Mental health first responders reflect on the first four months of operation in Flagstaff – JEMS: EMS, Emergency Medical Services

The photo shows the side of an ambulance with a blue Star of Life.
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Arizona Daily Sun, Flagstaff


The Flagstaff City Council approved a $2.5 million, three-year contract with Terros Health in March, funding the creation of a mental health response team that could be dispatched through the regular 911 system, which would lead to funding the launch of Community Alliance Response and Engagement — or CARE team.

Today, that team is out on the streets responding to incidents and providing community assistance.

Monday through Friday, 9 am to 7 pm, a mental health professional is paired with an EMT from the Flagstaff Fire Department. They prepare their patrol vehicle, an unassuming white Toyota minivan, for the day. They clean and disinfect the back seat, which is separated from the front seat by a black mesh barrier. The team makes sure your van is fully stocked with everything from water bottles, sandwiches (provided by the Flagstaff Family Food Center), candy (usually Smarties), and dog food to T-shirts and Narcan.

There are identical red and green backpacks in the backseat: the red one is equipped with the tools an EMT might need to monitor blood glucose, blood pressure and other vital signs. The green bag carries a portable oxygen tank.

The team will meet people where they are. They conduct outreach patrols, a process that sees the van slide down the alley behind Highway 89 Safeway, past a bagel delivery truck, rows of shopping carts and stacks of black milk crates. They then head to Bushmaster Park. These locations are “hotspots” where equipment is often dispatched and unsheltered people often congregate.

During the outreach, they will approach people on the streets. Crisis responders like Saira Ayers can hand out a T-shirt to someone who only has long-sleeved or cold-weather clothing on a hot July day. EMT Jimmy Devenney will ask if anyone needs water in a crowd gathered under a park shelter. Mariel Osorio, the lead crisis physician in the CARE unit, might offer a roll of round chalk candy to someone recovering from drinking alcohol or someone with low blood sugar.

Ultimately, the team will conduct wellness checks and address situations before they become emergencies or ask bystanders to call 911.

“Sometimes people don’t want help and we say, ‘Okay, we’re here if you need us.’ Sometimes just offering someone support can go a long way,” Ayers said.

She recalled a time when that turned out to be the case.

“There was a client that we met with several times who needed help. Often intoxicated. mental health problems He didn’t want any help. I just wanted transportation. So one day they said, ‘I want to get sober. Which was amazing,” Ayers said. “They wanted to go to detox and cleanse and get help and get back on their feet. From there I was able to coordinate with the orientation center. I have not seen them feel in the street. We don’t know what happens to people, but I have a good feeling. It was amazing to see the influence and the transformation.”

Sirene Lipschutz, clinical unit manager for CARE, said they typically won’t get in touch with a person in need and change their life in the same day. The process is more about offering resources and being a “safe face” in the community.

“Sometimes we’re just helping a person feel worthy,” Lipschutz added.

Calls come in on a lime green radio from the same dispatchers who send police, fire and ambulance units to crime scenes and medical emergencies. Dispatchers are trained to route calls to CARE when the situation is not a medical emergency and/or could involve a person experiencing a mental health crisis.

When the radio comes to life, the team responds to calls that refer to a “man down” (when a caller sees someone who may be asleep or unconscious in a public space) or “omega” code (which requires first responders drive normally through traffic, as opposed to a “delta” call that prompts first responders to use lights and sirens to get to a scene more quickly). About 19% of the time, the CARE team is dispatched to take a person in need to Flagstaff Shelter Services or another safe location of their choosing.

“What’s really cool is that it diverts these non-emergency calls so that a whole truck and an ambulance don’t come to the scene for someone who doesn’t need it. So, they are saved for emergencies and we can help those people,” Ayres said.

If the team is sent to help someone who is lying down, the EMT will make sure they are medically stable and safe. If they end up needing an ambulance, the EMT works with dispatch to send a team of Guardians to the scene.

The CARE team has been answering calls for four months and they have received more than 435 of them. Only 16% of the calls the team received had to go to the police, fire, or emergency medical response teams at Guardian.

“We’re lowering the load on the system and we’re lowering the number of people that need to get into the system,” Lipschutz said. “Either in jail or in a hospital.”

On the other side of the coin, police officers will call the CARE team if they find a person experiencing a behavioral or mental health emergency or someone in need of a compassionate trip to a shelter or food kitchen.

“It helps to have the right resources for calls for service,” said Sgt. Odis Brockman, public information officer for the Flagstaff Police Department. “Our dispatchers can triage these calls and determine which response is the most appropriate. All of our officers have at least some training in responding to calls where someone is having a behavioral health crisis, but there is no substitute for someone who has more training and time to provide needed services.”

Reaction to CARE’s work has been resoundingly positive since they’ve been in the field, but Lipschutz says that wasn’t always the case.

“There was some resistance from the community,” Lipschutz said. “I think some of it was about, ‘Oh, you’re going to get attacked. You are going to be in danger. That is not a thing. It hasn’t happened. We haven’t felt unsafe.”

Now the only complaint the police have about CARE is that they wish there were more teams. More personal.

“During especially busy times, the community would likely benefit from having additional resources available. There have been several times when an officer will recognize that one call is more suitable for the CARE team, and the CARE team is either unavailable or busy on another call,” Brockman said.

Right now there is only one CARE van at a time. That van is based on the east side of Flagstaff, and occasionally the team has to drive from one side of the city to the other to provide resources. They want to expand their reach as well, ideally launching another team on the west side and expanding hours into the night.

For now, they plan to continue appearing as staff and funds allow.

“We’ll show up in a minivan!” Osorio said. “We wear t-shirts. We’re just here to worry.”

Sierra Ferguson can be contacted at [email protected]

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