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Alameda County Behavioral Health
Mobile Crisis Assessment:
Findings Report
Submitted by:
Roberta Chambers, PsyD
Ardavan Davaran, PhD
Jamie Dorsey, MSPH
Prepared for:
Alameda County Behavioral Health
Date:
January 2025
2
Table of Contents
Introduction ................................................................................................................................ 3
Background Information ............................................................................................................. 4
Assessment Methodology .......................................................................................................... 6
Assessment Findings ................................................................................................................14
Findings Summary ....................................................................................................................27
Appendix. Supplemental Data ...................................................................................................29
3
Introduction
In late 2023, Alameda County, Disability Rights California, and the United States Department of
Justice entered into a settlement agreement addressing the provision of community behavioral
health services in the County. The settlement agreement includes provisions designed to assess the
need for Full Service Partnership (FSP) and mobile crisis services in order to inform the County’s
program development and expansion efforts. Alameda County Behavioral Health Services
(ACBH) contracted with the Indigo Project (Indigo) to conduct the Mobile Crisis assessment.
ACBH provides a full range of behavioral health services, ranging from crisis services through
outpatient, residential, and inpatient programs to address mental health, substance use, and co-
occurring disorders. Through a partnership with the Office of Homeless Care and Coordination
(OHCC), ACBH also funds a range of housing options for people with behavioral health issues.
This assessment focuses on mobile crisis services, specifically on the needs and gaps in mobile
crisis coverage. The assessment is designed to determine the amount and number of
mobile crisis teams needed to provide on a county-wide basis mobile crisis services that:
(1) provide timely in-person1 response to resolve crises as appropriate; and (2) are provided with
the purposes of reducing, interactions with law enforcement and 5150 and John George
Psychiatric Emergency Services (PES) placement rates, to the greatest extent possible, and
increasing the use of voluntary community-based services.
This assessment was informed by necessary data and information sufficient to assess the need
for crisis services, as well as community and stakeholder input. The assessment results in an
estimate of the amount and number of mobile crisis teams needed to provide timely, in-person
mobile crisis coverage county-wide. During the assessment process, the County had already
planned and began to implement mobile crisis expansion. These planned and new mobile crisis
teams are not reflected in the data presented in this assessment as they were not yet operational.
As a result of this mobile crisis capacity expansion, it appears that the County has already created
the mobile crisis capacity that is identified in this assessment.
This assessment does not include any evaluation of existing mobile crisis programs and therefore
does not assess quality and outcomes of existing mobile crisis programs. While this assessment
does use local service utilization data from mobile crisis programs, other crisis services, and
hospital emergency department admissions, this assessment does not include any assessment
or evaluation of the capacity or quality of any other crisis programs that individuals may access—
including mobile crisis programs operated by City-departments, hospitals, and other crisis
services.
1 When clinically appropriate, such services may also be provided through the use of telehealth.
4
Background Information
Internationally, mental health-related crises represent a large proportion of emergency service
calls.2 Providing crisis services in the community wherever they are and whenever they are needed
enables people with behavioral health conditions to live and be served within their communities.
The California Department of Health Care Services (DHCS) submitted an amendment to the
Medicaid state plan in 2023 to add mobile crisis services as a benefit to Medi-Cal beneficiaries.
The intention of the state plan amendment is to access federal funds to support the expansion of
mobile crisis coverage. DHCS defined mobile crisis services as:
Mobile crisis services are a community-based intervention designed to provide de-
escalation and relief to individuals experiencing a behavioral health or substance
use-related crisis wherever they are, including at home, work, school, or in the
community. Mobile crisis services are provided by a multidisciplinary team of
trained behavioral health professionals. Mobile crisis services provide rapid
response, individual assessment and community-based stabilization to Medi-Cal
beneficiaries who are experiencing a behavioral health crisis. Mobile crisis services
are designed to provide relief to beneficiaries experiencing a behavioral health
crisis, including through de-escalation and stabilization techniques; reduce the
immediate risk of danger and subsequent harm; and avoid unnecessary
emergency department care, psychiatric inpatient hospitalizations and law
enforcement involvement. The mobile crisis services benefit will ensure that Medi-
Cal beneficiaries have access to coordinated crisis care 24 hours a day, 7 days a
week, 365 days per year.3
The purpose of mobile crisis services is to provide timely, in-person response to an individual or
family experiencing crisis in order to reduce avoidable emergency department, psychiatric
emergency department, and hospital utilization as well as increase connection to ongoing
behavioral health services. Mobile crisis services are also intended to minimize law enforcement
contact and time spent on crisis calls, where possible. There are multiple mobile crisis models in
practice across the nation, including police-led interventions, co-responder interventions, and
interventions that do not include law enforcement. Alameda County operates the following three
models:
• Mobile Evaluation Teams (MET) that pair a mental health clinician with a police officer,
• Mobile Crisis Teams (MCT) with a team of two clinicians that may respond independently
to a crisis or in partnership with law enforcement, and
• Crisis Assessment and Transport Teams (CATT) that pair a mental health clinician with
an Emergency Medical Technician.
2 CAMH (2020). Mental health and criminal justice policy framework. https://www.camh.ca/-
/media/files/pdfs---public- policy-submissions/camh-cj-framework-2020-pdf.pdf
3 https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA-22-0043-Approval.pdf
5
Additionally, many cities within Alameda County operate their own mobile crisis programs, some
of which are in partnership with their local police department and some of which operate
independent of their law enforcement agency.
Within the myriad mobile crisis models that exist nationally and in Alameda County, there is
tremendous variability in terms of structure, staffing, and approach. As a result, there is minimal
evidence about which model may be the most effective, although collectively, evidence suggests
that mobile crisis interventions are generally effective at reducing unnecessary emergency and
psychiatric emergency services and hospitalization as well as increasing connection to care during
the mobile crisis intervention.4
The outcomes following a mobile crisis intervention have also been explored. Mobile crisis services
are associated with reduced post-crisis hospitalization, meaning that people who receive
community-based mobile crisis services are less likely to be hospitalized in the 30 days following
a crisis than their peers who received a hospital-based crisis intervention.5 Mobile crisis services
are also associated with increased service engagement post-crisis. Specifically, consumers who
receive mobile crisis services are 17% more likely to participate in community-based behavioral
health services in the 90 days following a crisis event. Among individuals with no prior mental
health service use, mobile crisis intervention consumers are almost 50% more likely to participate
in community-based behavioral health services than those who receive a hospital-based
intervention.6
Mobile crisis teams are an important component to providing community-based mental health
services for individuals who may otherwise be at risk of hospitalization and/or incarceration as a
result of their behavioral health issues. They function as a part of a larger behavioral health service
system as well as a larger emergency response system that includes dispatch, fire, emergency
medical, and law enforcement.
4 Center for Police Research and Policy. (2021). Assessing the Impact of Mobile Crisis Teams: A Review
of Research. University of Cincinnati. Retrieved May 10, 2024, from
https://www.informedpoliceresponses.com/_files/ugd/313296_8d01cdc7187a489893197f2d07300ee6.pdf
5 Guo, Shenyang & Biegel, David & Johnsen, Jeffrey & Dyches, Hayne. (2001). Assessing the Impact of
Community-Based Mobile Crisis Services on Preventing Hospitalization. Psychiatric services (Washington,
D.C.). 52. 223-228. Retrieved May 10, 2024, from https://pubmed.ncbi.nlm.nih.gov/11157123/.
6 Dyches, H., Biegel, D. E., Johnsen, J. A., Guo, S., & Min, M. O. (2002). The Impact of Mobile Crisis
Services on the Use of Community-Based Mental Health Services. Research on Social Work Practice,
12(6), 731-751.Retrevied May 10, 2024, from https://doi.org/10.1177/104973102237470.
6
Assessment Methodology
The primary question that guided this assessment was:
What is the amount and number of mobile crisis teams needed to provide on a county-
wide basis mobile crisis services that (1) provide timely and effective in-person7 responses
to resolve crises as appropriate; and (2) are provided with the purposes of reducing
interactions with law enforcement and 5150 and John George Psychiatric Emergency
Services (PES) placement rates, to the greatest extent possible, and increasing the use
of voluntary community-based services?
To further guide the assessment process and analysis, Indigo developed more targeted research
questions. Table 1 outlines the research questions that were addressed through quantitative and
qualitative methods.
The assessment includes a mixed methods analysis that leverages: 1) demographic and service
data about individuals who receive mobile crisis and other crisis services, 2) program information
about the existing mobile crisis programs in the County, and 3) community and stakeholder input.
The assessment culminates in an estimate of the number of mobile crisis teams needed as well
as guidance about where and when coverage may be needed in order to provide 24/7 mobile
crisis coverage that ensures all people living in Alameda County have access to timely mobile
crisis services. Greater detail is provided in the following sections about the specific methods and
data gathered to address the research questions.
7 When clinically appropriate, such services may also be provided through the use of telehealth.
7
Table 1. Mobile Crisis Assessment Research Questions
Research Question Sub-Questions to be answered with
Qualitative & Quantitative Methods Data Sources
What is the current state of mobile
crisis response in Alameda
County?
• What mobile crisis teams are operating in Alameda
County?
• What and how many calls are mobile crisis teams
responding to?
• FY21-24 ACBH Mobile Crisis Response Data
• FY23-24 City Mobile Crisis Response Data
• FY21-24 ACBH Crisis Program Data
• FY23-24 Hospital Emergency
Department Data via ACBH Data
Warehouse
• FY22-23 Crisis Line Data from Crisis
Support Services of Alameda County
(CSS)
• Interviews with ACBH Mobile Crisis &
CATT Leadership
• Interviews with City Mobile Crisis Team
Program Managers & Staff
• Interview with Crisis Support Services of
Alameda County Leadership
• Discussion with Subject Matter Expert
Stakeholder Group
What is the need for mobile crisis
services in Alameda County?
• What is the total number of known crisis
interventions in Alameda County?
• What proportion of known crisis interventions were
responded to by mobile crisis teams?
• How many additional mobile crisis teams are
needed to meet mobile crisis needs in Alameda
County?
How can Alameda County meet
the mobile crisis need?
• Where are there gaps in mobile crisis coverage and
utilization?
o What time of day are mobile crisis services
needed?
o Where in the County are mobile crisis teams
needed?
o Who is not receiving mobile crisis services?
8
Assessment Analytic Approach
The figure below summarizes the analytic approach and process to address the assessment question
and determine the County’s mobile crisis needs. More detailed information about each phase of the
assessment is provided below.
Describe Current State of Mobile Crisis: In order to describe the current mobile crisis program,
the assessment team gathered data from the ACBH Crisis System of Care and City-operated
mobile crisis teams about the current mobile crisis programs. This includes service utilization data
about mobile crisis services such as the time of day of encounters, locations of service, and
service dispositions—including placement of psychiatric holds and transportation to other crisis
receiving centers. We also conducted interviews with leadership and staff from mobile crisis
programs to gather information about programs models, types of calls teams respond to, call
duration, staffing, and hours of service.
Estimate Need for Mobile Crisis: The assessment then estimated the total need for mobile crisis
services. In order to capture unmet need for mobile crisis services, the assessment first quantified
the total number of crises known to the County, regardless of whether there was a mobile crisis
intervention. This includes the sum of all known admissions to crisis receiving centers—including
Psychiatric Emergency Services, Crisis Stabilization Units, Sobering Center, Medical Emergency
Departments for a mental health-related episode—as well as telephone interventions provided by
Crisis Support Services of Alameda County.
According to the Recovery International Crisis Now Calculator, 32% of mental health crises are
appropriate for mobile crisis intervention. 8 This proportion based on the mobile crisis interventions
in jurisdictions nationwide. To estimate unmet need for mobile crisis services, Indigo calculated
the proportion of known crisis interventions in Alameda County that were responded to by all
mobile crisis response teams and compared this to the national average (32%). We then
determined if and how many additional mobile crisis teams would be needed to meet the expected
8 Crisis Now: Transforming Crisis Services. Crisis Now Crisis System Calculator. Retrieved May 10, 2024,
from https://crisisnow.com/tools/
Describe Current State of Mobile Crisis Coverage
Estimate Need for Mobile Crisis
Coverage
Determine Gaps in
Mobile Crisis Coverage
Figure 1. Mobile Crisis Assessment Analytic Approach
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mobile crisis intervention benchmark (i.e., 32% of all crisis events responded to with mobile crisis
intervention).
Determine Gaps in Mobile Crisis Coverage: To explore how ACBH may address the mobile
crisis need, we explored patterns of crisis events and utilization that would identify gaps in current
mobile crisis coverage, including identifying geographic and temporal gaps in coverage by
comparing and triangulating operating hours of existing mobile crisis teams, geographic reach of
mobile crisis teams, and time and location of known mobile crisis episodes compared to crisis
receiving center admissions and/or crisis hotline calls. The assessment also explored differences
in demographic characteristics of individuals who receive mobile crisis services compared to
individuals who access other crisis services.
Feedback from Subject Matter Experts: The preliminary results of the assessment were shared
with a group of subject matter experts (SME), including mobile crisis and other crisis service
providers, first responders, and people with lived experience of mental health crisis and mobile
crisis services. The discussion with the SMEs served to refine estimates for mobile crisis services
and provide additional context and feedback about assessment findings.
Data Sources & Data Elements
Crisis Now Model: Crisis Resource Calculator
In 2017, Recovery International developed a Crisis Need Calculator to help jurisdictions plan and
develop their crisis systems. The Crisis Need Calculator is a nationally recognized tool that is
used to help estimate:
1. Optimal allocation of crisis system resources,
2. Associated healthcare costs, and
3. Shifts in costs and benefits based on incorporating specific Crisis Now elements such as
high-tech crisis call centers, 24/7 mobile crisis response, and crisis stabilization programs.
This Crisis Resource Need Calculator suggests that nationally, on average, mobile crisis should
respond to 32% of all known crisis episodes in a county. 9
9 Crisis Now: Transforming Crisis Services. Crisis Now Crisis System Calculator. Retrieved May 10, 2024,
from https://crisisnow.com/tools/
10
Quantitative Data
The quantitative data sources and specific data elements obtained for the assessment are
summarized below.
FY21-24 ACBH Mobile Crisis Data: Indigo worked with the ACBH Data Services Team to obtain
aggregate data regarding ACBH and CATT mobile crisis services from the ACBH electronic health
record system and ACBH Mobile Crisis Contact Tracking Log. For all ACBH-operated/contracted
mobile crisis teams, we obtained data regarding call volume, placement of psychiatric holds (i.e.,
5150 or 5585 psychiatric hold), and demographic characteristics of individuals receiving mobile
crisis services—including age (adults ages 18+ and minors younger than 18), gender,
race/ethnicity, language, and region of residence. For CATT, additional information about crisis
episodes was obtained via the Alameda County Emergency Medical Services electronic health
record system—including call time of day, location of calls, and transport destination. To the
extent possible, we examined data over the last three fiscal years (FY21-24) in order to assess
changes and trends in crisis service utilization over time.
FY23-24 City Mobile Crisis Team Data: Indigo worked with each City mobile crisis team to obtain
aggregate data regarding volume of mobile crisis calls and placement of psychiatric hold. Data
were requested only for FY23-24 as several City-operated programs began operations fairly
recently (within the last one to two years).
FY21-24 Crisis Receiving Center Data: Indigo worked with the ACBH Data Services Team to
obtain aggregate data regarding admissions to crisis receiving centers in Alameda County,
including—John George Psychiatric Emergency Services (PES), Amber House Crisis
Stabilization Unit (CSU), Telecare Adolescent CSU, Willow Rock Psychiatric Health Facility
(PHF), and Cherry Hill Sobering Center. Available data included number of admissions and
demographic characteristics of individuals. To the extent possible, we examined data over the
last three fiscal years (FY21-24) in order to assess changes and trends in crisis admissions over
time.
FY23-24 Hospital Emergency Department (ED) Data: Indigo worked with the ACBH Data
Services Team to obtain aggregate data via the ACBH Data Warehouse regarding admissions to
EDs for mental health-related crises—including number of admissions, time of day of admissions,
and demographic characteristics of individuals admitted to the ED. ED data were unavailable for
some EDs—including Children’s Hospital and Alta Bates Herrick Campus. Additionally, all ED
data unavailable prior to FY23-24.
FY22-23 Crisis Support Services of Alameda County Crisis Call Data: Indigo worked with
Crisis Support Services of Alameda County to obtain de-identified crisis hotline call log data—
including time of the call, type of call, suicide risk level, and referrals and emergency procedures.
We examined FY22-23 call data as the FY23-24 data were not yet available at the time of data
collection.
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Qualitative Data
During the assessment, the Indigo team conducted 9 interviews with the County and City mobile
crisis team leadership and staff, including:
• ACBH Director of Crisis Services;
• ACBH Mobile Crisis Program Manager;
• CATT Program Managers from Alameda County Emergency Medical Services, Bonita
House, and Falck
• Program Managers and/or Staff from City Mobile Crisis Teams including—Alameda,
Berkeley, Fremont, Livermore, Oakland, and Pleasanton
During these interviews, we discussed the mobile response team models, including hours of
operation, staffing and response models, the types and quantity of calls they respond to, call
duration, and how they coordinate with other mobile crisis teams and/or crisis services. As part of
these conversations, we also discussed quantitative data availability regarding mobile crisis
service utilization.
We also conducted an interview with leadership from Crisis Support Services of Alameda County,
including the Executive Director, Crisis Services Director, and Crisis Line Program Manager.
During this interview we discussed the volume and types of crisis calls they are receiving and
through what hotlines, what their crisis intervention entails, what types of calls would be
appropriate for mobile crisis intervention, and the extent to which calls are forwarded for mobile
crisis or other emergency intervention. We also discussed quantitative data availability and
potential limitations.
Subject Matter Expert Group
Indigo convened a diverse group of local subject matter experts to provide feedback on the
analytic decisions used to determine mobile crisis need as well as validate and refine assessment
findings. The subject matter expert group included one or more representatives from the following
groups:
• ACBH Crisis Services & Mobile Crisis Teams
• Alameda County Emergency Medical Services
• Berkeley Mental Health – Crisis Services
• Mobile Assistance Community Responders of Oakland (MACRO)
• Bay Area Community Services – Crisis Programs
• John George Psychiatric Hospital & Psychiatric Emergency Services
• Washington Hospital
• Cherry Hill Sobering Center and Detox
• Crisis Support Services of Alameda County
• Oakland Police Department
• ACBH Office of Peer Support Services
• ACBH Office of Health Equity
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Data Limitations and Methodology Adjustments
During the assessment process, Indigo encountered some data limitations and also made minor
methodology adjustments in response to emerging data trends and data availability. Key data
limitations are described below. Data limitations are also noted throughout the report where
relevant.
Notably, some quantitative data was not available or had quality concerns. For most crisis teams,
data were unavailable about the time of day, response time, service duration, call location, and
transport destinations. In some cases, these data are not tracked in a standardized way, or there
were data accuracy issues as staff do not always enter these data elements in real-time. However,
data for the CATT program was more complete as CATT is requested through the Alameda
County Regional Emergency Communications Center which tracks more call information. CATT
data was therefore used a proxy to describe ACBH mobile crisis calls when other ACBH mobile
crisis data was unavailable. To help address gaps in mobile crisis data availability, Indigo also
conducted interviews with mobile crisis teams to qualitatively assess information such as the time
of day, locations, and duration of calls.
Additionally, City mobile crisis teams utilize different data systems from the County and from one
another, resulting in inconsistencies across data elements and data format. City mobile crisis data
is also outside of the purview of ACBH, making it more difficult to obtain to some data elements.
We initially requested information about the volume of mobile crisis encounters, time of day,
encounter dispositions, and demographic information; however, this information was not available
across all programs. In order to standardize data elements across City mobile crisis teams, we
therefore only assessed the volume of mobile crisis calls and the number of calls resulting in a
5150 or 5585 psychiatric hold.
Some requested data were also unavailable for crisis receiving center admissions and crisis
hotline calls. Most crisis receiving center admission data included only the admission date, and
not time of day. Emergency departments were the exception and included information about the
admission time of a day. However, emergency department data was not available for all hospitals
in the County—including Children’s Hospital and Alta Bates – Herrick campus. As a result,
emergency department data is likely underreported. Crisis hotline data was available for a
different time period than mobile crisis and crisis receiving center data. At the time of the
assessment, crisis hotline crisis hotline data was not yet available for FY23-24 so we examined
FY22-23 crisis hotline data. Demographic information was also largely unreported for crisis hotline
calls.
Another key data challenge was assessing unmet need for mobile crisis services. One method to
assess unmet need for mobile crisis services would be to identify calls that the mobile crisis team
did not or could not respond to—including calls that come in outside of operating hours or calls
that the team did not have capacity to respond to at the time of the call. However, this data is not
standardized as mobile crisis programs have different methods of dispatch, with some using
dispatch call centers and others using a direct mobile crisis line or other method for dispatching
teams. Most mobile crisis teams and/or dispatch centers do not have a mechanism to track calls
13
that would have been appropriate for a field-response, but that mobile crisis was unavailable to
respond. Mental health-related calls to 911 dispatch and call centers are often coded
inconsistently and in several different ways, making it difficult to identify calls way that could have
been appropriate for mobile crisis response. 911 dispatch data is also highly protected data
outside the purview of ACBH, making it difficult to obtain.
Mobile crisis teams also serve as a diversion from law enforcement or other emergency response,
when it is safe and appropriate to do so. If and when mobile crisis teams are unavailable, law
enforcement may respond to individuals experiencing mental health crises that may or may not
result in incarceration. Similar to 911 dispatch data, jail booking data often has insufficient
information to identify individuals who could have been safely and appropriately served by a
mobile crisis and is not a reliable data source to identify unmet need for mobile crisis services.
Lastly, some individuals may benefit from mobile crisis services, but have not utilized any crisis
services (i.e., mobile crisis or other crisis receiving centers). As these crisis events are “unknown”,
it is not possible to account for these crisis events and the total volume of crisis events may be
underestimated.
To help address these challenges and assess need for mobile crisis services, Indigo examined
admissions to crisis receiving centers that did not involve mobile crisis. To identify whether a
mobile crisis team was involved in the admission to a crisis receiving center, Indigo examined
dispositions of mobile crisis events, including transport to a crisis receiving center and/or
placement of 5150 or 5585 psychiatric hold. In the absence of transport destination data, we used
placement of a 5150 or 5585 hold to estimate transports as all individuals placed on a psychiatric
hold must go to a crisis receiving center for evaluation. Indigo also examined crisis hotline calls
to capture crisis events that may not have resulted in admission to a crisis receiving center or
mobile crisis intervention.
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Assessment Findings
The following sections present the assessment findings, organized by the research questions
outlined in Table 1.
What is the current state of mobile crisis response in Alameda County?
What mobile crisis teams are operating in Alameda County? What and how many calls are
mobile crisis teams responding to?
There are several mobile crisis programs operating in Alameda County, including mobile crisis
programs overseen by ACBH as well as programs operated by City agencies.
ACBH Mobile Crisis programs: ACBH oversees and/or operates four mobile crisis programs:
1) Community Assessment and Transport Team (CATT),
2) Mobile Crisis Team (MCT),
3) Mobile Evaluation Team (MET), and
4) Hayward Mobile Evaluation Team (HMET).
ACBH operates the MCT, MET, and HMET programs and contracts with Bonita House and Falck
to operate the CATT program. The program models are summarized in Table 2 based on program
operations as of June 2024.
Table 2. ACBH-Operated and Contracted Mobile Crisis Programs
Mobile Crisis Team Hours of
Operation Staffing Model Number
of Teams Region Served
Community Assessment
& Transport Team
(CATT)
Sun – Wed:
24 hours a day
Thurs – Sat:
7am – 11pm
EMT (Falck) &
Bonita House Clinician 9
Countywide with 5 staging
posts:
Oakland, San Leandro,
Hayward, Livermore, Fremont
Mobile Crisis Team
(MCT)
8am – 6pm
Mon – Fri 2 ACBH Clinicians 3
Countywide with 1 team each
serving: North County,
South County, East County
Mobile Evaluation Team
(MET)
8am – 3pm
Mon – Thurs
Oakland Police Officer
& ACBH Clinician 1 Oakland
Hayward Mobile
Evaluation Team (HMET)
8am – 4pm
Mon – Fri
Hayward Police Officer
& ACBH Clinician 1 Hayward
Although the specific models differ across ACBH mobile crisis programs, all ACBH-operated and
contracted teams have at least one mental health clinician at all times and respond to acute
mental health crises including evaluation for placement of a 72-hour psychiatric hold (i.e., 5150
hold for adults ages 18 and older or 5585 holds for youth younger than 18). MET and HMET are
co-responder models with a mental health clinician paired with a police officer, while CATT and
MCT do not include police officers but may respond independently or in partnership with law
enforcement.
15
CATT is the largest program with 9 teams and operates countywide, 7 days a week. CATT
operates 24 hours a day Sunday to Wednesday and from 7am-11pm Thursday to Saturday.10 The
MCT, MET, and HMET programs operate on weekdays during typical business hours (from 8am
to between 3-6pm). MCT also operates countywide with three teams, with one team each serving
a different region—North County, South County, and East County.11 MET and HMET each have
one team and serve specific cities, with MET serving Oakland and HMET serving Hayward.
During the assessment process, the County planned and implemented additional mobile crisis
teams, including:
• ACBH MCT #3: ACBH implemented an MCT East County team in March 2024. As this is
a new team, the team was still ramping up services during the assessment period, and
their services were not yet at full capacity. As implementation progresses, ACBH
anticipates call volume will increase to full capacity.
• CATT #9: In partnership with ACBH, Bonita House and Falck implemented the first
overnight CATT team in May 2024, operating Sunday – Wednesday from 7pm-7am. As
this is a new team, the team was still ramping up services during the assessment period,
and their services were not yet at full capacity. As implementation progresses, ACBH
anticipates call volume will increase to full capacity.
• CATT #10: In partnership with ACBH, Bonita House and Falck planned to implement the
second overnight CATT team in November 2024, operating Wednesday – Sunday 7pm-
7am. With the addition of this team, CATT will provide overnight coverage 7 days a
week.12
• CATT #11: In partnership with ACBH, Bonita House and Falck plan to implement an 11th
CATT team in 2025. Based on identified mobile crisis coverage gaps, the County may
wish to consider operating this team out of CATT’s Oakland staging post to provide more
coverage in the Oakland area and North County region.
While these teams are not reflected in the subsequent data because they were not yet fully
operational, they are or will soon be part of the landscape of crisis services in Alameda County.
10 The CATT overnight team began providing mobile crisis services in May 2024. The overnight team
operates from 7pm – 7am. Prior to overnight coverage, CATT operated 7am-11pm 7 days a week.
11 ACBH implemented the East County MCT team in March 2024.
12 In November 2024, ACBH also began a pilot program with Crisis Support Services of Alameda County
wherein CATT can be dispatched through the 988 Suicide and Crisis Lifeline on nights and weekends.
Moving forward, the County expects to expand 988 dispatch to 24 hours a day, seven days a week.
16
In FY23-24, ACBH-operated and contracted mobile crisis programs responded to 2,501
crisis episodes (Table 3).13 CATT responses accounted for half of the ACBH mobile crisis
episodes (48%, n=1,189), reflecting the larger number of teams and longer operating hours of
CATT compared to other ACBH mobile crisis programs. MCT accounted for 31% of mobile crisis
episodes, and the MET and HMET programs each accounted for approximately 10% of mobile
crisis episodes.
Table 3. Volume of ACBH Mobile Crisis Episodes in FY2023-24
ACBH Team
FY2023-24 ACBH Mobile Crisis Episodes
Episode N % of Total
CATT 1,189 48%
ACBH MCT 758 31%
ACBH MET 260 10%
ACBH HMET 294 12%
TOTAL EPISODES 2,501 100%
Data Notes: The MCT East County Team was implemented in March 2024 and the CATT overnight team began in
May 2024. Both of these teams were implemented toward the end of the assessment period and were still ramping up
services. As a result, these teams responded to very few crisis episodes during the assessment period.
City-Operated Mobile Crisis programs: Many cities within Alameda County operate their own
mobile crisis programs in partnership with their local police departments, fire departments, other
city agencies, and/or community-based organizations. Table 4 briefly describes the known mobile
crisis programs that were operated by City Agencies in Alameda County as of June 2024.
13 ACBH mobile crisis responses are likely underreported as data were only available for incidents where
the individual in crisis was located and opened to a mobile crisis service in the electronic health record.
Data were unavailable for calls that were canceled or the individual referred to mobile crisis could not be
located. Additionally, the CATT overnight team and MCT East County teams were implemented at the end
of the assessment period and were not yet operating at full capacity.
17
Table 4. City-Operated Mobile Crisis Programs in Alameda County
Mobile Crisis Team Lead Agency Hours
of Operation Staffing Model Region
Served
Alameda CARE Team
(Community Assessment,
Response, and Engagement)
Alameda Fire
Department (AFD)
& Alameda Family
Services (AFS)
24 hours a day
7 days a week
AFD Paramedic & EMT
with on-call support
from AFS clinician
Alameda
(City)
Berkeley Mobile Crisis Team
(MCT)
City of Berkeley -
Mental Health
Division (BMH)
11:30am-10pm
Sun - Mon &
Wed - Fri
Berkeley Police Officer
& BMH Clinician Berkeley
Berkeley Specialized Care
Unit (SCU)
City of Berkeley &
Bonita House
Sun - Tue: 24 hours
Wed - Sat: 12am-4pm
& 8pm-12am
Bonita House EMT,
Peer Specialist, &
Clinician
Berkeley
Fremont Mobile Evaluation
Team (MET)
Fremont Police
Department (FPD)
& Fremont Human
Services
Mon-Thurs: 6am-7pm
Fri: 9am-7pm
FPD Sargeant,
2 FPD Officers,
Community Service
Officer, & Clinician
Fremont
Livermore Mobile Evaluation
Team (MET)
Livermore Police
Department (LPD)
9am-7pm
Mon - Thurs
LPD Officer &
LPD Clinician Livermore
MACRO (Mobile Assistance
Community Responders of
Oakland)
Oakland Fire
Department
6:30am-8:30pm
7 days a week
EMT & Community
Intervention Specialist Oakland
Pleasanton Alternative
Response Unit (ARU)
Pleasanton Police
Department (PPD)
& Bonita House
7am-5pm
Mon - Fri
PPD Police Officer &
Bonita House Clinician Pleasanton
Across City-operated programs, there is more variability in the program structure, staffing, and
approach than the ACBH-operated and contracted programs. Some programs—Berkeley MCT,
Berkeley SCU, Livermore MET, and Pleasanton ARU—have a full-time mental health clinician on
each team and respond to higher acuity mental health crises. Berkeley MCT, Livermore MET,
and Pleasanton ARU employ a co-responder model with a police officer paired with a mental
health clinician.14 The Berkeley SCU does not involve law enforcement, and each team includes
a mental health clinician, EMT, and peer specialist.
Other programs—such as Alameda CARE and Fremont MET—have a mental health clinician
available on-call or that may respond to specific calls and requests. The Alameda CARE teams
include a paramedic and an EMT who respond to non-behavioral health concerns and less acute
mental health needs. However, the program also has a mental health clinician from AFS on-call
14 At times when the mental health clinician is off-duty, Pleasanton ARU police officers respond to lower
acuity mental health crises without the clinician.
18
24/7 to provide crisis intervention for higher acuity mental health calls and evaluations for 5150
or 5585 psychiatric holds.
The Fremont MET program is composed primarily of FPD officers with specialized training to
provide crisis intervention, de-escalation, follow-up and linkage to mental health and homeless
services. The team also includes a mental health clinician who provides additional mental health
support and evaluation but may not be involved in all Fremont MET requests and services.
The MACRO program does not include a mental health clinician, and each team is composed of
an EMT and community intervention specialist. MACRO primarily responds to calls for lower
acuity mental health and non-behavioral health concerns, and also provides a high volume of
street outreach and linkage to community services and resources.
In FY23-24, City-operated mobile crisis programs responded to a total of 8,816 episodes,
2,808 (32%) of which were higher acuity mental health episodes that involved a mental
health clinician (Table 3). Of the 2,808 mobile crisis episodes involving a mental health clinician,
Berkeley MCT accounted for the greatest portion of responses (31%, n=863).
Table 5. Volume of City Program Mobile Crisis Episodes in FY2023-24
City Mobile Crisis Team FY2023-24 City Team Mobile Crisis Episodes
Episodes with Clinician Total Episodes
Alameda CARE 224 523
Berkeley MCT 863 863
Berkeley SCU 500 500
Fremont MET* Unavailable 1,106
Livermore MET** 650 650
Pleasanton ARU 571 1,016
MACRO -- 4,158
TOTAL EPISODES 2,808 8,816
Data Notes: *The number of Fremont MET responses for higher acuity mental health calls that involved a mental health
clinician were not available. However, only 24 Fremont MET responses in FY23-2024 resulted in placement of a 5150
hold, suggesting most episodes may have been lower acuity. Additionally, as of October 2024, the Fremont MET
program no longer includes a mental health clinician.
**Livermore MET began operations on January 25, 2024. As of June 30, 2024, Livermore MET responded to 271
mobile crisis episodes. To estimate the total number of episodes that Livermore MET would respond to in a year,
Livermore mobile crisis episodes during the 5-month period from January 25, 2024 – June 30, 2024 were annualized
to a 12-month period.
19
What is the need for mobile crisis services in Alameda County?
To estimate the need for mobile crisis services in Alameda County, Indigo conducted the following
analysis:
1) Determined the total number of mobile crisis interventions in Alameda County to estimate
the current mobile crisis response,
2) Determined the total number of known crisis interventions in Alameda County in Alameda
County to estimate total crisis events,
3) Calculated the proportion of total crisis interventions that were responded to by existing
mobile crisis programs and compared this to the national average, and
4) Estimated how many additional mobile crisis teams are needed to address need for mobile
crisis response.
Findings for each step of the analysis are summarized in the following sections.
1. What is the total number of mobile crisis interventions in Alameda County?
5,309 TOTAL MOBILE CRISIS INTERVENTIONS:
2,501 ACBH Mobile Crisis Episodes + 2,808 City Team Mobile Crisis Episodes
Total Mobile Crisis Interventions: To estimate the current mobile crisis response in Alameda
County, Indigo examined the number of mobile crisis program episodes that occurred in in
Alameda County in FY23-24, including:
• Mobile crisis episodes responded to by the four ACBH-operated/contracted programs
• Mobile crisis episodes responded to by the City-operated programs that included a mental
health clinician (reflecting higher acuity mental health crises)
In FY23-24, ACBH-operated and City-operated mobile crisis teams responded to 5,309 crisis
episodes. ACBH-operated/contracted programs responded to 2,501 mobile crisis episodes,
reflecting 47% of mobile crisis interventions. City-operated mobile crisis teams responded to
2,808 crisis episodes with a mental health clinician, reflecting 53% of mobile crisis interventions.
2. What is the total number of known crisis interventions in Alameda County?
22,994 TOTAL CRISIS INTERVENTIONS:
5,309 MOBILE CRISIS INTERVENTIONS + 17,685 NON-MOBILE CRISIS INTERVENTIONS
To estimate the total volume of crisis events that are occurring in Alameda County, we examined
crisis interventions that are known to the County. The total number of crisis interventions is defined
as the sum of mobile crisis interventions and non-mobile crisis interventions. Information about
how non-mobile crisis interventions were defined and estimated is available below.
In FY23-24, there were 22,994 total crisis interventions, including 5,309 mobile crisis interventions
and 17,685 non-mobile crisis interventions.
20
What is the total number of non-mobile crisis interventions in Alameda County?
17,685 TOTAL NON-MOBILE CRISIS INTERVENTIONS:
16,937 Crisis Receiving Center Admissions Not Involving Mobile Crisis
+
748 Crisis Hotline Calls Appropriate for Mobile Crisis Response
Total Non-Mobile Crisis Interventions: To estimate the current volume of crises that occur in
Alameda County and were not responded to by mobile crisis teams, Indigo examined the following
data elements:
• Admissions to Crisis Receiving Centers in Alameda County: Crisis receiving centers
included: John George Psychiatric Emergency Services (PES), Amber House Crisis
Stabilization Unit (CSU), Telecare Adolescent CSU, Willow Rock Psychiatric Health Facility
(PHF), Cherry Hill Sobering Center, and Hospital Emergency Departments (EDs) in Alameda
County.15
• Mobile Crisis Interventions Resulting in Transport to Crisis Receiving Centers in
Alameda County: Some mobile crisis episodes that cannot be resolved in the community may
result in transport to a crisis receiving center for further crisis intervention, stabilization, or
evaluation—including all individuals placed on a 5150 or 5585 psychiatric hold as well as
individuals who request or agree to transportation to a crisis receiving center voluntarily. In
order to examine crisis receiving center admissions that likely did not include mobile crisis
intervention, we subtracted the number of mobile crisis episodes that included transport to a
crisis receiving center from all crisis receiving center admissions.
Crisis Receiving Center Admissions Not Involving Mobile Crisis =
Admissions to crisis receiving centers
–
Mobile crisis episodes resulting in transport to crisis receiving center
and/or 5150/5585 hold
• Crisis Hotline Calls Appropriate for Mobile Crisis Response: Indigo also examined crisis
hotline calls to capture crises that did not result in admission to a crisis receiving center but
that may be appropriate for mobile crisis response. Crisis hotline calls included calls received
by Crisis Support Services of Alameda County via the 988 National Suicide Prevention Lifeline
and the local 24-hour Crisis Hotline. Calls assessed to have a medium-high suicide risk (rating
of 3 or 4 on a scale of 0 to 5) may benefit from in-person crisis support and would likely be
appropriate for mobile crisis response.
15 Data were not available for all Hospital Emergency Departments in Alameda County, including Children’s
Hospital and Alta Bates – Herrick Campus.
21
In FY23-24, there were 18,514 admissions to crisis receiving centers in Alameda County. At least
1,577 mobile crisis episodes (30%) resulted in transport to a crisis receiving center. This equates
to 16,937 crisis receiving center admissions that likely did not involve mobile crisis intervention.
In FY22-23, Crisis Support Services of Alameda County received and connected to 25,653 crisis
calls through the 988 National Suicide Prevention Lifeline and local 24-hour Crisis Hotline.16 Of
these calls, 748 (3%) were assessed to have a medium-high suicide risk and may be appropriate
for mobile crisis response.
Additional data is available in the Appendix regarding admissions to crisis receiving centers,
mobile crisis interventions resulting in transport to crisis receiving centers, and crisis hotline calls.
3. What proportion of known crisis interventions were responded to by mobile crisis teams
in Alameda County?
% OF KNOWN CRISIS EPISODES RESPONDED TO BY MOBILE CRISIS:
23% = 5,309 Mobile Crisis Interventions ➗ 22,994 Total Crisis Interventions
As mentioned previously, Crisis Now estimates that mobile crisis response accounts for an
average of 32% of crisis interventions in jurisdictions nationwide.17 To estimate unmet need for
mobile crisis services, Indigo calculated the proportion of known crisis interventions in Alameda
County that were responded to by all mobile crisis response teams and compared this to the
national average (32%).
In FY23-24, 23% of all known crisis interventions in Alameda County were responded to by ACBH-
operated/contracted and City-operated mobile crisis teams. To meet the national average of
32% of crises responded to by mobile crises teams, Alameda County would need to
respond to 2,050 additional crises through mobile response.
4. How many additional mobile crisis teams are needed to address mobile crisis needs in
Alameda County?
ACBH needs a minimum of 2.5 – 5 additional full-time Mobile Crisis Teams
to meet the estimated mobile crisis need.
In order to estimate the number of additional mobile crisis teams that would be needed to meet
mobile crisis needs, we examined: duration of team shifts, shift time needed for call
documentation and transition, and average duration of crisis calls. A team is defined as at least
two full-time equivalent (FTE) staff including at least one FTE mental health clinician responding
16 At the time of the assessment, FY23-24 crisis hotline data were not yet available.
17 Crisis Now: Transforming Crisis Services. Crisis Now Crisis System Calculator. Retrieved May 10, 2024,
from https://crisisnow.com/tools/
22
to all crisis calls; however, the estimates do not specify a particular response model (e.g., police
and clinician co-responder model, EMT & clinician co-responder model, dual clinician model, etc.).
As mentioned, the mobile crisis programs in Alameda County vary widely in terms of program
model and staffing. However, it was common among ACBH-operated and City-operated mobile
crisis teams to work 4, 10-hour shifts in a week. Some mobile crisis teams also spoke of allotting
at least two hours during each 10-hour shift for case notes and documentation as well as time to
transition between crisis calls and shift changes.
Quantitative data regarding the duration of mobile crisis calls were largely unavailable and call
duration was assessed through interviews with mobile crisis teams. Mobile crisis teams shared
that the duration of calls varies widely based on the client’s needs and whether transportation to
a crisis receiving center is needed, with some calls lasting as short as a few minutes and other
calls lasting several hours. ACBH and CATT leadership shared that on average, crisis calls last
approximately 2 hours, and teams typically have capacity to respond to up to 3 to 4 crisis calls
per shift.
To account for variability in program models and crisis call duration, Indigo modeled several
scenarios exploring the number of mobile crisis teams needed in order to respond to 2,050
additional crises (i.e., the number of crises that would need mobile response to align with the
national average of 32% of crises addressed by mobile crisis teams). Each scenario utilized a
different average crisis call duration (ranging from 2 to 4 hours) and/or different average calls
responded to during each shift (ranging from 2 to 4 crisis episodes). In all scenarios, estimations
assume one team works 4, 10-hour shifts each week—including 8-hours per shift when teams
are available to respond to crisis calls and 2-hours for documentation and transitions. Findings
are presented in Table 6.
Table 6. Estimated Number of Additional Mobile Crisis Teams Needed
in Alameda County
Additional
Mobile Crises
Average
Duration of
Crisis Episodes
Average
Crisis Episodes
per Shift
Average
Crisis Episodes
per Year
Additional
Mobile Crisis
Teams Needed
2,050 Crises
2 Hours 4 Episodes 832 Episodes 2.5 FTE Teams
2.5 Hours 3.2 Episodes 665 Episodes 3.1 FTE Teams
3 Hours 2.7 Episodes 562 Episodes 3.7 FTE Teams
4 Hours 2 Episodes 416 Episodes 4.9 FTE Teams
In order to meet the mobile crisis need, Alameda County needs a minimum of 2.5 to 5 additional
mobile crisis teams. On the low end of the estimate, Alameda County would require 2.5
additional mobile crisis teams if each team responds to an average of 4 mobile crisis calls every
23
shift (average of 2 hours per call), equating to 832 mobile crisis episodes per team per year. On
the high end of the estimate, Alameda County would require 5 additional mobile crisis teams if
each team responds to an average of 2 mobile crisis calls every shift (average of 4 hours per
call), equating to 416 calls per team per year.
How can Alameda County meet the mobile crisis need?
When are the gaps in mobile crisis coverage?
Based on mobile crisis team operating hours and time of mobile crisis calls, there are
gaps in mobile crisis coverage overnight and on weekends.
As described in the current state of mobile crisis response in Alameda County, most mobile crisis
programs operate on weekdays during typical business hours (e.g., 8am-6pm, 7am-5pm, etc.).
The CATT, Alameda CARE, Berkeley SCU, and MACRO teams are the only programs that
provide overnight and weekend coverage. Additionally, CATT did not implement an overnight
team until May 2024.
We examined the number of CATT mobile crisis calls by time of day to identify periods with higher
or lower call volume. The time of CATT mobile crisis calls were then compared to the time of
Emergency Department (ED) admissions for mental health needs and the time of 988 and crisis
hotline calls to assess if there are differences in the utilization patterns of mobile crisis services
compared to other crisis interventions.
Table 7. Time of Day of Crisis Interventions,
by Mobile Crisis and Non-Mobile Crisis Episodes
Time of Day of
Crisis Intervention
CATT Episodes in
FY23-24
ED Admissions in
FY23-24
Crisis Hotline Calls
in FY2-23
12am – 8am 26 (2%) 653 (25%) 97 (13%)
8am – 12pm 336 (28%) 361 (14%) 129 (17%)
12pm – 4pm 458 (38%) 569 (21%) 132 (18%)
4pm – 8pm 331 (28%) 515 (19%) 210 (28%)
8pm – 12am 49 (4%) 566 (21%) 180 (24%)
TOTAL EPISODES 1,200 (100%) 2,664 (100%) 748 (100%)
Data Notes: CATT episode data and ED admission data reflect episodes in FY23-24. Crisis Line data reflect calls in
FY22-23. Time of day of mobile crisis episodes was not available for other ACBH-operated mobile crisis teams or City-
operated teams. Day of the week data was also unavailable. The 12am-8am category reflects 8 hours whereas the
other categories are 4 hours.
As shown in Table 7, nearly all CATT mobile crisis episodes in FY23-24 occurred between 8am-
8pm (94%). Only 6% of CATT mobile crisis calls in FY23-24 occurred overnight (from 8pm to
24
8am), reflecting the program’s operating hours of 7am-11pm before overnight coverage was
implemented in May 2024. In comparison, ED admissions for mental health needs and crisis
hotline calls were more evenly distributed throughout the day. Nearly half of ED admissions (46%)
and 37% of crisis hotline calls occurred overnight. These findings further demonstrate there are
crisis events occurring overnight that may benefit from mobile crisis response.
Where are the gaps in mobile crisis coverage?
Additional mobile crisis coverage may be needed in North County, particularly Oakland.
Mobile crisis programs serve the entire county, with CATT and ACBH MCT programs operating
countywide and the remaining programs serving designated cities. To identify if there are specific
regions or areas within the county that may require more mobile crisis coverage, we first examined
ACBH-operated/contracted mobile crisis call volume by the mobile crisis clients’ region of
residence. We then compared this information to the region of residence for individuals admitted
to crisis receiving centers and the general ACBH client population with high utilization of crisis
services.
The county regions were defined as follows:
• North County: Alameda, Albany, Berkeley, Emeryville, Oakland, Piedmont
• Central County: Castro Valley, Hayward, San Leandro, San Lorenzo
• South County: Fremont, Newark, Union City
• East County: Dublin, Livermore, Pleasanton, Sunol
Table 8. Client Region of Residence,
by Mobile Crisis and Non-Mobile Episodes and ACBH Population
Region of
Residence
ACBH Mobile Crisis
Episodes
in FY23-24
Crisis Receiving
Center Admissions
in FY23-24
ACBH Population
in FY22-23
North County 1,115 (48%) 10,148 (55%) 2,829 (59%)
Central County 776 (33%) 5,207 (28%) 1,450 (30%)
South County 137 (6%) 1,279 (7%) 356 (7%)
East County 114 (5%) 713 (4%) 175 (4%)
Unknown 192 (8%) 1,167 (6%) --
TOTAL EPISODES 2,501 (100%) 18,514 (100%) 4,810 (100%)
Data Notes: Location of mobile crisis episodes was only available for the CATT team. Client residence was therefore
used as a proxy for location of mobile crisis interventions for all ACBH-operated/contracted programs. County Team
Mobile Crisis episode and ED admission data reflect episodes in FY23-24. Out-of-County residents receiving mobile
crisis services or admitted to an Alameda County ED were excluded from analysis. ACBH population includes FY22-
25
23 FSP clients, Service Team clients, and individuals not enrolled in FSP or Service Teams with high incidence of
admission to crisis receiving centers and/or incarceration.
As shown in Table 8, nearly half (48%) of individuals receiving ACBH-operated/contracted mobile
crisis services in FY23-24 resided in North County and one-third (33%) resided in Central County.
The remaining individuals resided in South County, East County, or their residence location was
unreported.
Trends were similar across individuals admitted to crisis receiving centers and the general ACBH
client population with high utilization of crisis services. However, a slightly greater proportion
ACBH clients and individuals admitted to crisis receiving centers lived in North County (59% and
55%, respectively). This data suggests that individuals in North County may be slightly more likely
to be admitted to crisis receiving centers rather than receive mobile crisis services. Additionally,
the high percentage of ACBH clients living in North County and who have a high incidence of
crisis receiving center admissions further suggest there may be a need for more mobile crisis
coverage in North County.
Mobile crisis programs and community stakeholders corroborated these findings, sharing that
Oakland in particular needs more mobile crisis coverage to respond to the high volume of crises
occurring in the city.
Who is not receiving mobile crisis services?
Male and Black and African American individuals were less likely to participate in mobile
crisis services and were more likely to be admitted to crisis receiving centers.
To identify if there are differences in populations that receive mobile crisis services as compared
to other crisis interventions, we examined demographic characteristics of individuals utilizing
ACBH-operated/contracted mobile crisis services compared to individuals admitted to crisis
receiving centers. Demographic data were incomplete for mobile crisis episodes and crisis
receiving admissions in FY23-24; given this limitation, FY22-23 data were examined.
As shown in Table 9, males comprise half of county mobile crisis episodes (51%), but two-thirds
of crisis receiving center admissions (67%). Additionally, Black and African American individuals
comprised about one-third of county mobile crisis episodes (35%), but half of crisis receiving
center admissions (48%). This data suggests males and Black and African American individuals
were more likely to be admitted to crisis receiving centers than to participate in mobile crisis
services.
In comparison, females and Asian individuals and Pacific Islanders appeared more likely to
participate in mobile crisis services than to be admitted to crisis receiving centers. Females
comprise half of mobile crisis episodes (49%), but only one-third of crisis receiving admissions
(33%). Asian individuals and Pacific Islanders made up 14% of mobile crisis episodes, compared
to 6% of crisis receiving center admissions.
Among other race / ethnic groups, the proportion participating in mobile crisis services was similar
to the proportion admitted to crisis receiving centers. There were no differences in language, with
26
94% of individuals receiving mobile crisis services or admitted to crisis receiving centers speaking
English, 4% speaking Spanish, 2% speaking another language, and <1% with language
information unknown or unreported.
Table 9. Demographic Characteristics of Individuals Receiving Mobile Crisis Services
compared to Individuals Admitted to Crisis Receiving Centers
Demographic
Characteristics
ACBH Mobile Crisis Episodes
in FY22-23
Crisis Receiving Center
Admissions in FY22-23
Gender
Female 1,313 (49%) 5,491 (33%)
Male 1,349 (51%) 11,126 (67%)
Race / Ethnicity
Black / African American 925 (35%) 7,900 (48%)
White 729 (27%) 3,930 (24%)
Hispanic / Latino 390 (15%) 2,263 (14%)
Asian / Pacific Islander 373 (14%) 1,050 (6%)
Other 154 (6%) 901 (5%)
Unknown 99 (4%) 560 (3%)
TOTAL EPISODES 2,670 (100%) 16,626 (100%)
Data Notes: Demographic data were incomplete for FY23-24. Given this limitation, FY22-23 data were examined for
County Mobile Crisis Teams and Crisis Receiving Centers. Race/Ethnicity information sums to greater than 100% as
some individuals may have reported more than one race/ethnicity.
27
Findings Summary
The aim of the mobile crisis assessment was to identify the number of mobile crisis teams needed
to provide county-wide mobile crisis services that deliver timely and effective in-person crisis
response 24-hours a day, 7 days per week. The assessment found that ACBH needs a minimum
of 2.5 – 5 additional FTE Mobile Crisis Teams from the baseline identified in this assessment in
order to meet the estimated mobile crisis need, based on the Crisis Now benchmark that 32% of
known crisis events are responded to by mobile crisis intervention.
During the assessment process, the County expanded mobile crisis coverage and has added or
plans to add the following four mobile crisis teams:
• ACBH MCT #3: ACBH implemented an MCT East County team in March 2024. As this is
a new team, the team was still ramping up services during the assessment period, and
their services were not yet at full capacity. As implementation progresses, ACBH
anticipates call volume will increase to full capacity.
• CATT #9: In partnership with ACBH, Bonita House and Falck implemented the first
overnight CATT team in May 2024, operating Sunday – Wednesday from 7pm-7am. As
this is a new team, the team was still ramping up services during the assessment period,
and their services were not yet at full capacity. As implementation progresses, ACBH
anticipates call volume will increase to full capacity.
• CATT #10: In partnership with ACBH, Bonita House and Falck planned to implement the
second overnight CATT team in November 2024, operating Wednesday – Sunday 7pm-
7am. With the addition of this team, CATT will provide overnight coverage 7 days a
week.18
• CATT #11: In partnership with ACBH, Bonita House and Falck plan to implement an 11th
CATT team in 2025. Based on identified mobile crisis coverage gaps, the County may
wish to consider operating this team out of CATT’s Oakland staging post to provide more
coverage in the Oakland area and North County region.
While these teams are not reflected in the data for this assessment because they were not yet
fully operational, they are or will soon be part of the landscape of crisis services in Alameda
County. With these new and planned expansion of mobile crisis programming, ACBH has fulfilled
the identified mobile crisis need identified in this assessment.
The assessment also identified existing gaps in mobile crisis coverage. Based on mobile crisis
team operating hours and time of mobile crisis calls in FY23-24, mobile crisis coverage is needed
18 In November 2024, ACBH also began a pilot program with Crisis Support Services of Alameda County
wherein CATT can be dispatched through the 988 Suicide and Crisis Lifeline on nights and weekends.
Moving forward, the County expects to expand 988 dispatch to 24 hours a day, seven days a week.
28
overnight and on weekends. Mobile crisis coverage is also needed in North County, particularly
Oakland. Males and Black and African American individuals also appeared less likely to
participate in mobile crisis services and were more likely to be admitted to crisis receiving centers.
Based on ACBH’s mobile crisis team expansion of 4 FTE mobile crisis teams, including 2
overnight CATT teams and an MCT East County team, the County has fulfilled the addition of 2.5
– 5 FTE mobile crisis teams necessary to address mobile crisis needs. However, going forward,
ACBH should regularly monitor mobile crisis capacity and coverage to ensure mobile crisis
services continue to meet community needs.
29
Appendix. Supplemental Data
Admissions to Alameda County Crisis Receiving Centers in FY23-24
In FY23-24, there were 18,514 admissions to crisis receiving centers in Alameda County. Most
admissions were to John George PES and Cherry Hill Sobering Center.
Table 10. Number of Admissions to Crisis Receiving Centers in Alameda County
in FY23-24, by Crisis Receiving Center
Crisis Receiving Center FY23-24 Alameda County
Crisis Receiving Center Admissions
John George Psychiatric Emergency Services 7,214 (39%)
Amber House Crisis Stabilization Unit (Adult) 751 (4%)
Telecare Crisis Stabilization Unit (Adolescent) 159 (1%)
Willow Rock Psychiatric Health Facility (Youth) 326 (2%)
Cherry Hill Sobering Center 7,400 (40%)
Hospital Emergency Departments 2,664 (14%)
TOTAL EPISODES 18,514 (100%)
Data Notes: Hospital ED data reflect admissions to the Hospital EDs in Alameda County for mental health
concerns. ED data were not available for all hospitals, including Children’s Hospital and Alta Bates – Herrick
Campus. Admission data was available for Alameda Hospital, Alta Bates (Alta Bates & Merritt campuses),
Eden Medical Center, Highland Hospital, San Leandro Hospital, St. Rose Hospital, and Washington
Hospital. Data for some hospital EDs in Alameda County were unavailable. Out-of-county residents
admitted to these EDs for mental health concerns were excluded from analysis.
30
Mobile Crisis Episodes Resulting in Transport to a Crisis Receiving Center in FY23-24
Of the 5,309 mobile crisis episodes in FY23-24, at least 1,577 mobile crisis episodes (30%)
resulted in transport to a crisis receiving center due to voluntary transport or placement of a
5150/5585 psychiatric hold during the crisis episode. Slightly less than half (45%) of all ACBH-
operated/contacted episodes resulted in transport to a crisis receiving center, while 16% of City-
operated mobile crisis episodes resulted in transport to a crisis receiving center (based on
5150/5585 psychiatric hold placement).
Table 11. Number of Mobile Crisis Episodes resulting in Transport to
Crisis Receiving Centers in FY23-24, by Mobile Crisis Team
Crisis Team FY23-24 Mobile Crisis Episodes with
Transports to Crisis Receiving Centers
County Mobile Crisis Teams 1,129
CATT 486
ACBH MCT 357
ACBH MET 140
ACBH HMET 146
City Mobile Crisis Teams 448
Alameda CARE 74
Berkeley MCT 198
Berkeley SCU 63
Livermore MET 43
Pleasanton ARU 70
TOTAL EPISODES 1,577
Data Notes: Transport data were only available for the CATT program. For other programs, individuals
placed on a psychiatric hold are assumed to be transported to a crisis receiving center (PES, Willow Rock,
or Hospital ED). For MCT, MET, and HMET episodes, dispositions of “Voluntary PES” were considered
voluntary transports to a crisis receiving center. *Livermore MET began operations in January 2024 and
data were available through June 30, 2024. Livermore MET data were annualized to estimate total calls in
a full year of operations.
31
Admissions to Alameda County Crisis Receiving Centers in FY23-24
In FY22-23, Crisis Support Services of Alameda County received and connected to 25,653 crisis
calls. Of these calls, 748 (3%) had a medium-high risk level (risk level of 3 or 4 on a scale of 0 to
5), suggesting that may benefit from in-person, mobile crisis intervention.
Suicide risk levels are defined as follows:
• Risk Level 0: No reported suicidal thoughts or feelings
• Risk Level 1: Some desire for suicide but no/low intent & no means
• Risk Level 2: suicidal desire present, some intent & limited access to means
• Risk Level 3: suicidal desire present, some intent, & ready access to means
• Risk Level 4: suicidal desire present, resolved intent, & ready access to means
• Risk Level 5: caller has already or is resolved to make a suicide attempt
Table 12. Suicide Risk Level of Crisis Hotline Calls in FY22-23
Suicide Risk Level FY22-23 Crisis Calls to Crisis Support
Services of Alameda County
Risk Level 0 17,242 (67%)
Risk Level 1 or 2 7,588 (30%)
Risk Level 3 or 4 748 (3%)
Risk Level 5 75 (<1%)
TOTAL CALLS 25,653 (100%)
Data Notes: Data reflect completed incoming crisis calls to and follow-up/outreach calls from the Crisis
Support Services of Alameda 24-hour Crisis Line and 988 National Suicide Prevention Lifeline. Calls that
received an out-of-county referral were presumed to be out-of-county callers and were excluded.
Incomplete calls, calls for inappropriate use of the crisis line, and afterhours calls for the ACBH MH
ACCESS line and SU Helpline were excluded.