Laurel Carraher carries two cellphones: one for personal calls and one for mental health crises. When the latter device rang on Friday afternoon, she picked it up, jotted down an address and rushed out of her office.
Within minutes, the licensed clinical therapist pulled her Honda up to the urgent care center across from Christus St. Vincent Hospital, where a man was threatening to kill himself. The man, six months off heroin, had depleted his anxiety medication, and a doctor would not prescribe more.
Carraher sat the man down and devised a safety plan. He promised not “to hurt myself in any way.” Another doctor prescribed him enough Klonopin to get him through the weekend.
Fires, strokes and robberies all beckon first responders with distinct skill sets. But who do we call when the emergency is about mental health?
One year ago, Santa Fe County partnered with Presbyterian Medical Services to launch a mobile crisis response team. Funded through a $350,000 annual contract, the program opened up a 24/7 line that dispatches therapists and caseworkers to people in crisis, whether they’ve become a danger to themselves (or others) or their mental state has deteriorated to a point that significantly affects their daily living.
About 2,500 adults in the county have a serious mental illness, according to the most recent community health profile. The Santa Fe Behavioral Health Alliance estimates 400 of those people have contact with the criminal justice system, whether through jail, probation or pretrial release programs.
In the program’s first 11 months, therapists report that they have answered 266 requests for on-scene assistance. About 75 percent of calls come from first responders, including police, sheriff’s deputies and paramedics. Schools, residential facilities and, increasingly, families of those with mental illness, have also utilized the service.
Having a therapist ready to go helps put first responders at ease, according to those who spoke with SFR about using the mobile crisis response team. “As a paramedic, you’re trained to handle trauma and acute medical problems,” says Ramos Tsosie, who has worked for both the city and county fire departments. “But we have a fewer tools in our toolbox to handle psychiatric problems and mental illness.”
“Before the mobile crisis response team came, really our only resource was taking people with mental illness to the hospital,” says city police Captain Mark Lewandowski.
Resolution of a crisis is the end goal for first responders. For therapists on the scene, it’s just the beginning. The mobile crisis response team claims success when it’s connected someone to all the outpatient services they need, says Mark Boschelli, clinical director of Presbyterian Medical Services’ Community Guidance Center.
“The follow-up is not as glamorous as the crisis intervention,” Boschelli says. “However, it is more effective. The crisis is a call for help. And like an iceberg, there is a lot more below the surface.”
Carraher says this second step is far more challenging than initially responding to a crisis situation. When she’s not in the field, Carraher is paging through a growing list of cases, determining what services people need and making the appropriate inquiries. She responded to a call at a senior housing facility, where she discovered that a woman living there didn’t have any food or shampoo. When she couldn’t find the right provider to help the woman buy groceries, Carraher did it herself. “We’re still working on that case,” she says, adding that the response team has picked up on an entire community of elders with mental health needs but no avenue to service.
“We find people of means in beautiful Santa Fe homes, but they are at risk of setting their homes on fire,” Carraher says.
It’s a lot of work for one person, so much that “we’re very quickly going to be buried in all this follow-up.” Carraher is the sole psychotherapist working full-time on the team. Presbyterian is in the process of hiring another. For crises that occur during nights and weekends, 39 clinical staff members take turns carrying on-call phones.
First responders seem to understand the limits of the new resource available to them. “Until we have a system where we have a bunch of Laurels readily available, or a system in which someone like Laurel can be directly dispatched, it’s not practical to apply that resource to every psychiatric call we get,” says Tsosie, who currently works for a city fire department program that aims to pull frequent 911-callers out of destructive cycles .
Presbyterian’s contract is good for another three years before it is up for renewal. For the time being, the team will continue to aim for 20 to 25 call-outs a month, though Boschelli says there are talks with the county to develop a center that would be able to service more patients.
Looking toward the more immediate future, Boschelli says Presbyterian wants to divert people experiencing mental health crises, except in certain life-threatening scenarios, from the emergency room to the community guidance center on Rodeo Park West. The team has also started reaching out directly to patients’ families through the National Alliance on Mental Illness, offering the crisis dispatch line as an alternative to 911.
Presbyterian’s Santa Fe County crisis team is one of two in New Mexico. La Clinica de Familia runs the other one in Doña Ana County. In March, Presbyterian made a presentation to Bernalillo County officials, who are interested in setting up a crisis response team there. In 2014, the police shooting death of a schizophrenic homeless man in Albuquerque led to protests and scrutiny of the department’s approach to mental illness.
Carraher started practicing psychotherapy almost three decades ago. Before Presbyterian, she worked at a maximum-security prison, a halfway house for women and her own private practice. She likes her new job because she doesn’t have to sit around in an office all day. It’s also exposed her to a side of therapy she hadn’t before encountered on a day-to-day basis. “When you meet people in crisis, they’re open, they’re raw, they’re ready for change in a way that doesn’t happen in other situations,” she says. “It’s important to for us to bear witness, to just listen, to help a person feel, to be seen or heard.”
Reach the crisis response team at 820-6333