RAMS Statement on Changes to San Francisco’s Street Crisis Response Team
October 1, 2026
San Francisco – For nearly six years, RAMS Peer Counselors has been part of San Francisco’s Street Crisis Response Team (SCRT) that responded through the City’s 911 system to nonviolent behavioral health crisis calls. Our Peer Counselors worked alongside Fire Department emergency medical personnel 24/7, serving across as many as eight SCRT teams citywide each day. Over the years, the SCRT model has received national recognition. Its effectiveness has been well documented by researchers and other behavioral health experts. RAMS believes the innovation lies in its highly coordinated and interdisciplinary team of community paramedics/Emergency Medical Technicians and peer counselors. Together, SCRT has achieved real results. They have saved lives, improved the quality of life for all San Franciscans, and achieved cost savings across the board.
In July 2026, RAMS was informed by San Francisco Fire Department (SFFD) leadership of their decision to remove RAMS Peer Counselors from SCRT, effective August 15, 2026. RAMS was not consulted before the change was made. The decision was not driven by a loss of funding or by poor performance. Funding for the peer component remained in place, and SFFD described the change as an operational decision rather than a budget reduction. SFFD did acknowledge they did not give RAMS the opportunity to learn or discuss about the change prior to the decision being made.
Peer Counselors were central to SCRT’s successful, multidisciplinary approach. As RAMS staff who helped develop and supervise the program have described publicly; pairing traditional first responders with peer counselors brought lived experience, specialized counseling training, and the ability to build rapport and trust quickly with people in crisis. That combination helped teams develop more nuanced plans for care and connect people to the most appropriate resources, rather than simply the most convenient ones.
As an interdisciplinary team, SCRT diverted tens of thousands of 911 calls from law enforcement over the life of the program. This most effectively triaged City resources to respond to the relevant situations. Delivering this model required ongoing coordination across agencies, field support, schedule management, and continual adjustment of protocols to keep the program effective. RAMS managed those operational demands throughout the program while continuing to meet or exceed its contracted performance requirements. In San Francisco Department of Public Health’s latest monitoring report for RAMS’ SCRT program, RAMS received the highest overall rating, “Commendable/Exceeds Standards,” achieved 100% of its contracted performance objectives, delivered 103% of its contracted units of service, and had no identified performance deficiencies or required corrective action. Monitoring reports also documented service to 3,320 people during FY 2024-25.
Prior to the decision to remove peers from the SCRT team, behavioral health clinicians had already been taken off the field teams. Now, SCRT teams are solely staffed by SFFD personnel without the behavioral health specialists. SFFD officials have said community paramedics receive additional behavioral health and de-escalation training which the department predicts will result in successful engagement with the public, but this had not been tested prior to this systemwide change. RAMS holds in high regard the skills of SFFD community paramedics/EMTs, yet we firmly believe that it is the interdisciplinary approach – a model that includes peer counselors – is what makes SCRT the most effective in meeting the needs of our community.
RAMS is deeply committed to peer services and to the value of lived experience as professional expertise in behavioral health care. Peer specialists bring skills and perspective that complement, rather than duplicate, emergency medical response. As San Francisco’s crisis response model continues to evolve, there are still important questions about how peer expertise will be incorporated into that system and how resources previously supporting the peer component of SCRT will be used.
RAMS has navigated change for more than five decades while remaining focused on the people and communities we serve. That resilience will continue to guide us. We will remain a steady partner, a strong advocate for peer expertise, and a provider committed to effective, accountable behavioral health care across San Francisco.
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For media inquiries or interview requests, please contact:
Domenica Giovannini, RAMS Director of Development & Communications
DomenicaGiovannini@ramsinc.org
