Palo Alto's newest emergency-response team features first-aid responders, crisis-intervention specialists and community residents with firsthand experience with mental health struggles and substance abuse.
It's most remarkable, however, for whom it does not include: police officers.
That's what sets the North County TRUST (Trusted Response Urgent Support Team) apart from other recently established programs that seek to provide an alternative to law enforcement for calls that involve mental health, substance abuse and homelessness.
One such program is Palo Alto's Psychiatric Emergency Response Team (PERT), in which a police officer partners with a behavioral clinician from Santa Clara County. (The program that is now on hiatus as the city looks for a new clinician to replace one that recently departed.)
Another county program is the Mobile Crisis Response Team (MCRT), which consists of clinicians who are trained in crisis response and which works closely with law enforcement. The program launched in 2018 and and handled about 5,000 calls in 2021, according to the county. That's up from about 3,400 in 2020 and 1,200 in 2019, according to county data.
Of the three, North County TRUST comes closest to the paradigm that Eugene, Oregon, established nearly three decades ago when it launched its CAHOOTS program. By responding to calls involving intoxicated, mentally ill or disoriented individuals, Eugene's mobile crisis-intervention program takes on calls that in other communities would be handled by police officers.
North County TRUST, which rolled out last November, similarly relies on vans staffed with clinicians and de-escalation professionals and focuses on relatively low-risk calls. The goal, according to staff, is to meet people where they are, de-escalate the situation and provide them with a safe space.
The program received a big boost last year in the form of a $2-million earmark from U.S. Rep. Anna Eshoo, D-Menlo Park. This week, the Palo Alto City Council formally accepted the grant and heard a presentation from the program administrators from Momentum for Health, the nonprofit overseeing North County TRUST.
Dr. Shefali Miller, chief medical director at Momentum, said the TRUST program augments the two county programs already in place.
"Those two teams are really meant more for higher acuity situation, where you might think there's an imminent danger to self or others," Miller told the council. "Whereas the TRUST team will be more of a preemptive, low-acuity response to something that hasn't yet involved to that level of acuity."
The TRUST team covering Palo Alto, Mountain View and Los Altos is one of three units in Santa Clara County; the other two are based in San Jose and Gilroy. Before the north county unit was launched last year, County Supervisor Joe Simitian lauded the program for helping to "ensure the right response in a moment of crisis."
"Obviously, when the police are needed, we want them there. But we've got to be smarter and more adapt about getting the right kind of help to the right place in the right set of circumstances," Simitian said in a statement.
The TRUST vans are on duty between 7 a.m. and 7 p.m., seven days per week. The Mobile Crisis Response Team handles calls that fall outside the hours, in addition to helping the TRUST team with more urgent calls.
The TRUST teams are directed through a call center operated by the mental health nonprofit Pacific Clinics. The van responds to calls that come in through the suicide and crisis hotline, 988, and they follow up after the initial interaction with case management and assistance in navigating health care, housing, education and other services, according to a report from Palo Alto City Manager Ed Shikada.
A key component of the program is community engagement. North County TRUST includes eight outreach workers charged with educating residents, businesses and organizations in the three cities about the new response service.
"These workers will also engage with local community-based providers to let them know about the services and how to access these so they can in turn share the information with their constituency," the report states.
The program also has a goal of training 1,040 individuals in mental health first aid to make referrals to behavioral health services through the new model. And it includes two case managers charged with providing follow-up assistance to people who've already had a field visit from the North County TRUST team.
In describing the program, Miller cited data that between 25% and 50% of fatalities caused by police officers involve individuals with mental health problems. Many other individuals end up incarcerated, a response that does not address their underlying issues.
"So we really want to dissociate a behavioral health response from a criminal justice response and really try to avoid unnecessary fatalities, unnecessary incarcerations for people who really need something other than that in order to resolve their issue," Miller said.
"The idea is, if you bring people who are trained in behavior health work to the scene, unarmed and without police backup, you can really de-escalate the situation much more peacefully and get to a better outcome by even then follow up and linking them to the resources they need."
The council strongly supported the program, which is being funded for five years. Mayor Lydia Kou said she was "very excited" to see the TRUST team getting boots on the ground to take care of local residents, while Council member Pat Burt said he was struck by the high percentage of police-related fatalities that involve someone with a severe mental illness, a statistic that he said "further reiterates while programs like this are so badly needed."
Kou said the federal grant will augment the county program and allow it to add scope to Momentum for Health, including more case management.
"We really hope the community takes advantage of this program in their times of need," Kou said.
Vice Mayor Greer Stone, who strongly supported establishing the program, said he was relieved to hear that the program is now up and running. The CAHOOTS program, he noted, has saved Eugene tens of millions of dollars over the years by redirecting law enforcement resources to alternative models.
"I'm excited to see how much we can expand this," Stone said.