LA County more than doubled its mental health crisis teams in four years. But it still needs more

Over nearly four years, Los Angeles County has more than doubled its number of mental health crisis teams — to more than 70 — and cut response times to two hours on average, providing more opportunities for people in crisis to get in-person help without calling paramedics or police, authorities said.

That’s progress, but the county still has much more to do to expand the number of crisis response teams, which serve as an alternative to 911, and reach its goal of dropping response times to 30 minutes on average.

To help get there, the county Board of Supervisors voted last week to explore options to recruit and retain workers for its field teams. Proposals include providing signing and retention bonuses for clinicians, and reinstating a loan forgiveness for psychiatrists.

“I think there’s nothing more frustrating to family members or for our public -- who many times comes across people in the streets having a mental health crisis -- to call and hear it will be two hours,” said Supervisor Janice Hahn, the author of last week’s motion, said.

County supervisors voted unanimously last week to order county staff to report back in two months on how to maintain the incentives.

Hiring difficulties

The county Department of Mental Health has long maintained that it is difficult to find trained personnel to staff its alternative crisis response teams, which are made up of trained mental health professionals and people with lived-experience with mental illness.

Historically, county officials have said it’s hard to find mental health professionals who are willing to work late hours under taxing conditions, especially as the effort has moved to 24/7 coverage. Some staff doing crisis work have been lost to other programs and employers who offer telework.

In 2021, L.A. County had fewer than 30 field teams that only operated during business hours, according to county documents. It now has 72 teams, which together are able to respond to calls 24 hours a day, seven days a week.

Response times have decreased by 70%, from six hours to about two hours on average, according to county authorities. They attributed the change to several efforts, including expanding a financial incentive program to include psychiatric technicians, and partnering with colleges and universities to recruit qualified candidates.

A graph from a Department of Mental Health report showing average response times for mental health crisis teams in LA County.

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LA County

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But the county has acknowledged that those response times are “still too long.”

According to the supervisors, the Department of Mental Health allocated more positions to its network of crisis teams, and now it needs to fill them. Right now the county has 40 vacant field team positions.

That’s not easy, they say, in part because of a “highly competitive mental health market.” What’s more, the county said some of the one-time funding that went toward signing bonuses and shift differentials will soon expire.

Hahn said the county has more than doubled the number of those teams, from 30 in 2021 to more than 70 today. And response times have gone from an average of six hours in 2023 to two hours in July 2024.

Part of that boost in teams has come from partnering with local nonprofits. Sycamores, a behavioral health agency, began responding to mental health crisis calls alongside the county’s teams in 2022. They’re one of three groups contracting with the county for mobile crisis response.

According to a report last fall from the Department of Mental Health, 13 teams are staffed by three outside contractors. A spokesperson for Hahn said the proposed incentives will not be available for teams hired through the nonprofit contractors.

Sheila Carter, with the National Alliance on Mental Illness Westside Los Angeles, underscored the urgency to get response times down during public comment last Tuesday.

“Many families I work with feel helpless as they navigate a system where support is often delayed, leaving them in critical need of assistance,” Carter said.

The proposed incentives

The proposed incentives and actions include:

• Further increasing shift differentials for night shifts that have been harder to staff.
• Implementing bonuses for geographical locations that have been harder to hire in.
• Further increasing field-based bonuses for clinician positions, which have been the hardest to fill.
• Increasing partnerships with colleges and universities by creating more internship or student worker positions with the Department of Mental Health as a pathway to a career in the Department.