There are many reasons for Sacramento’s homeless crisis, and Dr. Gregory Kann, county director of emergency services, has come up with a plan that sounds like it can make a difference.
It’s called TAD, for “Triage to Alternate Destination.” It could be shorthand for “empathy and common sense.”
In the past, when people living on the streets engaged with the 911 system, they were taken to an overcrowded hospital emergency room.
Federal law requires they cannot be turned away without treatment. For this and other reasons, including how a growing number of people visit emergency rooms because doctor appointments are often booked up far in advance, ERs have, as Kann says, “become a public health emergency.”
Emergency departments aren’t equipped to provide meaningful treatment to people with alcohol, substance-abuse or other behavioral and psychiatric health issues—common among people living on the streets.
“The amount of time these patients can take up in an emergency department is stunning,” Kann says. “We do what we can. They may get some medicine and then often times they’re discharged, or it can take days to get them to a psychiatric care center. They’re able to go to a shelter for a day or two, but typically they are back on the street and homeless without having their underlying psychiatric illness addressed.”
The triage program is just starting. It allows paramedics—newly trained to recognize and deal with psychiatric issues and substance abuse—to deliver patients to one of three care facilities better equipped to meet their specific needs: Sacramento County Behavioral Health Treatment Center for behavioral health services, Sierra Vista Hospital for mental health, and Wellspace Health for alcohol or substance abuse.
“An effective triage program where our medics out on the street are trained and savvy enough to recognize who these people are so we can get them directly in front of trained psychological professionals can consistently make a difference,” Kann says. “I honestly don’t think we are providing them a service in the emergency department.”
Kann is known for his thoughtful approach to solving problems. He led efforts to improve the dismally slow process of offloading ambulance patients to area hospitals. Sacramento County had one of the worst records in the state, 97 minutes for people not suffering acute trauma. Delays have been reduced by more than half.
Sacramento County had 6,615 people experiencing homelessness in 2024, a 41% drop since 2022 for those not in shelters. Estimates vary on how many have substance-abuse, alcohol or psychiatric disorders.
But doing quick math, Kann says he expects county paramedics could take four or five patients a day to the treatment centers.
Spread out over time, the numbers are significant. They mean fewer people in emergency rooms. And if patients land back on the streets, they will at least have received some targeted treatment and maybe a better shot at breaking the homelessness cycle.
In October, when the county announced a $50,000 training grant to start the triage program, it listed several benefits, such as better patient outcomes and freeing up hospital space and resources. Also noted were greater patient satisfaction and community health benefits.
“We’ve been searching for decades really for some type of program where we can get people who need the services directly to a psychiatric care facility,” Kann says. “The vast number of these patients who we have been seeing in the emergency room need nothing from me as an emergency department doctor. Now that we have the legal ability to do so, with this program, we can get them to the place they need to be at the right time they need to be there.”
Gary Delsohn can be reached at gdelsohn@gmail.com. Follow us on Facebook and Instagram: @insidesacramento.
