San Francisco, CA — Mayor London N. Breed today announced a new program that will expand training to community paramedics as part of a Citywide effort to help people experiencing behavioral health crises on our streets.
San Francisco Fire Department (SFFD) community paramedics that respond to people in crisis on the streets are training to initiate 72-hour involuntary psychiatric hospitalization holds to better serve people experiencing mental health emergencies in San Francisco. Colloquially, these 72-hour hospitalizations are known as “5150 holds” or “5150s.” Currently, only captain level community paramedics are authorized to place involuntary mental health holds.
To date, 55 active community paramedics and community paramedic captains have successfully completed the training; 23 are part of this expansion.
“This new program will give SFFD community paramedics the tools to better help people experiencing a mental health emergency,” said Mayor London Breed. “When someone fits the criteria of a 5150 hold, it is critical that they receive care in a timely manner. This is about getting people the help and care they need in their moment of crisis.”
SFFD community paramedics on the Street Crisis Response Team respond to 911 calls for individuals experiencing a behavioral health crisis. Local legislation provides authority for paramedics and community paramedics to receive the specific behavioral health training and authorization like other mental health providers to initiate 5150 holds so that individuals can receive the appropriate assessment in a hospital setting.
Community paramedics have six weeks of additional training that includes practicing trauma informed care, de-escalation techniques, resource navigation, and recognizing social determinants of health.
Under section 5150 of the California Welfare & Institutions code, an individual can be observed and treated in a psychiatric facility for up to 72 hours if they are determined to be danger to themselves or others or is gravely disabled. Once the individual is placed under a 5150 hold, they are further assessed at a hospital to determine whether the 72-hour involuntary placement is warranted.
There were approximately 13,669 5150 holds treated at the six largest local medical centers (Zuckerberg San Francisco General Hospital, California Pacific Medical Center; Kaiser Permanente; Saint Francis Memorial Hospital; Saint Mary’s Medical Center; and the University of California, San Francisco) in San Francisco in Fiscal Year 2021-22.
Under Welfare and Institutions Code, peace officers and professionals authorized by a county director of behavioral health, including licensed behavioral health clinicians, have the authority to initiate 5150s. The county reviews 5150 holds to ensure quality of services and appropriate use of involuntary treatment.
The San Francisco Department of Public Health (SFDPH) began training SFFD non-captain level community paramedics to initiate 5150s last month. Additional rounds of training will occur every four months, as needed. After trained paramedics pass the training and test, Dr. Hillary Kunins, SFPDH Director of Behavioral Health and Mental Health SF, will authorize 5150 application powers.
“Expanding 5150 training to community paramedics will support the City’s ability to respond to mental health crises,” Dr. Kunins said. “Our goal is to deliver life-saving care to people in crisis and to facilitate their wellness and recovery.”
The San Francisco Health Code was updated effective September 2021 to expand designation for initiating 5150 WIC holds to SFFD paramedics. The newly trained paramedics may begin placing holds on Monday, July 10, granted all requirements are met.
The Department of Emergency Management (DEM) coordinates street response teams from City departments, including SFFD, SFDPH, the San Francisco Police Department (SFPD), and Homelessness and Supportive Housing (HSH).
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