Reimagining Public Safety: How San Mateo's Mental Health Co-Responder Model Protects Liberty and Saves Lives

The Crisis in Mental Health Response

Across America, police departments have increasingly become the default responders to mental health crises, a role for which they are often ill-equipped and untrained. This problematic dynamic has led to unnecessary escalations, tragic outcomes, and the criminalization of mental health conditions that should be treated as medical issues. In San Mateo County, California, officials recognized this systemic failure and took bold action to create a more humane and effective approach to mental health emergency response.

The county’s innovative co-responder program pairs law enforcement officers with mental health clinicians when responding to 911 calls involving psychiatric crises. This model represents a fundamental rethinking of public safety that prioritizes care over containment, treatment over incarceration, and human dignity over institutionalization. The results, documented in a comprehensive Stanford University study, demonstrate both the practical effectiveness and moral necessity of this approach.

The San Mateo Model: Facts and Findings

Implemented four years ago as a pilot program across San Mateo County’s four largest cities—Daly City, San Mateo, Redwood City, and South San Francisco—the co-responder model was designed to address the growing number of mental health emergencies overwhelming traditional police response systems. The program emerged from recognition that law enforcement officers, while essential for public safety, lacked the specialized training and resources to effectively manage psychiatric crises.

The Stanford study, conducted by researchers Tom Dee and Jaymes Pyne from the John W. Gardner Center for Youth and Their Communities, revealed stunning results: the program reduced involuntary psychiatric holds by approximately 17% and decreased the likelihood of future mental health 911 calls among participants. These involuntary holds, which allow hospitals to detain individuals for up to 72 hours for evaluation, represent some of the most severe infringements on personal liberty in mental health care.

The financial implications are equally significant. Researchers estimated annual cost savings of $300,000 to $800,000 due to the reduction of roughly 370 involuntary psychiatric holds over two years. The entire pilot program cost approximately $1.5 million over the same period, split between the county and participating cities, making it both fiscally responsible and socially transformative.

Briana Fair, a mental health clinician with the San Mateo Police Department, exemplifies the program’s human impact. Her work involves proactive engagement with individuals experiencing mental health challenges, providing ongoing support that prevents crises from escalating to the point requiring police intervention or emergency hospitalization. As she notes, “I fill in the gaps. It’s just a matter of getting her the right supports.”

The Constitutional and Ethical Imperative

From a constitutional perspective, the co-responder model represents a significant advancement in protecting civil liberties while ensuring public safety. The Fourth Amendment protects citizens against unreasonable seizures, which includes involuntary psychiatric detainment without proper cause. By reducing unnecessary hospitalizations by 17%, San Mateo’s program directly safeguards this fundamental right.

The program also honors the principle of due process under the Fifth and Fourteenth Amendments. Mental health clinicians like Briana Fair bring specialized training that allows for more nuanced assessments of dangerousness and appropriate level of care, ensuring that liberty restrictions occur only when absolutely necessary for safety. This professional judgment stands in stark contrast to the binary choices previously available to police officers: hospitalize, arrest, or leave to their own devices.

Furthermore, the program embodies the Eighth Amendment’s protection against cruel and unusual punishment. Jails and prisons have become America’s de facto mental health facilities, with devastating consequences for vulnerable individuals. By providing appropriate mental health care in community settings, the co-responder model prevents the criminalization of mental illness and the trauma of incarceration for those needing medical care.

The Human Dignity Dimension

At its core, this approach recognizes the inherent dignity and worth of every individual, regardless of their mental health status. The article’s portrayal of Briana Fair helping her client with everyday challenges—from navigating social services to something as personal as hair care—demonstrates the profound humanity often missing from traditional crisis response. This isn’t just about preventing bad outcomes; it’s about affirming human value.

The program also represents a crucial shift from crisis response to crisis prevention. By maintaining ongoing relationships with vulnerable individuals, clinicians can intervene before situations escalate to emergency levels. This proactive approach respects individuals’ autonomy while providing the support needed to maintain stability and independence.

San Mateo County Executive Officer Mike Callagy articulated the moral imperative behind the program: “We’ve got to look to alternatives and really understand that police are not the best equipped to handle mental health crisis situations.” This acknowledgment represents a significant evolution in how communities understand public safety and the role of law enforcement.

The Broader Implications for Democratic Society

The success of San Mateo’s program has profound implications for how we conceptualize public safety in a free society. Traditional models that rely primarily on law enforcement for mental health crises often result in the violation of fundamental rights and the reinforcement of systemic inequalities. The co-responder model offers a alternative vision where public safety encompasses both physical security and the protection of civil liberties.

Mariela Ruiz-Angel, director of Alternative Response Initiatives at Georgetown Law’s Center for Innovations in Community Safety, rightly notes that this approach represents “evolving to a level in which we don’t have to send out cops or fire for basic-level need calls.” This evolution is essential for a society that values both safety and freedom.

The program also demonstrates the importance of evidence-based policymaking. The Stanford study provides rigorous evaluation of the program’s effectiveness, allowing for informed decisions about implementation and expansion. This data-driven approach ensures that reforms are both principled and practical.

Challenges and Future Directions

Despite its successes, the co-responder model faces implementation challenges that must be addressed for broader adoption. As researcher Tom Dee noted, “This is a common-sense reform with a great deal of promise. That being said, it’s not a cut-and-paste kind of reform. There are serious design and implementation details that matter for realizing the promise of these sorts of initiatives.”

Key considerations include ensuring police buy-in, training dispatchers on effective call triage, and properly integrating mental health staff into emergency response systems. San Mateo Police Chief Ed Barberini initially worried about officer pushback but found that “without clinical expertise, police officers were being put in a difficult position.” The program’s success in gaining law enforcement support demonstrates that well-designed reforms can serve both community needs and officer safety.

The program’s expansion to nearly every city in San Mateo County, with each participating municipality finding ways to sustain their programs, demonstrates the model’s viability and scalability. The conversion of Briana Fair’s position to a permanent role and the addition of part-time clinicians shows institutional commitment to this new approach.

Conclusion: A Blueprint for Liberty and Compassion

San Mateo County’s mental health co-responder program represents exactly the type of innovative, compassionate, and effective governance that strengthens democratic institutions while protecting individual rights. By reducing unnecessary institutionalization, preventing crisis escalation, and saving public funds, the program demonstrates that better outcomes are possible when we approach public safety with both expertise and empathy.

This model should serve as a national blueprint for communities seeking to uphold their constitutional obligations while addressing mental health crises humanely and effectively. It proves that we can maintain public safety without sacrificing civil liberties, that we can care for vulnerable community members without resorting to coercion, and that we can build systems that reflect our highest values rather than our deepest fears.

As we continue to reimagine public safety in America, the San Mateo model stands as powerful evidence that liberty and security are not opposing values but complementary goals that, when properly balanced, create communities that are both safer and more free. This is the promise of thoughtful governance: systems that protect both our safety and our humanity, our communities and our constitutional rights.