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In 2015, Neil Shah noticed a startling trend: More and more, concerned citizens were calling 911 to report non-emergency mental health crises. From there, police often committed people to hospitals, after which they’d be released to the streets to start the cycle all over again — each time costing thousands of taxpayer dollars. After watching the same people cycle through the system countless times, Neil became fed up. So he joined a team with a novel idea to transform how communities respond to people in crisis.
In Neil’s words, the story of Concrn from his interview on GoFundMe’s podcast, True Stories of Good People:
I grew up in Southern California the child of Indian immigrants, and I didn’t have a very stable childhood in some ways. My father had a mental health breakdown when I was 13, and we had to put him in the hospital against his will. He was bipolar, and he went through a lot of addiction. It was really difficult to see him go through that, especially as a young child. Later in life, I’d see myself go through the same things in parallel.
I ended up getting a great education, but I also had some demons inside of me. I made it up to the Bay Area for college and got an undergrad degree from Stanford in human biology. Then, I did a college internship in the Tenderloin district of San Francisco at an organization that doesn’t exist anymore called Tenderloin Health. I just wanted to be in what I’d call “ground zero.” That was a great experience for me to get to know people in the community who live on the streets and work in the space. While there, I ran harm reduction workshops, connected people to services, and got to know the landscape.
Then, I spent about two to three months in the Ninth Ward of New Orleans after they’d gotten all of the water out from Hurricane Katrina, and I hooked up with a nonprofit down there. That changed my whole way of looking at social justice, what I wanted to accomplish in life, and who I wanted to be.
But at the same time, I was a walking contradiction. I was arrested eight times by the time I was 27 for substance abuse problems and mental health issues. I was a hot mess. I like to tell people that bit, too, because I used to be so ashamed of it, but it’s a part of my story. It completes who I am. I’m just as dirty as everybody else. I try as much as I can now to reframe those negative experiences and learn to become resilient from all of my personal tragedies.
From both my work and personal experiences, health equity and the activation of humanity in communities became core to who I am. It’s now a big driver of how I live my life, and it’s why I joined Concrn, first as a board member and now as CEO.
Concrn is a nonprofit that provides a compassionate alternative to 911 for people experiencing mental health crises. Our core value is compassionate response, and we make that front and center for our responders. When you respond from a place of empathy, you can step in someone’s shoes. But compassion goes a step further to take action and alleviate a person’s suffering.
Today, 80% of 911 calls in the Bay Area are about someone experiencing mental illness or mental health issues. But police are not trained to respond to mental health crises; they are trained to respond to crime. And we shouldn’t be using police — nor do they want to be used — as the first responders for mental health crises. But they have become our de facto responders.
When police show up, they’ll often take people to hospital emergency rooms. In San Francisco in particular, they’ll take people to psych emergency, a special part of the emergency room just devoted to 5150s (involuntary psychiatric holds). And that costs a lot of money—tens of thousands of dollars for every 72-hour hold. Once stabilized, that individual is released back on the street with no ladder of care. I’ve learned this from direct conversations I’ve had with medical directors at these hospitals.
In researching Alameda County, which includes the city of Oakland, I found that since 2012 the number of 5150 calls has gone up 30% from about 9k to 14k. And most of the people who are presenting for 5150s at emergency rooms are experiencing homelessness. In San Francisco, it’s about 80%.
So people experiencing homelessness are cycling through jails, hospitals, and shelters. They are in a vicious revolving door into their grave. I’m not saying that Concrn is the single solution to this problem, but we’re trying to be a part of the system-wide solution.
In the Concrn app, you can make a report and take a picture of what you’re seeing and add notes, and we have drop-downs available for identifiers like approximate age, what the person is wearing, and gender. Once that comes in, we have a dispatch platform. We’ll see the phone number of the person who called and their pictures and notes, and we’ll assign a responder to dispatch. Then, the responder shows up on the scene.
Our compassionate responders have purple shirts and vests. Purple is a great color for calmness, helping to differentiate between police and social workers, and getting attention. If someone’s in a crisis, you really need to attract their attention. Then, the deescalation happens. A lot of times, that just includes listening to figure out why the person is in crisis. So much of it, I’d say, has to do with people living in concentrated poverty and the stress and trauma of that. Then, the goal is to figure out not necessarily where to take them but how to turn that crisis into an opportunity to be calm.
To deescalate situations, I’ve played music on my phone, taken requests from the person, and one of our responders has even gone out and played live music. It sounds silly, but sometimes music is the best way to snap someone right out of what they’re in. If they hear a familiar tune, it gets their endorphins going and can be soothing. We also ask them if they need anything and carry basic supplies. Imagine your brother, sister, aunt, uncle — how would you treat them? You’d want them to know that they can trust you. And with a stranger, it’s especially important for us to build that trust.
If someone needs to go to a hospital, we’ll call emergency services ourselves if we feel it’s necessary. And if it’s a violent crisis or someone is causing property damage, we always tell people to call 911 rather than use Concrn. What we believe is that if we can deescalate situations ourselves and prevent trips to the ER, we’ve done our part. From the experts I’ve talked to, they say that from a systemic perspective, that’s a huge savings. If we can do that consistently in a targeted fashion, then I think we can be successful.
Starting in late 2015, we piloted Concrn in the Tenderloin district of San Francisco, and then we expanded to other parts of the city. We were able to receive about 3,500 crisis reports sent in via the app and responded to about ⅔ of them. By respond, I mean anything from giving the reporter a call back or, in a lot of cases, dispatching a peer responder to get to a situation, deescalate, and sometimes connect people with services. We didn’t do any formal marketing to get people to use our app. I think it was just community demand to get something different.
Since July of 2018, we’ve been part of the Kapor Center for Social Impact’s Innovation Lab residency. It started out as a six-month residency program in downtown Oakland and allowed us to get to know the Oakland community. In 2018, we also received a grant from Kaiser Permanente in San Francisco to build out our peer training and behavioral health crisis response operation. We then launched our GoFundMe as part of our end-of-year campaign, and I’ve been surprised and grateful for the support we’ve received. Our plan is to use these funds to hire someone to help us speak to Oakland community members and design a pilot for them in 2019.
My goal is to build a proof of concept in Oakland and show others what they can do to activate their own communities. I’ve talked to people in other cities — including the mayor’s office in New York City — who are trying to revamp their own behavioral crisis systems. People want an alternative to calling 911 and committing people to hospitals. Take a second to imagine if something like Concrn existed everywhere.
It’s so important to me that people get the help they need in the moment that they need it. But there are so many things that can make you not want to be a part of someone else’s problem. I hope to make compassionate response the default. Ultimately, I hope to activate people everywhere to be accountable for everyone in their communities, whether they’re housed or unhoused.
Neil continues to raise money through his GoFundMe for Concrn’s expansion and daily operations.