When Amelia Harmon arrived at the scene of the 911 call, an ambulance, several police cars and a mental health clinician were gathered around an apartment building, at a standstill.
At the top of the outside staircase, there was a woman holding a baseball bat, screaming and crying. Around the stairs, police officers and EMTs stood at a safe distance, unable to approach because the woman was armed.
Harmon stepped forward, introduced herself to the woman, and began walking up, following de-escalating tactics and asking the woman what was wrong.
“She said, ‘If there’s anything I need, it’s a hug,’” Harmon said. “I’m not sworn staff. I am non-uniformed, and I can walk up there and hug her. So I did.”
The woman dropped the bat and took the hug.
Harmon is not an EMT, a police officer, or a firefighter. She does not wear a uniform. She’s a peer counselor, a person familiar with mental-health or substance-abuse issues, and is trained specifically in de-escalation techniques.
As a member of the city’s Street Crisis Response Team, she works aboard a fire department ambulance, responding to emergency reports of people in mental health crises.
Now, Harmon’s role, and that of her colleagues, is quietly coming to an end. On July 8, the handful of peer counselors that have worked with the San Francisco Fire Department to respond to mental health-related emergency calls since 2020 learned that the fire department has chosen to terminate their contract, effective Aug. 14.
While the city still employs some peer counselors, they will no longer be going out on 911 calls.
The mayor’s office declined to comment on the contract’s cancellation.
“We defer to SFFD, as it was an operational matter,” wrote spokesperson Shelby Weiss.
The cut is a mystery. Their roles are subsidized by the city’s public health department, and funding for their roles appears to still be in place.
Also a mystery, said Harmon, is how SFFD plans to fill the unique role in emergency response that peer counselors have held. The fire department has developed its own community paramedicine program, which trains paramedics to deal with individuals in mental health crises.
But the paramedics often don’t have the lived experience of a peer counselor, and the uniform can make people feel uncomfortable, peers say.
“Having that non-uniformed approach without the steel-toed boots really does help people feel more comfortable talking to us,” Harmon said. “I can tell them about the time something happened to me. And that’s a very different experience than someone coming in with a uniform.”
In her five years on the job, Harmon has helped people in crisis with tasks that are well beyond the scope of what a firefighter, EMT, paramedic or police officer employed by the city would normally do. She’s on the scene and then helps people navigate the city’s archipelago of mental health services and get connected to help.
“We respond to people in any type of situation, whether it’s a packed SRO and someone just needs a break from their psychotic roommate, or someone having a first episode of psychosis after they moved out of their parents’ house.”
The people Harmon encounters on emergency calls cover a wide range, she said, from the city’s wealthiest residents to its poorest. Sometimes they’re a college student. Sometimes they’re a new mother struggling with postpartum depression or mania. Sometimes they’re a burnt-out caregiver.
Sometimes it’s a homeless person. Some of the peer counselors who go out on emergency calls work with the city’s Homeless Outreach Team, which gives them access to the ONE System, an online database that serves as the central coordinating system for the city’s mental health resources.
That access is critical, said one peer counselor, who asked not to be named, for helping people not fall through cracks in the system.
They described going out on a call in which, using the ONE system, they discovered that the person in crisis had secured a spot in a longer-term shelter. Without that information, they said, the man likely would have been taken to a drop-in-shelter by the EMT and paramedic, and lost the shelter they already had.
Peer counselors can also use the ONE system to make shelter reservations on the spot. It’s a process that takes skill and knowledge of the system, one counselor said, comparing the shelter bed system to “Hungry Hippos.”
“We’re just flying, typing it out on our phones,” they said. “It’s like getting Taylor Swift tickets. They [EMT and Paramedic] are never going to get Taylor Swift tickets.”
From rumor to reality
In early June, a rumor began to go around that the fire department was considering terminating its contract with peer counselors.
Harmon went directly to fire leadership, who denied the rumors at first. Then, after nearly a month of asking for updates in meetings with the fire department, Harmon’s organization, RAMS, received verbal confirmation from the fire department that their contract would be terminated.
“It was only through our very direct questioning from individuals that we found out,” Harmon said.
On July 8, EMS Deputy Chief Garreth Miller made a statement to the Fire Commission.
“As part of our evaluation of the community paramedicine program and focusing on its mission and really orienting to high-acuity calls — which we think our personnel are uniquely qualified to respond to — we have decided to discontinue the practice of deploying peer counselors on the apparatus,” Miller said.
Miller also said that it was inconvenient for EMS to pick up peer counselors at 555 Stevenson St. on their way to calls and that the peer counselors had “inconsistent” levels of training.
Peer counselors said that they have offered to be on site at fire stations, and that the issue of inconsistent training has not been brought up in previous meetings between the peer counseling teams and SFFD as a serious issue.
One peer counselor described the shock of their non-peer co-workers when they shared the news.
“Are you serious or just messing around,” one of them texted back.
“Holy fucking shit,” another co-worker responded.
Harmon appeared before the Health Commission on July 8 to make a public comment. The commissioners appeared surprised by the news. So did the commissioners on the Fire Commission and the Police Commission when she spoke to them a few days later.
After hearing her speak during the public comment period, the police commissioners called Harmon back to hear more about the change. “They didn’t seem to know at all,” Harmon noted.
The peer counselors aren’t the first group to be removed from 911 calls. In 2023, the passage of SB 43 gave police the ability to issue a psychiatric hold, and mental health clinicians who had previously been on the Street Crisis Response Team were laid off, leaving only the peer counselors to do mental health work.
Since the announcement was made official, said Harmon, she has reached out to community partners and city leaders to try and save the program, walking more than 23 miles in the process.
She developed a seven-point “collaborative framework” on how peer counselors could work more effectively with the fire department and sent it to the SFFD as well as the Mayor’s Office, and built out a website, with sample letters of complaint to local officials, along with a collection of studies on the effectiveness of peer counselors.
“Research, testimony, and common sense say the same thing: peers are often the only team member a person in crisis will trust enough to be honest with,” writes Harmon, on the site. “We’re asking the Fire Commission, Health Commission, Board of Supervisors, and the Mayor’s Office to keep workers with lived experience on this 911-dispatched crisis response team — not as an afterthought, but as a core value of how we treat our community.”
At Tuesday’s meeting of the Board of Supervisors, Harmon spoke out in support of the program during the public comment period. The agenda for that day said that more than 35 of the letters had been submitted to the Board ahead of the meeting in favor of saving the program, signed by firefighters, EMTs, primary care providers, and an array of mental health program leaders.
“Removing the peers will create more frequent 911 use from our most vulnerable,” read one letter. “This proposed removal will undermine the Mayor’s Office.”
After the Board of Supervisors meeting, Harmon wasn’t sure if her efforts would be successful. But, she said, that’s not the only thing that matters.
“Even if we don’t win this fight,” Harmon said. “People deserve to know.”
These cuts go against well researched and documented evidence-based practices. Such a short-sighted, poorly thought out decision, likely made by someone who has no experience on the ground.
Peer counselors are well known to be strong, effective support to people experiencing any number of crises. They can lift people up and out of a situation better than anyone else.
Remember, they also lift up the peer counselors themselves, providing training, jobs, benefits, and work experience.
“the city’s archipelago of mental health services” that seems to require the efforts of DBI-expediter-style facilitators like Harmon is the problem that needs fixing.
The decision to eliminate Peer positions overlooks the unique value that we have brought to the City and County of San Francisco. Throughout my time as a Peer, I have responded to countless crisis calls where my lived experience, de-escalation skills, and bilingual Spanish abilities made a meaningful difference.
There were numerous situations involving families seeking asylum who faced significant language barriers. When no Spanish-speaking personnel were available from the Fire Department, I was able to communicate directly with these families, explain what was happening, build trust, and help them receive the services they needed.
I have also worked with angry, emotionally distressed, and erratic individuals who were unwilling to communicate with others but responded when I spoke with them. Through patience, respect, and effective de-escalation, I was able to calm people in crisis and gain their cooperation without unnecessary escalation.
One of the most meaningful parts of my work involved Spanish-speaking mothers experiencing mental health crises while their children were present. Because I could communicate with them in their own language, I was able to build rapport, calm the situation, and help prevent it from escalating to the point where law enforcement would need to use force. These moments protected not only the individuals in crisis but also their children, responding personnel, and the community.
This is the value that Peers bring. We connect with people in ways that cannot always be taught in a classroom. We build trust where others cannot, reduce trauma, improve outcomes, and serve some of San Francisco’s most vulnerable residents.
It is disappointing that the Fire Department is choosing not to recognize the impact of Peer Specialists and the countless lives we have touched. Our work has helped not only San Franciscans but also families and individuals from around the world who came here seeking safety and hope. I hope this decision is reconsidered so that future residents in crisis continue to benefit from the unique skills, compassion, and lived experience that Peer Specialists provide.
The peer counselors support 911 first responders. An incredibly foolish decision ro eliminate them.
I was once homeless and surviving an abusive situation, feeling like I had nowhere to turn. Peer counselors were the ones who helped me navigate through that trauma. They didn’t just give me resources—they made me feel seen and guided me toward stability. Every day, I saw them doing the same for others in crisis. Without them, I honestly don’t know where I’d be. Peer counselors change lives, and they changed mine.”
Replacing peer counselors with paramedics ignores the reality that lived experience can’t be learned from a textbook. Paramedics are incredible at what they do—they save lives medically. But when it comes to crises rooted in trauma, fear, or trust, peer counselors bring something essential. They understand the streets, the trauma, and how to connect with people who might otherwise shut down. The paramedics should handle the medical emergencies, and peer counselors should handle the human emergencies. Without peer counselors, we lose the bridge between crisis and trust. It would be a disservice to both the community and the first responders to remove that partnership.
When you are next wondering why there seem to be more sick and disturbed and disoriented people on the streets of San Francisco, remember Mayor Daniel Lurie and thank him.
“In 2023, the passage of SB 43 gave police the ability to issue a psychiatric hold…”
Incorrect. The police, like doctors and licensed mental health professionals, have been able to issue psychiatric holds (5150W&I) seemingly forever.
In 2023, SB 43 expanded “the definition of gravely disabled to also include a condition in which a person, as a result of a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is, in addition to the basic personal needs described above, unable to provide for their personal safety or necessary medical care, as defined.”
Please consider sharing your voices with city leadership at the link here. https://crisisneedspeers.com/
I am the mother of a severely mentally ill adult son. Many times I have called 911 for a 5150 evaluation, both fire dept and peers came to my home spoke with my son for an hour then left because they had no ability to 5150 anyone only to take them to an ER if they wanted to go. Same happens with mobile crisis. Only the police hav ever 5150 my son and they treated him very well Not all who need mental health services are drug addicts.
SF’s policy of indulging junkies hasn’t worked. We don’t have fewer crazy people wandering around screaming at themselves and others.
So, let’s see less handholding and more arrests. Run the city for the people who live and work here, not junkies from out of town.
You seem nice.
So sick and tired of this trope. There is no reality where this is true. You would rather lock people up and spend hundreds of thousands of dollars a year keeping them in a cage? What a waste of everyone’s time, energy, and money. Not to mention that you are further traumatizing those who have to participate in this system of oppression.