The limits of mobile mental health support

This is the second part of a two part series. If you haven’t already, we recommend listening the first part before starting the second part. This story was published in November 25, 2024 Crosscurrents event.

Last week, we had to contact Sonoma County’s Mobile Support Team or MST. We saw what happens when someone calls, and how they support clients dealing with local issues, such as homelessness, mental health and substance abuse. One of their calls led us to a woman named Linda Alfano. But Linda’s call about a fight with her boyfriend Stephen tested the limits of what the Telephone Support Team could do.

At the end of the last story, MST was heading to the hospital to talk to Stephen. In today’s story, we will learn a little about the large network of service providers that MST works with and what happens after a disaster.

Warning to listeners: the following story contains depictions of violence and drug abuse.

It seems like a lot of work, driving to the hospital to visit Stephen, when he wasn’t the one who made the emergency call. During a short car ride, Kris Rouse and Lauren Gamble from the Mobile Support Team reflect on what just happened.

“So we’re leaving Linda’s beautiful house,” Lauren informs her boss on the phone. “But we’re going to the hospital to do some helpful things.”

They tell me that this is not something they usually do, but then again, there is no standard for their work. They are willing to visit Stephen if it means getting Linda’s helpline in the right hands.

“You know, this might have to happen a few times before you’re like, ‘I’m done,'” says Kris.

But they don’t expect to solve their customers’ problems in one visit. Their job is to deal with the urgent problem, and then transfer their customers to the next service provider. Callers, like Linda, should be willing to accept their help. But then other networks – networks that include rehabs, shelters and hospitals – must play their part as well.

Kris says: “At least we were able to give him a place to talk.” “And obviously he needed it.”

Hospital Visit

Stephen fell asleep when we entered his room. There is an IV dripping in his arm and Kris and Lauren gently approach him.

They ask how he is doing, and a few life questions. They have to explain many times that they have a Telephone Support Team and that Linda called them for help.

They asked what his plan was once he got out of the hospital. But he says he doesn’t have it. He wants Linda back. They asked if he had somewhere, anywhere the other goes, but does not go.

There is a group in Sonoma that may be able to get him temporary housing. But it’s Friday, and the other team doesn’t work on weekends, so he has three nights before he can get help. As we leave the hospital, Kris and Lauren seem convinced that he will return to Linda’s house tonight.

Limitations of Telephone Support Groups

Kris admits: “It takes a long time. But there are ways in which, you know, they can start getting on the list of finding real homes. The frustrating part is that we know it won’t happen overnight. ”

But Stephen doesn’t just need a home, he needs medical care, mental health care, and — perhaps most importantly — serious drug addiction treatment.

As we drive, I notice that Linda’s call for help has turned into help for Stephen, and I wonder if there is anything else they should do for him. I show a wound on his hands. They’re concerned, yes, but since he doesn’t want to press charges, MST’s job is to file a report with Adult Protective Services – or APS – and move on.

“You know, we’d love to be like, oh, you guys need to break up,” Kris tells me. “Here, we have this little apartment for you and a caretaker and food and all that stuff. It is not what we do, nor can we do. But at least we can help start it. ”

After they are transferred, MST work is done. Now, it’s up to other social service websites to help Linda and Stephen.

The Network

In mid-August Linda dropped Stephen off at a Santa Rosa shelter called Redwood Gospel Mission. They offer long-term housing, and addiction recovery classes. Linda was hopeful that she would get the help she needed. But Stephen did not stay long.

For a while Linda didn’t know where he went. He was worried, but he didn’t know who to turn to. But APS had not forgotten about his case.

Around the time Stephen disappeared, an APS social worker called a “multi-group meeting.”

Lauren explains: “It was APS, they were social workers. “They were hospital people. It was nurses, it was a social worker from there, it was us—MST was there, Response was there.”

Lauren says there were about 20 people talking about Linda and Stephen. But it is not because their situation is unique. Rather, it’s because it reflects the larger trend of Sonoma County.

Lauren says: “There are a lot of older people who are using these services in this way now.

According to data from MST, more than a quarter of their customers are 55 or older.

“And so – not everyone – but most of the people at this meeting met him, in particular. I met Linda.”

Lauren tells me that meetings like this happen once a month. It’s a way for everyone to make sure they’re on the same page when it comes to specific issues or demographics they serve. That their work supports each other instead of undermining each other.

“I think the biggest thing that came out of it was that that social worker had information from every department. Okay?” explained Lauren. “It wasn’t just for the APS report. It was not like a little report from the hospital. It was everyone there talking about it and everyone was getting on the same page. ”

It is attached to the Cycle

Weeks pass, and one day, Linda receives a call from another social worker. Stephen was in the hospital, being treated for COVID and pneumonia.

He had had a difficult few weeks cycling in and out of shelters and hospitals. They were ready to get him out, so they called Linda and asked if she would accept him. But he refused.

I was surprised to hear that the hospital called him. It was different from the advice on setting boundaries that the MST gave. Shouldn’t everyone be on the same page about what they need? But Kris was not surprised.

“No, no. It’s just a desperate ER,” he says. “If he was ready to be released, then he needs a place to go and – that’s hard, isn’t it? If you don’t have a place to go, then what?

After being moved from a shelter to a hospital to a shelter to a hospital — a cycle that often repeats itself with homeless patients — Stephen was moved to a post-hospital care facility in San Rafael. When I told Kris and Lauren what happened, they looked relieved. This is Lauren.

“There’s a lot of different ways it could have gone, but the fact that he’s taking those steps to set his boundaries, and he’s in a place where he’s getting the help that he really needs, you know? I mean it’s …” Lauren laughs softly. “We have to work within the limits of our system. And in that regard, this is a very big win. ”

It is important for the city to have a Telephone Support Team. But if there isn’t a strong health system and social services around that unit — accessible health care, adequate public transportation, and housing for everyone who wants it — then sending in disaster response teams can be like applying a bandaid to someone in need. stitches.

I ask Lauren and Kris what they will do to improve the system.

Lauren begins by saying: “If I had all the money in the world, I would build more houses for people, like real houses.” And create programs to manage as many people as we really needed. Instead of having, you know, five magistrates with a hundred cases, it would be, you know, a hundred magistrates with five cases. So they were really able to do what they had to do.”

But it’s not, and it can often feel like governments are playing whack-a-mole with housing, health and social issues.

“Do you feel like that’s going to be resolved in your boys’ lives?” I ask.

“No,” Lauren answers immediately.

“No,” said Kris, quickly. Unfortunately I don’t know. And I don’t think we’re confused. I think, yeah, that would be cool. But also in our times when we go out to help people, that feels good. But we don’t go, ‘Okay, problem solved.’ You know, we’re helping right now and we can try to do more, but… we’re helping right now. ”

Kris and Lauren tell me they don’t find ‘happy endings’ in this job. And I can’t tell you that Linda and Stephen are no exception to that rule. But it’s not because MST made a mistake, it’s because the system they’re working on is overwhelmed by demand. And it’s going to take a lot more than Mobile Crisis Units to solve that.

If you, or someone you know, is experiencing Domestic or Intimate Partner Violence, you can call the National Domestic Violence Hotline at 800-799-7233.

Also, if you have hurt or are thinking about hurting a close partner or family member, there is a hotline for you. Anonymous and confidential, a trained person will listen to you and help you come up with solutions and find resources. Their number is 877-898-3411.

This series was produced as a project of USC Annenberg Center for Health Journalism’s 2024 California Health Equity Fellowship.