Starting Saturday, San Francisco’s Street Crisis Response Teams will respond to behavioral health emergencies without the peer counselors who have been part of the program for nearly six years, relying instead on teams composed entirely of fire department paramedics and EMTs.
The change was set to take effect, no matter the dozens of peer counselors, behavioral-health workers and former clients who packed Wednesday’s Fire Commission meeting to urge officials to reconsider it.
The matter was scheduled for discussion only, meaning commissioners could hear testimony and question fire department leaders, but could not vote to stop the change.
Still, for almost an hour of public comment, peer counselors, behavioral health professionals and former clients argued that no amount of trained personnel could substitute for the “lived experience” of peer counselors.
Del Seymour, a former Los Angeles Fire Department paramedic who underwent years of addiction and homelessness in the Tenderloin, welcomed the department’s plans for additional training but said it could not replicate his ability to connect with people in crisis.
“You can’t train someone how it is to piss on yourself in the street,” Seymour said. “You can’t train someone how it feels at 3 o’clock in the morning when your tent’s got a hole in it. There’s no training for that. That’s why we call that lived experience. You can’t train lived experience.”
The new teams will consist of either a community paramedic and an EMT or two community paramedics.
The department will also reduce overnight operations and concentrate its teams between 5 a.m. and midnight, when Assistant Deputy Chief April Sloan said 91 percent of street crisis calls occur.
The overhaul is part of a broader reorganization. Sloan said the current Street Crisis Team structure created “operational inefficiencies” that strain the 911 system and put too much administrative responsibility on Street Crisis captains, but did not elaborate on how the existing model caused those problems.
Sloan said the changes were a return to the teams’ “core mission” of responding to behavioral-health crises and people who repeatedly use emergency medical services.
The changes come after the department quietly decided last month to stop deploying peer counselors, which have been part of the program since its launch in 2020. It affects 19 staff members, according to Angela Tang, the CEO of Richmond Area Multi-Services, the nonprofit that employed them.
The decision does not appear to be driven by a loss of funding. The peer counselors are paid through a Department of Public Health contract with the nonprofit, not by the fire department. The funding agreement appears to remain in place, and is scheduled to run through Dec. 31, 2026.
Instead, fire officials framed the decision as an operational one. Sloan told commissioners that community paramedics receive more than 160 hours of advanced training in behavioral health, substance-use disorders, de-escalation, trauma-informed care and community-based intervention.
She said department data show similar outcomes on calls handled with peer counselors and those handled without them. But the department did not present data showing that removing peer counselors would improve outcomes.
That became a point of contention. Peer counselors and behavioral health providers repeatedly asked why the city would eliminate part of its crisis response program if outcomes were merely comparable.
Chantel, a District 2 resident who did not give her last name, recalled flagging down a Street Crisis vehicle four years ago while sleeping at a bus stop, soaked in urine, wearing one shoe and contemplating suicide.
A peer counselor named Britt told her that she understood what she was going through and helped get her to a medical clinic, then a sobering center and detox.
“I couldn’t have done any of it if it had not been for her,” Chantel said.
Richard Zevin, a clinical social worker involved with Street Crisis since its inception, argued that removing peer counselors leaves street teams without any mental health specialists.
“What is not fine is ending alternative crisis response in San Francisco at the very time our city needs it most,” Zevin said.
The testimony appeared to sway several commissioners. Commissioner Armie Morgan said he initially viewed the change as a managerial decision but had reconsidered, saying the city “needs all the help we can get.”
Commissioner Stephen Nakajo likewise questioned why the fire department would give up an additional resource funded through a different department, and called for a pause or further evaluation before the change takes effect.
Fire Chief Dean Crispen defended the decision, calling it “very challenging” but saying its community paramedics can handle the work.
Sloan pushed back on one recurring concern from speakers: that removing peers could push behavioral health calls back to police. “None of these calls are going to go back to law enforcement,” she said, adding that when the Street Crisis team is unavailable, calls will continue to go to ambulances.
