photo credit: Sonoma County
Sonoma County crisis support vehicle.

For the past few years, mobile crisis teams made up of mental health professionals have been responding to many police calls in Sonoma County — instead of armed officers.

Now, the proposed state budget puts California’s mobile crisis teams at risk.

KRCB’s Shandra Back speaks with Press Democrat healthcare reporter Martin Espinoza about what the shift could mean for the North Bay.

 KRCB: What does a mobile crisis team look like in practice?

ESPINOZA: It’s staffed mostly by mental health professionals — people who work in concert with law enforcement — and they respond to mental health crises, like if somebody is having some kind of breakdown or if something is happening on the street and somebody’s having an episode.

The way it was before, in Sonoma County, those situations would usually get a response from first responders, usually law enforcement. And about 20 years ago, we had a string of fatal incidents involving law enforcement and people in mental health crisis. In the span of about 12 months, four people were killed.

In response to that, in 2012 the county set up its first mobile crisis team, and it has evolved since then. They’ve been very helpful in acting as a buffer between law enforcement and the people who are — many of them on the street, but some of them calling from home.

KRCB: If it was set up in 2012, help me understand a little bit of the funding.

ESPINOZA: It was primarily local funding at that time. But during the pandemic, the federal government enhanced its funding of Medicaid — in California, that’s called Medi‑Cal. It operates on a federal match and a county match. Usually it’s about 50/50, so the federal government pays 50% and the county pays the other 50%.

But after the pandemic, the federal government said, “We’re gonna kick in 85% of the funding for this.”

Under the enhanced federal match, the federal government says, “We’re gonna pay 85%. The state or the county can pay the other 15%.”

The state says, “Well, that’s 15%. That’s not a lot of money. We’ll pay that, and we’ll make this a mandatory benefit.” When the state designates a Medi‑Cal benefit as mandatory, it’s telling counties, “You have to do this.”

KRCB: In your reporting, you wrote that the state is stepping back from this funding.

ESPINOZA: Right. That 85% federal match expires next year. Now it’s going to go back to the usual 50/50 match.

So the state — because it’s paying only 15% right now — says it can’t afford to do the other 50. It’s pulling back. It’s going to redesignate the benefit as an optional benefit. As an optional benefit, the state no longer has to pay that non‑federal match.

So it’s up to counties to come up with the other 50% after next year. And the state says it would cost about $170 million to cover mobile crisis services at their existing level. It’s facing a $3 billion deficit this year, and it’s saying, “We don’t have the money to do this.”

KRCB: What would that mean if some counties can pick up those costs and some can’t?

ESPINOZA: Fundamentally, it raises the risk of loss of life if a situation escalates. Many times, police officers are not the most appropriate response for somebody who’s having a mental health crisis. They’re not behavioral health professionals. They don’t know how to approach that kind of situation.

For counties like Lake that don’t have a lot of money, they’re not going to be able to support something like this. Marin might. Sonoma County would probably have to reduce the level of service it provides. So you’re going to have a situation where some counties can afford it and others won’t.

KRCB: Why did you choose to report on Lake County?

ESPINOZA: The behavioral health director in Lake County was one of the first in this area to respond to that change. They offered a ride‑along with their behavioral health team. I tried to do the same here in Sonoma County, but there were some hurdles.

KRCB: What were people saying about what that shift would mean for the mobile crisis team in Lake County?

ESPINOZA: It would put the burden of responding to these mobile crises back onto the police department. And one of the things the chief at the Lakeport Police Department told me was that many of their police officers have only been there a couple of years. He’s worried that having young, inexperienced police officers responding to psychiatric crises is just not a good idea.

KRCB: You went on this ride‑along. Explain what that was like.

ESPINOZA: At the time I was there, there weren’t a lot of calls. We did mostly outreach. We visited a guy — it was just a checkup. We sat with him and talked about his experience.

He has multiple diagnoses: schizophrenia, PTSD, ADHD, and he’s an alcoholic. One of the things he told me is that the team keeps tabs on him, checks up on him, inspires him to stay healthy and sober. He got very emotional about the relationships he’s developed. It’s a reflection of the humanity these people bring to these crises when they respond. I’m not saying law enforcement doesn’t bring that same humanity, but it’s a different model.

They’re not behavioral health professionals, and they’re constantly on guard.

KRCB: And with that person you spoke with, did they respond to what might happen if the mobile crisis team is dissolved?

ESPINOZA: He said these people have basically saved his life, and he fears what would happen if they weren’t there. And we know what would happen because it’s happened in the past here in Sonoma County. We’ve come a long way from that.

But it’s a model that works. And if it’s gone, we’re going to have to fall back on something — and we already know what that looks like when it’s just law enforcement responding to a growing number of mental health crises.