San Francisco (CA) Proposal Would Allow Paramedics to Order Mental Health Holds

Steve Rubenstein

San Francisco Chronicle


Paramedics — not just police officers — could impose mental health holds on disturbed people in San Francisco under legislation introduced Tuesday.

The proposal by Supervisor Ahsha Safaí would give about three dozen paramedics the authority to order people they believe are experiencing a mental health crisis and are a danger to themselves or others to be held in confinement for up to 72 hours.

“It’s time to try something different,” Safaí said. “It’s heartbreaking to see people who need help sitting by themselves, talking to themselves, deteriorating. We have a mental health crisis on our streets and we need to show compassion.”

Emergency workers receive about 15,000 calls a year about people in mental health emergencies. Of those, 148 resulted in psychiatric holds in 2020.

Paramedics, he said, are as suited or more suited to making mental health decisions than police officers. Granting them the authority could reduce the mental health crisis and the specter of clearly troubled persons wandering about without help.

Safaí’s ordinance follows a proposal unveiled Monday by Mayor London Breed to create “wellness teams” to respond to non-emergency calls for services that are most often handled by police officers. The proposal builds on last year’s rollout of mental-health crisis teams who respond to calls for psychiatric emergencies.

The proposed ordinance would amend the city’s health code to allow paramedics specially trained in mental health procedures — about half of the current paramedic force — to “initiate temporary psychiatric holds.”

Safaí acknowledged that no county in California authorizes paramedics to make that decision.

“We absolutely have to proceed with caution,” he said. “But it’s important to have this tool, to shift responsibility away from the police, to avoid criminalizing a situation when someone is in crisis.”

UC Berkeley law school professor emeritus Jesse Choper, an expert on constitutional law, said the proposal raised no immediate civil liberties concerns in his view and “sounds like a reasonably OK thing to do.”

Berkeley law school dean Erwin Chemerinsky agreed that the proposed law made sense and he “can’t see why it would be different” to extend to paramedics the same discretion to make mental health hold decisions that police exercise.

“I can see the benefit in having this handled as a medical issue as opposed to a law enforcement issue,” the dean said.

Steve Rubenstein is a San Francisco Chronicle staff writer. Email: Twitter: @SteveRubeSF


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