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Alt to 911 - NOW OPEN 24/7, 365!

This write-up was informed by a conversation between SJPC and Dr. Corrine McIntosh Sako, Chair of the Sacramento County Mental Health Board. Direct quotes from Dr. Sako will be sprinkled throughout this write-up!


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Introduction


Sacramento County’s Community Wellness Response Team (formerly known as the Wellness Crisis Call Center and Response Team, which was formerly known as the County’s Alternatives to 911 Program) is officially up and running

- 24/7, 365 days per year! This is huge news, especially considering that having the program running 24/7 has been the goal since its inception. This program provides Sac County with a response team - that does not include law enforcement - that can help to de-escalate, keep safe, and provide connections to community support to individuals experiencing mental health crises. CWRT is housed under the County’s Division of Behavioral Health Services (BHS), and overseen by the County’s CWRT Advisory Committee, a subcommittee of the County’s Mental Health Board (MHB). CWRT responds to calls throughout Sacramento County - including incorporated cities & unincorporated areas.


Table of contents:


What is the CWRT?



The following is the official description and goals of the Community Wellness Response Team; pulled from the CWRT Advisory Committee’s bylaws (approved by the MHB on 2/7/24):


Description: “The Community Wellness Response Team (CWRT) receives calls from community members requesting behavioral health services or when they are experiencing a mental health crisis. Clinicians and staff with lived experience can be dispatched to respond immediately to locations throughout the County. These Call Center and Response Teams staff provide immediate, 24/7 crisis intervention and de-escalation services, assess needs and risks, and create safety plans. This includes identifying and leveraging individual strengths and natural supports; coordinating with existing Mental Health Plan (MHP) and Substance Use Prevention and Treatment (SUPT) providers as appropriate; linking to services; voluntary transport to urgent/emergency resources and accessing alternate response teams or emergency responders when necessary.”


CWRT Goals: 

  • Safely de-escalate crises 

  • Provide linkages to accessible culturally responsive behavioral health resources to decrease repeat crises and emergency department visits 

  • Offer a response team that meets the cultural, ethnic and language needs of the community and does not include law enforcement staffing 

  • Ensure the model is community-based 

  • Decrease criminalization of mental health and homelessness 

So, in practice, what does that mean?

As stated above, the CWRT is a program of the County’s BHS; it is composed of both County staff and staff from Bay Area Community Services (BACS), and as of March 1st, 2024, it is officially up and running 24/7, 365 days per year! BACS was brought into staff the program after the County failed to hire enough staff itself - more on this later. Whether the staff being discussed (or included in County reports) are from the County itself or BACS, it’s important to know that they’re both part of the CWRT team, and "CWRT" always refers to staff from both entities.


How do folks access CWRT?

Community members experiencing a mental health crisis can access CWRT by calling 988. Calls that come through 988 are funneled to Wellspace Health’s call center, and calls screened there that meet the criteria for a response from CWRT are forwarded to the program. Third parties (people waiting on the scene with the person experiencing a mental health crisis) can call 988 to assist the person in crisis as well, but so far the calls have been mainly self referrals. 


Wait, what’s 988? And what’s Wellspace? 

988: here's a quick description from the CA Health and Human Services Agency - “[t]he 988 Lifeline [as of July 2022] is an easy to remember three-digit number that anyone can call to receive support when experiencing a suicidal, mental health and/or substance use- related crisis. To reach the Lifeline, people can call or text 988 or chat at Lifeline (988lifeline.org). People who are worried about a loved one who may need crisis support may also use 988 to receive guidance and support.”


Wellspace Health: Wellspace Health is a local healthcare provider, and they operate “...the region’s Suicide Prevention Crisis Line. The hotline, which is nationally accredited and a vital member of the National Lifeline network, serves Sacramento and Placer counties and many other counties in Northern California. We answer calls 24 hours a day, 365 days a year.” 988 calls come to Wellspace and can then be referred to CWRT.


When CWRT receives a call, who responds?

Response teams (NO law enforcement involvement) are made up of 2 peer specialists, with a licensed clinician stationed at the CWRT office to provide oversight and direct communication throughout the call response. Here’s a little more on what to expect from the response teams:

[CWRT peer specialists] arrive in plainclothes and an unmarked car. They’re able to help community members with [things like] crisis stabilization in the moment, if they need to go to the mental health urgent care clinic, or if they just need a bottle of water, or help making an appointment for a clinician or to get connected to resources

-Dr. Corrine McIntosh Sako


Bonus content!

Dr. Corrine McIntosh Sako provided the following graphics and report back from the 3/12/24 CWRT Advisory Committee meeting:

  • Report back: Sacramento County has had CWRT in effect for 1 year - they’ve received almost 200 calls & only 1 resulted in incarceration

  • Important note: Dispositions are from March '23 through December '23. This data field was discontinued after Dec '23. Follow-up Outcomes are from June '23 through Feb '24. This data was not collected prior to June '23

On the right below is a breakdown report of outcomes between March '23 - Feb '24, on the left are pie charts of dispositions (March '23 - Dec 23') and follow up outcomes (June '23 - Feb 24')



Monthly reports of CWRT activity can be found on the program’s web page

How did we get to the CWRT we have today?


CWRT’s long and winding road to implementation:


During the September 2020 Sac County budget hearings, Supervisor Patrick Kennedy (pictured left) directed county staff to research alternatives to 911 for folks experiencing mental health crises. The staff brought back a proposal for a short-term pilot program that would run Monday-Friday from 9a-5p. The public rightfully pushed back and demanded a permanent 24/7, 365 program, as mental health crises don’t only happen during regular business hours. The members of the Board of Supervisors (BOS) agreed and directed staff to come back with a proposal that would mirror the community’s demands.


Ultimately, CWRT received $15M in funding, and was supposed to go live 24/7 in July of 2022. Instead, the program went live in March 2023 with the only operating hours being Monday-Friday from 9a-3:30p. In September of 2023 these hours were extended to 8a-6:30p. Throughout this process, CWRT had not been able to effectively hire and retain staff. 


It’s worth noting that during the CWRT’s development process we have continued to see some elected officials, their appointees to the Mental Health Board, and community members demanding that law enforcement be included in standing up CWRT, dispatch teams, or both - despite that being in violation of the entire point of this program. Advocates, service providers, folks on both the MHB and the CWRT Advisory Committee, and impacted community members - as well as the broader Sac County community - fought hard for law enforcement to not be given a place in the CWRT program. Despite the Sacramento County Sheriff’s Office’s 2023/24 budget of $695.3 million and the County jails being one of largest behavioral health providers in the County, we STILL have leaders in our County government endlessly advocating for increased surveillance and criminalization of our most vulnerable community members. The irony of demanding a law enforcement presence in a program that’s meant to exist as an alternative to 911 cannot be overstated.

Big shoutout to community members, as well as members of the Mental Health Board and CWRT Advisory Committee for continuing to push back and both limit law enforcement’s involvement AND ensure that our impacted community members are always at the forefront of developing and overseeing CWRT 

During the development of CWRT, the County hosted a series of “community stakeholder workgroups” to get input on how to build the program. A clear message from the community was the importance of partnering with local community organizations already doing this work. However, instead of partnering with a trusted community organization (Mental Health First for example), and despite advocacy from members of the County’s MHB to establish this partnership, BHS leveraged an existing county contract with Bay Area Community Services (BACS [an org initially from the Bay but now working in Sacramento]), to staff CWRT. 


Choosing to work with a trusted community provider would have kept this program in alignment with input the County received from the community during CWRT development stages. Instead, they have refused to open a new request for proposals - effectively cementing the partnership with BACS.  


Below Dr. Corrine McIntosh Sako provides some more insight into BACS involvement with this program:

[Sac County struggling to hire for CWRT] was not so much [that] people don't want to do the work, it's that they may feel underappreciated, [that they're] not being compensated to the extent that other kinds of first responders are being compensated, and [put off by] all of the bureaucracy and politics of working for a county…

Dr. Sako further elaborates on the pivot to contracting with BACS:

It was early to mid last year [Sac County] started thinking that people may be more likely to want to be employed by a community organization versus the county. The community organization [BACS] pays a little bit higher, provides more benefits, and has more flexibility in the shifts scheduling. So BACS started hiring, and started getting folks on board, but then were also unable to deliver quite as promised because of the [previously mentioned] workforce crisis

During this extended development process, members of CWRT Advisory Committee

(which will be discussed further down below) were putting pressure on all parties involved with CWRT to get it up and running 24/7 because there were folks in our community experiencing criminalization in response to mental health crises (Kaylin Footman for example, pictured right) who should have received services from mental health experts, rather than a punitive response from law enforcement. Committee members drafted a letter of recommendation to the County Board of Supervisors (BOS) and the BHS Director underscoring how important it was to get this program up and running as promised. They brought up Mental Health First (again), pointing out that that group of folks had already expressed willingness to partner with the County in that way. Before the letter could be sent, BACS came to the 2/13/24 CWRT Advisory Committee meeting and reported that they were ready to launch CWRT 24/7, 365. Due to this news from BACS, the letter of recommendation was not sent. 

- paraphrased from a segment of the convo between SJPC and Dr. Sako


So, this all was not precisely what the community asked for, and the County did not follow through on some of their promises, despite strong advocacy from a wide range of impacted community members. 


Dr. Sako on how she thinks BACS has been doing so far: 

...part of the reasoning [from BACS] for why it took them so long to hire folks is that they wanted to make sure that they weren't just getting warm bodies - that they were really getting the right individuals…ones who are going to be very, very human-centered and inclusive and know how to be culturally responsive and trauma-informed.  At this point, we've [members of CWRT Advisory Committee] not heard anything that has caused us to be concerned or alarmed. When I look at the data and I see that folks aren't being taken to jail, then they're [response teams] doing a big part of the job

Bonus! You can read more about the history of the County’s journey to create an alt to 911 response system and structure on our blog 


Some significant articles include: 

  • Published May 2022 - covers developments leading up to the formation of what is now known as the Community Wellness Response Team Advisory Committee

  • Published December 2021 - covers the powerful feedback we got from the community on how to design the (formerly known as Alt 911) program (which was known at that time as the Wellness Crisis Call Center and Response Treatment Program [WCCCRT]) & the County’s performative attempts at community engagement

  • The full WCCCRP Community Stakeholder Input report can be found here and the presentation slidedeck can be found here 

  • Also published December 2021 - covers the amazing community turnout at the MHB meeting confirming guidance for criteria for including people on the (what would become known as) Community Wellness Crisis Response Team Advisory Committee

  • As this meeting the MHB approved the criteria excluding folks with LE involvement/ties be excluded from serving on the committee, thanks to the boldness and bravery of both the community and(most of) the MHB members - however it’s important to note that community members should not have to give comment reliving their trauma in order for LE to be excluded from an ALTERNATIVES TO 911 PROGRAM

Who oversees CWRT?


CWRT is a program of Sac County BHS, and is overseen by the CWRT Advisory Committee. 


On the CWRT Advisory Committee (content listed below pulled from same Bylaws doc mentioned above):


“There shall be a Behavioral Health Services Community Wellness Response Team (CWRT; formerly known as Wellness Crisis Call Center and Response Program) Advisory Committee composed of Mental Health Board Members and community members with diverse community, ethnic, cultural, and linguistic representation. All members shall have voting privileges. The purpose of this committee is to make programmatic recommendations to the Behavioral Health Director and the Board of Supervisors about the CWRT that will be submitted to the Mental Health Board for review and approval, review outcomes regarding the CWRT, and other responsibilities as described in the CWRT Advisory Committee bylaws.” 


Membership (abbreviated):


The CWRT Advisory Committee shall have nine (9) seats. There will be a purposeful overrepresentation of community members to Mental Health Board members. Of these nine seats, three (3) shall be filled by current Mental Health board members and six (6) shall be filled by community members.


Important note: members of the CWRT Advisory Committee are not appointed, rather they are screened and chosen by a selection committee of the MHB. 


We at SJPC will work to continue monitoring this program and providing updates! If you have an experience regarding CWRT or other Sacramento City/County mental health care (or lack thereof) services you'd like to share, please reach out to us! You can always email us at info@socialjusticesac.org, or DM us on Instagram @socialjusticesac


We'd love to hear from you!


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“Join Decarcerate Sacramento, Disability Rights California (DRC), and the California Pan-Ethnic Health Network (CPEHN) as we gather in Sacramento for a community conversation on recent mental health policy changes. Learn about the history and context behind recent mental health changes (e.g. CARE Court, SB 43, and changes to the Mental Health Services Act) through racial equity and disability justice lenses, as we connect and build relationships and power in order for people to protect themselves, their families, their communities, and the programs and services that matter. This includes knowing your rights, knowing what works for you and your community.”





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