in San Diego County that pairs law enforcement and mental health clinicians to respond to psychiatric emergencies, which was run by someone she knew.
Moon originally saw the mobile crisis team as an opportunity for greater efficiency in a small office spread thin across the nearly 1,000 square miles of this largely rural county of 100,000 people about an hour northeast of Sacramento. Putting a social worker in the field could save time for deputies who encounter someone in a mental health crisis and must make a judgment call about whether to transport them to the emergency room for a formal evaluation. The team could also more directly connect people to services, rather than simply moving on if they did not meet the criteria for a psychiatric hold.
“People don’t think clearly in crisis,” Moon said in an interview at the sheriff’s office. “When you have the opportunity to slow down, you are able to come to a really good dialogue about what’s best for someone, and get someone to calm down and really look out for their best interest. But they have to be able to trust you to do that. And that trust is built on that conversation. It’s all about the conversation.”
The first team was formed in October 2020 and a second was added last November. The two now split the week, working either three or four 12-hour days, from 7 a.m. to 7 p.m., responding to issues such as suicide threats, psychotic breaks and drug use.
One recent case involved a homeless man who threatened to kill himself because his dog had been taken and he couldn’t afford to get it out of the shelter. Alvarado, the clinician on the team, said he contacted the county homeless outreach program, which paid the shelter bill for the man’s dog and then set him up with a caseworker.
Alvarado — who has two decades of social work experience with child welfare, adult protective services, homeless youth and behavioral health — said his goal is to find an outcome that allows a person to remain in the least restrictive environment. While someone that he and Spittler assess to be a danger to themselves or others can be detained for psychiatric evaluation, more than 70% are not. Most calls are resolved with a “safety plan,” a verbal agreement with the person that might involve seeking help from family, their therapist or other services in the community.
“We go into every…situation making sure that we both feel comfortable walking away,” Alvarado said. “And then we walk away, what do we have to do to ensure that this person is going to continue to be safe? That takes a lot of energy.”
That means that for the vast majority of people they encounter, Spittler said, “we didn’t further traumatize to be able to get them the help that they needed.”
‘We are the fixers’
On a sunny Tuesday in March, Spittler drove Alvarado around the expansive backroads of western Nevada County over the course of their 12-hour shift, a soundtrack of hard rock occasionally keeping them company. Spittler frequently checked a computer terminal next to his seat for details on calls for service to determine whether they should respond: “We get really good at triple-tasking while we’re driving,” he said.
Alvarado’s bulletproof vest sat upright in the backseat of the truck like another passenger. Though Spittler is required by the department to wear his vest at all times, Alvarado tries to avoid it on most calls to draw a distinction between his role and that of law enforcement — and also, he says, because he doesn’t want to look like a “poser.”
Late in the morning, a colleague called the mobile crisis team for backup to check on a woman with a broken wrist. Though her medical provider suspected potential domestic violence, the sheriff’s department already knew the woman, who had recently been calling 911 to falsely accuse people of sexually abusing animals and filming child pornography on her property. Her children had told deputies it was likely due to a growing brain tumor.
Like other residents the mobile crisis team dealt with that day, CalMatters is not naming the woman to protect her privacy.
While Spittler and the other deputy pulled the woman aside to ask about her wrist, Alvarado spoke to her partner, who towered in the door frame, snacking on a handful of nuts. Alvarado suggested that he try to reassure the woman when she told him she was seeing things outside, rather than walking away and shaking his head.
“She’s probably scared, you know? Because she thinks she’s seeing someone. That would be pretty frightening,” Alvarado said. “So maybe just say, like, ‘Well, okay, maybe just stay inside with me and I’ll keep you safe.’ Something simple like that.”
Alvarado asked if the woman was enrolled in Medi-Cal, the health insurance program for poor, elderly and disabled Californians. Because she was, he promised to refer her to the in-home supportive services program to get more help caring for her at home.
“She’s gonna fight it,” her partner said. “She’s in denial. She honestly believes she sees these people.”
Requests for the mobile crisis team are becoming more common as it receives more attention in the community, Spittler said, a reflection of how people turn to law enforcement for help when they don’t know how else to deal with a situation. During the patrol shift, a woman called Spittler asking if the mobile crisis team could be there when she evicted a man living on her property.
“We are the catch-all for everything,” he said. “If someone doesn’t know how to fix something, we are the fixers.”
‘It was like a comedy of errors’
That reputation was tested early. On Feb. 4, 2021, less than four months after the team was created, Nevada County sheriff’s deputies killed Sage Crawford in the unincorporated residential community of Alta Sierra. Though the shooting happened in the early afternoon, Spittler and Alvarado were unavailable to respond, according to the sheriff’s office, because one of them had gone home sick.
Instead, two deputies responded to several 911 calls about a woman, reportedly distressed that she was being pursued and carrying a knife, walking through the streets with her two young children.
In dashboard camera video later released by the sheriff’s office, Crawford appears immediately anxious when the deputies arrive, yelling at them not to “hurt my babies” and trying to put herself in front of her children. The deputies ask Crawford to put away her knife and talk to them. As she slowly walks toward one of the deputies, screaming that the world “will know the truth” if they kill her, the other fires his taser at Crawford from behind. She immediately chases after him and the first officer opens fire, apparently hitting Crawford, who falls to the ground.
The confrontation lasts just less than 90 seconds. The sheriff’s office said the deputies rendered medical aid to Crawford, who died at a hospital. Sheriff Moon asked for an independent investigation by the Nevada County District Attorney’s Office, which still has not issued a report on its findings.
A series of vigils and protests followed, led by local activists who questioned why the mobile crisis team was not dispatched and whether the deputies who responded had adequate training to de-escalate the situation.
“Why didn’t the cops just simply slow down, back off and call for mental health backup?” asked Lorraine Reich, a local attorney who formed a community task force to look into police training and policies in the area. “It was like a comedy of errors, Keystone Kops, just stupid, stupid.”
Moon would not discuss the specifics of the shooting, citing pending litigation and the investigation, and would not say whether her department had drawn any lessons from what went wrong. But acknowledging the outrage that resulted in the community, she said it was not realistic to expect that a clinician could be available to respond to every call for service, or that a different approach to mental health crises would automatically change the outcomes.
“To take a specific incident and say, in a perfect world, would this team have had a different outcome? I don’t know,” Moon said. “I look at every single instance, whether we’ve done great work or whether the outcome isn’t great, like a tragedy like that. And I say, no matter what, what can we do to improve services?”
“De-escalation also is a two-way street. You still need to get someone that believes in that process, that deescalates,” she added. “Sometimes in complex situations, tragedies happen.”
‘They’re not my friend’
More than a year later, a group of activists is still pushing for changes to crisis response in Nevada County.
The relationship with local law enforcement had already been frayed by several other incidents, including an August 2020 Black Lives Matter march in Nevada City, where officers were criticized for not stepping in to protect demonstrators from violent counter protestors.
But the Crawford shooting sparked a sustained campaign calling for a new approach similar to CAHOOTS — a program established in Eugene, Oregon, in 1989 that diverts low-level 911 calls related primarily to mental health to two-person teams of medics and crisis workers. It has become a widely-considered model over the past few years as governments struggle to reimagine public safety.
San Francisco and Los Angeles launched pilot programs to send mental health workers instead of police to assist people who are mentally ill, homeless or on drugs, and another is rolling out in Oakland this spring. A handful of community-based crisis response teams, operating entirely outside of the 911 system, have also emerged, such as Sacramento’s Mental Health First, which staffs an overnight hotline on the weekends with volunteers. Last year, the state approved $10 million in grants to expand these types of projects.
Woods and other Nevada County activists have been working for the past year toward setting up their own hotline, which they say could provide an alternative for vulnerable residents who would rather not call the police for help, or who want a buffer when law enforcement is on the scene. They hope to launch it later this year, starting on weekend nights when other services are not available.
But in recent months, they have focused on crisis intervention training and building trust with the communities they expect to serve, including by hosting a holiday meal and focus groups with local homeless residents.
On the first weekend in February, a small group gathered in downtown Nevada City to memorialize the anniversary of Sage Crawford’s death and to distribute supplies, such as food, water, first aid kits, sleeping bags, Narcan and fentanyl testing strips.
A modest plaza, anchored by an imposing 12-foot tall turbine long retired from power-generating service, was decorated with neon-colored paper lanterns. One table, covered in a cloth with a pattern of flowers and leaves, offered trays of homemade burritos.
The event alternated between solemn memorial — Woods led a moment of silence for people who died by “state violence” — and joyful celebration, where attendees hula-hooped to Whitney Houston’s “I Wanna Dance With Somebody.”
Monte, a local artist who said he became homeless about five years ago when the rent on his studio increased, held a sign demanding “Justice for Sage.” He said he met Crawford while working at the local emergency shelter and was frustrated that her death had been largely ignored. It exemplified the poor treatment that homeless people in the area routinely face, he said, from the broader community and from police.
“They’re not my friend. The word to me in the middle of law enforcement is force,” said Monte, who declined to give his last name. “A lot of people have been hauled in by law enforcement, so they don’t look at them with benevolence.”
Near a small altar for Crawford, decorated with dried flowers and corn cobs, Olivia Steele burned sage to cleanse the space. A student at Sierra College who is homeless and building out a van to live in, Steele said the shooting was a reminder that tragedy is never far away for someone without access to good mental health resources.
“It could have been me,” she said. “It’s been justified so much when the reality is we deserve to be safe.”
Steele said she was wary of Nevada County’s mobile crisis team and favored removing police from mental health calls because it creates an association with crime that stigmatizes people. Law enforcement, she said, would always prioritize a criminal response over getting someone the help that they need.
“The police are not going to protect us the way we need to be protected,” Steele said.
Jamie Williams, who is organizing a network of counselors who could volunteer for the crisis response hotline, said she struggled to get help for her son when he began exhibiting bipolar disorder three years ago. As his behavior became more intense and paranoid — including getting into confrontations with other skateboarders at the local skate park and hiding knives in his backpack — Williams feared her son might be killed by law enforcement. She circulated his photo to officers so they would know his story if they encountered him.
Crawford’s death demonstrated why people need another option than calling 911 when they see someone in distress, Williams said. “The more we educate ourselves about what we can reach towards, besides the police, the more we create a change.”
‘I don’t want to risk my own safety’
A widespread shift away from law enforcement, however, would require the state to invest extensively in building a separate emergency response system for mental health, according to Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California.
While the country has begun to take some steps in that direction, with the scheduled July launch of the 988 dialing code for the National Suicide Prevention Lifeline, the patchwork of services available in California has long been at the discretion of local agencies.
In a survey last year, Cabrera’s organization found that 36 of California’s 58 counties offered some type of mobile crisis service. Most respond to calls at the request of law enforcement, but some are separate teams of behavioral health workers dispatched by 911 or a co-response of officers and clinicians, as in Nevada County. It’s difficult to pull apart that infrastructure, Cabrera said, because 911 has historically been where people in crisis are connected to mental health services.
“Diversion away from criminalization is a good thing,” she said, but working in tandem with law enforcement serves an important safety function. She noted that even in the CAHOOTS model, where calls for service are screened by dispatchers, only about one in five are diverted to the crisis response teams, who can call on police if a situation becomes dangerous.
“We need to evolve the conversation where there’s not so much drama,” Cabrera said.
In Nevada County, officials remain committed to the sheriff’s mobile crisis team. After receiving a $250,000 grant from the U.S. Department of Justice last fall to fund the second team, Moon is exploring whether to add two more to cover the evening and late-night hours.
Moon said she believes the number of people in the community who distrust police and are looking for an alternative is “very small.” During mobile crisis team calls, Spittler and Alvarado said, as many people gravitate to Spittler because of his uniform as avoid him, while some want nothing to do with Alvarado because of bad past experiences with social workers.
Amid the ongoing turmoil over the Crawford shooting, Alvarado believes that some residents have developed unrealistic expectations for their team and a misunderstanding of their work. There’s no guarantee, he said, that the situation would have turned out different had he had been there that day.
“I’m not a wizard. I can’t just wave my hand and calm everybody,” he said.
While he agrees that crisis workers in community-based programs can benefit from a more grassroots relationship with the people they serve, he said not having a member with the authority to arrest someone gives their teams less leverage. And there’s a flipside to the concern that police responding to a mental health call with a gun inject another level of risk into the situation — it leaves clinicians and medics vulnerable.
“I won’t do that job,” Alvarado said. “I don’t want to risk my own safety to do that.”
During their afternoon call to the home of the Penn Valley man who reportedly threw a baseball bat at his mother, Spittler and Alvarado quickly agreed that they should place him on another psychiatric hold.
“Have things not been going very well between you and your mom?” Alvarado asked the man. He did not engage, and Alvarado concluded that he did not have enough insight into his own behavior to allow him to stay home with his terrified mother.
Spittler said the man seemed rehearsed as he argued with the deputy that he was sober and did not need to be detained, like someone who had been through numerous stays in mental health facilities and knew what he was supposed to say to avoid getting sent back.
But the man grew agitated as it became clear that he wouldn’t get his way. For nearly 15 minutes, Spittler and two other deputies tried to coax him to voluntarily seek help.
“Can we please discuss it and then go?” the man asked.
“Nothing’s going to change what’s going to happen,” one of the officers finally said, before the three of them pushed him into the back of a patrol truck and strapped him in.
At the emergency room in Grass Valley, Spittler led the man to an exam room, changing him into a hospital gown and mask as nurses paraded through to administer a series of tests.
Next door, Alvarado was filling out the paperwork to place him on the psychiatric hold, their eighth of the year so far, squeezing the justification into the two lines provided. Given the man’s history, Alvarado wanted to strike the right balance — make it clear that the man needed help, without discouraging a mental health facility from providing him a bed because they might not want a violent patient.
When Alvarado returned with the form an hour later, the mobile crisis team handed off the man to hospital security and his case to the behavioral health department. Because of medical confidentiality, Spittler and Alvarado would know little, if anything, about what happened to him.
As they headed back to the office to finish paperwork, they simply had to hope for the best — hope that the man got the help he needed this time, hope they wouldn’t encounter him again on another call.