There are New Yorkers fuming around street corners and collapsing on sidewalks next to overloaded handcarts. They can be friendly, angry or suspicious. For me and my colleagues, they are patients.
I’m a paramedic lieutenant with the Fire Department’s Office of Emergency Medical Services, and it’s rare to go a day without being called to help a mentally ill New Yorker. Medical responders are often their first, if not only, point of contact with the chain of healthcare professionals who should be treating them. We know their names and their routines, their delusions, even their birthdays.
It is a sad and dispersed community. And it grew like a mushroom. In nearly 20 years as a medical responder, I have never witnessed a mental health crisis like the one New York is currently experiencing. During the last week of November, 911 dispatchers received an average of 425 calls per day for “emotionally disturbed people” or EDP. Even in the decade before the pandemic, those calls had almost doubled. EDPs are people who have fallen through the cracks of a chronically underfunded mental health system, a house of cards built on sand that the Covid pandemic has crushed.
Now Mayor Eric Adams wants medical responders and police to get more mentally ill people in distress into medical treatment. I get it – they desperately need professional help and a safe place to sleep and eat. Energetic action makes splashing headlines.
People with mental health problems can be victims of violence. I am also painfully aware of the danger that people with serious mental illness and without access to treatment can pose to the public. Assaults against New York City Fire Department EMS workers have steadily increased year over year. Our medical responders have been bitten, beaten and chased by unstable patients. A man believed to suffer from schizophrenia has been charged with the fatal stabbing of my colleague Captain Alison Russo-Elling in Queens on September 29.
But sending medical responders to confuse mentally ill people living on the streets and transport them to overcrowded mental institutions is not the answer.
On the one hand, the mayor shifts more responsibility for a systemic crisis to an overworked medical profession, exhausted by years of low pay and the strain of the pandemic. Many EMS workers suffer from depression and lack adequate professional mental health support, just like the patients we treat. Several members of the fire department’s emergency medical services have died by suicide since the pandemic began, and hundreds have quit or retired. Many of us who are still working are stretched to the breaking point.
I myself have taken the path of despair. The spring and fall of 2020 left me so empty, exhausted and sleepless that I also thought about suicide. Our ambulances are just the entrance to a broken pipeline. We burned down the sanity house in this town, and the people you see on the streets are the survivors who rose from the ashes.
Those who are supposed to respond and help them are not doing well either. Since March 2020, unions that represent fire department medical responders have been so inundated with calls from members asking for help that we have partnered with three mental health organizations, all funded by the EMSFDNY Help Fund, an independent charity group founded and funded by medical responders and the public through donations to help us in times of crisis.
We have to sift through the embers and see what we can salvage. Then we have to lay a new foundation, put some beams to support the structure and start building.
What New York, like so many cities in the United States, needs is sustained investment to fund mental health facilities and professionals providing long-term care. This effort would undoubtedly cost tens of millions of dollars.
I’m not against taking the mentally ill in distress to the hospital — our ambulances do that all the time. But I know this is unlikely to solve their problems. Hospitals are overwhelmed, so they sometimes try to move patients to other facilities. Governor Kathy Hochul has promised 50 more beds for psychiatric patients in New York. We need a lot more to manage patients who would qualify for involuntary hospitalization under Mr. Adams’ vague criteria.
Often a patient is examined by hospital staff, given a sandwich and a place to rest for a few hours, and then discharged. If the person is intoxicated, a nurse can offer a “bum bag” – an intravenous solution of vitamins and electrolytes – and time to sober up. Chances are that already overworked staff can’t do much, if anything, about the depression that drove the patient to drink or take drugs in the first place.
Let’s say a patient is receiving treatment in the hospital. Mr Adams says that under the new guideline, this patient will not be discharged until a plan is in place to connect the person with ongoing care. But the mechanisms in charge of this care – sheltered accommodation, access to outpatient psychiatric care, social workers, social reintegration pathways – are terribly insufficient. There are not enough shelters, there are not enough social workers, there are not enough outpatient facilities. Thus, people who no longer know how to take care of themselves, who need to hold hands in a complex process, find themselves alone in the street.
A few days ago, I treated a manic-depressive person in his thirties who was yelling at people on a subway platform in downtown Brooklyn. The man said he had gone two years without medication because he didn’t know where to find it. He said he didn’t want to go to a shelter and I told him I knew where he was from: I was homeless for two years in my early twenties and slept in my car to avoid shelters — one night at the Bedford-Atlantic Armory was enough for me.
I persuaded the man to come with me to Brooklyn Hospital Center and made sure he got a prescription. Whether or not he will remember to take it, I don’t know.
While I don’t know how forcing people into medical treatment will help, I can see how much it will hurt. Trust between a medical provider and the patient is crucial. Without it, we wouldn’t be able to get patients to talk to us, let us touch them, or shove drug-filled needles into their arms. But if we herd people into our ambulances against their will, that trust will be shattered.
In addition, medical responders are not equipped to handle confrontations with psychiatric patients. In my experience, the police do not want to intervene with the mentally ill. They don’t have the medical knowledge to assess patients. So, who will decide to transport them? What if we don’t agree? According to protocol, EMS personnel make the decision. Will the police now order us to take them away? I can only imagine the hours medical responders and cops will spend debating what to do with a patient.
Rather than looking for a superficial solution, Mayor Adams should turn his attention to our neglected health care apparatus. We need to invest heavily in social services, housing and mental health care if we are to avoid this unfolding tragedy. We need this kind of investment across the United States, where there is a severe post-pandemic mental health crisis. My contact with New York’s mentally ill population over the years and my own contact with depression and homelessness has taught me that we are all much closer to the abyss than we realize.
Antoine Almojera is a paramedic lieutenant with the New York City Fire Department’s Office of Emergency Medical Services, vice president of the Uniformed EMS Officers Union, Local 3621, and author of “Riding the Lightning: A Year in the Life of a New York City Paramedic”. ” This article originally appeared in The New York Times.
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