LA County presents expansion of alternative crisis response; highlights 988 usage, field teams and coordination with city programs

Representatives of the Los Angeles County Department of Mental Health provided a verbal overview of the county's alternative crisis response (ACR) system to the Los Angeles City Council ad hoc committee on alternative crisis response.

Ruben Wilson, head of the ACR unit at DMH, explained the county's 24/7 crisis system and said it is designed to provide an alternative to law enforcement for many behavioral health incidents. Wilson described a four-part continuum: 988 or a 24/7 helpline as entry points; 24/7 field response teams; short-term alternatives to hospitalization such as psychiatric urgent care centers (UCCs); and follow-up to connect people to long-term care.

DMH officials reported that Didi Hirsch operates the county's 988 center for calls, texts and chats; when an issue cannot be resolved by phone, Didi Hirsch can refer callers to DMH for an in-person field response. DMH said LAPD has been an early adopter of diverting certain 911 calls to 988.

Key metrics presented by DMH:

- 988 receives roughly 6,400 calls per month in the county; about 93% are first-person calls and roughly 96% of those are resolved over the phone. - DMH's 24/7 helpline receives about 5,600 calls per month and dispatches a field intervention team to roughly 45% of those calls; last month DMH's FIT teams were dispatched to a little over 2,000 calls. - DMH dispatched field teams to about 21,000 calls in the prior year, a roughly 35% increase over the previous year. - The county now has more than 70 field intervention teams; DMH reported hiring 23 new teams last year and added eight follow-up teams to make post-crisis outreach. - Psychiatric urgent care centers (UCCs): 9 countywide (about 4 in the City of Los Angeles); crisis residential treatment programs: 19 with two more coming online; DMH lists 40 hospital partners used for inpatient placements when required. - About 44% of DMH dispatches resulted in a 5150 hold, per the presentation. - Response times have fallen significantly since January 2023; DMH said response times were reduced more than 70% over two years, with many responses now in the 30- to 45-minute range and an average often around 1 to 2 hours. DMH identified pockets of time when demand exceeds capacity.

Wilson and Latina Jackson (Deputy Director, Countywide Engagement) described team composition (a clinician plus a community health worker or peer) and the county's efforts to diversify team models (psychiatric mobile response teams, mobile crisis outreach teams, therapeutic transport teams) and to expand contracted after-hours coverage. DMH officials highlighted training sessions and technical support provided to city unarmed response programs (UMCR and Circle) and said less than 1% of UMCR calls are referred back to a DMH field intervention team.

Elon Schultz, described on the record as DMH's chief of policy and strategy, said ACR funding is drawn from Medi-Cal reimbursement, MHSA (Prop 63), and grants. Schultz warned that federal Medicaid funding uncertainties could pose risks to DMH budgets and reimbursement streams.

Councilmembers asked about pay and hiring challenges, criteria used by PSRs and 911 operators to route calls to county versus city programs, how 988 referrals are connected to field teams, and the scale of dispatches to city neighborhoods. DMH said it is using bonuses, shift differentials and other incentives to recruit for field roles and is investing in technology to improve dispatching and scheduling.

Councilmembers and DMH officials agreed to pursue further coordination around dispatch protocols and warm handoffs so callers and first responders are routed to the most appropriate resource. Several councilmembers stressed the need for continued outreach to communities, including undocumented residents, who may fear seeking services.

DMH offered to provide materials and video assets to support public awareness, and said it has an MOU with the City to ensure partnership and coordination. Committee members said they will continue meeting with county staff to refine operational and dispatch-level coordination.