San Diego Revives MIH-CP Program to Reduce Frequent Flyer Calls

The San Diego Union-Tribune

The city and county are partnering to revive a mental health program that aids frequent 9-1-1 callers and has saved taxpayers hundreds of thousands of dollars.

On Monday San Diego Mayor Kevin Faulconer and County Supervisor Nathan Fletcher announced that there will be staffing increases for the city’s Resource Access Program, also known as RAP, an initiative that provides outreach and resources to residents who are frequent 9-1-1 callers while reducing unnecessary emergency room visits.

RAP teams use real-time data to identify residents who frequently use the 9-1-1 emergency system for non-medical emergencies. Then it connects them to appropriate services, including those for mental health, homelessness and substance abuse.

RAP was essentially disbanded in 2017 when the city removed its response teams and reduced staff to one position.

The newly constituted RAP teams began working in May and consist of two American Medical Response paramedics, two fire department staff, and two clinicians from the county’s Psychiatric Emergency Response Teams, or PERT. In its previous iteration RAP did not include PERT clinicians.

“This program is exactly the right kind of positive outreach that cities across the country should be doing,” said Faulconer. “We are identifying those individuals who need specialized care and connecting them with the help they need so they don’t have to call 9-1-1. It is a shining example of how the city and the county can work together to find solutions to our region’s mental health crisis.”

RAP was once a highly regarded program for reducing the strain of unnecessary 9-1-1 calls place on the city’s emergency system. RAP clients represented less than 1% of the city’s total population, yet they generated nearly 20% of 9-1-1 calls in San Diego, city officials said.

Formally established in 2010 as a pilot program, RAP tried to help people who called 9-1-1 multiple times each month for non-emergencies. More than 70% of frequent users were homeless, according to a San Diego County Grand Jury report on the program in 2018, and their calls often were connected to “hunger, loneliness, and the harsh circumstances of living on the streets.”

State law requires agencies to dispatch emergency medical services to each call. The RAP team would try to engage the callers so they wouldn’t have to go to emergency rooms.

The program received a portion from a series of grants over its first four years, and it contributed to a reduction in 9-1-1 calls and emergency room visits. For example, in 2016 RAP intervention and assistance resulted in 325 fewer emergency room transports and more than $543,000 in savings, according to the grand jury.

Despite such savings, RAP ultimately struggled to find long-term financial support after its pilot period ended in 2016. City Council did not include funding for it in the 2017-18 budget beyond maintaining one staff position.

American Medical Response decided not to supply paramedics to work on RAP teams. At the time, American Medical Response was struggling to meet performance standards and said it needed to devote more of its paramedics to overcome staffing shortages for emergency medical calls serving the general population.

Today paramedic staffing levels are back on track and the company said it is excited resume its involvement with RAP, said Madeleine Baudoin, an American Medical Response spokeswoman.

The county’s commitment to provide two PERT clinicians to the RAP teams reflects increased collaboration between the city and county, officials said.

“So often when you confront problems it’s like one entity or one group tells the other, ‘There’s a leak in your side of the boat’,” Fletcher said. “The reality is we’re all in this boat together, and we all have to work together to try and address the very significant issues that our region faces.”

Dr. Mark Marvin, director of the Psychiatric Emergency Response Team, said he hopes this is a first step in expanding PERT’s involvement in the program countywide.