Evolved Response

After picking up Andrew Haul from La Sala Crisis Intervention Center late Monday afternoon, Felina Ortega and Jesse Flores took him to St. Elizabeth Men’s Shelter, next to the Railyard. On arrival, the trio learns that an electronic monitoring anklet Haul has to wear is dead and needs to be charged before the shelter can let him spend the night.

Haul tells SFR he was recently mugged and his belongings, including the ankle monitor’s charger, were stolen.

Haul, Ortega and Flores jump back in the car, drive out to the Santa Fe County jail, pick up a new charger and return to the shelter as the sun sets behind them on the drive east.

Without a lift from Santa Fe’s relatively new Alternative Response Unit, Haul tells SFR he would have tried to catch a ride with the police, relying “just on my wits alone,” to get back to the shelter in time to spend the night.

Ortega explains these types of calls—transports—along with disturbances make up a significant portion of the unit’s responses. Prior to helping Haul, Ortega, a case manager, and Flores, an EMS captain with the Santa Fe Fire Department, responded to a flurry of calls as members of the unit.

Ortega says the services the unit provides are invaluable to residents who need support that otherwise isn’t provided by either the health care system or social services.

“I definitely think there needs to be more units and not just maybe Monday through Friday, 8 to 5,” Ortega tells SFR just after dropping off Haul at the shelter. “Oftentimes things happen after we’re not on call.”

The City of Santa Fe launched the Alternative Response Unit in April, a collaboration between Community Services and the Police and Fire departments, to provide a different way of responding to non-violent emergencies. The unit is a program of the Mobile Integrated Health Office, which employs 10 staff members and operates under the fire department’s EMS division, which costs the city $1.2 million.

Law enforcement responds to an overwhelming majority of 911 calls; the unit alleviates some of that burden. Unit managers monitor the computer-aided dispatch system and responding to incidents that meet the team’s issue.

In the unit’s central office, Andrés Mercado outlines the fire department’s chain of command on a whiteboard bordered by holiday lights. Mercado, the fire department’s mobile integrated health officer, explains that the office under his command comprises about 5% of the fire department’s resources.

Mercado tells SFR the Alternative Response Unit is the busiest crew in the fire department, responding to roughly one call every hour. As of last week, the unit had responded to 833 calls since its inception.

With overdoses rates spiking and behavioral health issues rising, the need for a different approach to public safety and health is more pressing than ever before, explains Nicole Ault, behavioral health director with the fire department.

Ault tells SFR that a team of four case managers, which the office is hoping to expand to eight including a case manager supervisor, each take on up to 30 clients. While the office has worked with some people for up to a year, Ault says the goal is to connect them to longer-term case management.

Their work, Mercado and Ault explain, fills in the gaps of social services and hospitals that exist in Santa Fe and nationally.

Part of why those gaps exist, Mercado says, is because the “system is built for episodic care.”

Mercado offers the example of an elderly resident who called 911 to help with a fall 22 times before connecting with the Alternative Response Unit. Once that happened, staff secured more hours each week with a home health aid, which reduced the number of times emergency services were called for that individual.

Mercado explains that emergency services are traditionally built around responding to an individual incident—to “put out a fire”—but his office is shifting away from episodic responses to “longitudinal” outreach.

The team has evolved to better serve the community’s needs since it began work in the spring. Originally the unit was composed of three responders: a paramedic, a case manager and a uniformed police officer.

Since the majority of the calls that the unit responds to come through 911 and the police department’s non-emergency line, having an officer to navigate those systems helped at first.

But Mercado explains that when police officers were part of the response—fully equipped with a gun, pepper spray and other weapons—their presence cast a shadow over the interactions with the public.

The unit slimmed down to a team of two: a case manager and EMT, who learned to safely respond to incidents without a police presence and focus on outreach and de-escalation. The police officer assigned to the unit has stayed on as a liaison between the mobile integrated health office and the police department, but doesn’t respond to calls.

Ortega says that the people she works with feel more comfortable without police presence, adding that what the city needs instead are more units that can respond to calls when law enforcement is unnecessary.

Editor’s note: An earlier version of this story incorrectly stated what percentage of the fire department’s resources the Mobile Integrated Health Office uses, it’s 5%.