Some New Yorkers rant on street corners and panic on sidewalks by packed wheelbarrows. They can be friendly, angry, or mistrustful. To me and my colleagues, they are patients.
I am a paramedic in the Fire Department’s Emergency Medical Services Agency, and I seldom go a day without calling to help mentally ill New Yorkers. Your first or only point of contact with a range of medical professionals. We know their names and routines, their delusions and even their birthdays.
It’s a sad scattered community. And it turned into a mushroom. In my nearly 20 years of working as a healthcare professional, I have never witnessed a mental health crisis like the one that is happening in New York City right now. In the last week of November, a 911 dispatcher said he received an average of 425 calls a day about an “emotionally disturbed person” or her EDP. EDPs are people who fall through the cracks in chronically underfunded mental health systems. The system is Trump’s house built on sand crushed by the Covid pandemic.
Now Mayor Eric Adams is calling for medical responders and police officers to forcibly treat people with mental illness. Ok – they desperately need professional help. Powerful action makes for flashy headlines.
People with mental health problems can become victims of violence. I am also acutely aware of the danger that people with severe mental illness and lack of treatment pose to society, and the attacks on her EMS personnel at the New York City Fire Department have steadily increased over the years. Our medical responders have been bitten, beaten and chased by unstable patients. A man reportedly suffering from schizophrenia has been charged with stabbing to death my colleague, Captain Alison Russo Elling, in Queens on September 29th.
But dispatching medical responders to crack down on mentally ill people living on the streets and transferring them to overcrowded psychiatric facilities is not the solution.
For one thing, mayors are shifting more responsibility for the systemic crisis to an overworked medical corps that has been burned out from years of low wages and pandemic strains. , just like the patients we treat, lack adequate professional mental health support. Several members of the Fire Department Emergency Medical Service have died by suicide since the pandemic began, and hundreds have resigned or retired. .
I myself have walked the path of despair. The spring and fall of 2020 were so empty and exhausting that I couldn’t sleep and even thought about suicide. Our ambulance is just the gateway to the broken pipeline. We burned down mental health homes in this city. The people you see in the streets are those who survived, stumbling through the ashes.
Those who are supposed to help in response are not doing well either. Since March 2020, the union representing fire department medical responders has been inundated with calls from members seeking help, so we partnered with three mental health organizations. We are funded by medical responders and the general public through donations to help us in times of crisis.
You have to sift through the embers and see what you can recover. Next, you need to start construction by laying a new foundation and putting in some beams to support the structure.
Like many cities across the country, New York needs sustained investments to fund mental health facilities and long-term care professionals. No doubt this effort will cost tens of millions of dollars.
I am not against taking a suffering mentally ill person to the hospital. Our ambulance always does. But I know it’s unlikely to solve their problem. Hospitals are so overwhelmed that they sometimes try to move patients to other facilities. Governor Kathy Hochul said he has promised 50 additional beds for New York City’s psychiatric patients. By Adams’ vague criteria, more needs to be done to manage patients who qualify for involuntary hospitalization.
Patients are often examined by hospital staff, given sandwiches and a place to rest for a few hours, and then discharged. If the person is intoxicated, the nurse may offer a “banana bag” (an intravenous solution of vitamins and electrolytes) and time to calm down. If anything, you may not be able to do much about the depression that drove you.
Let’s say a patient is being treated in a hospital. Under the new directive, Adams said the patient will not be discharged until a plan is in place to connect him to continued care. But the systems that deliver this care – sheltered housing, access to outpatient psychiatric care, social workers, pathways to reintegration into society – are woefully inadequate. There are not enough shelters, social workers or outpatient facilities. So people who don’t know how to take care of themselves and need to hold hands through a complicated process are once again alone on the street.
A few days ago, I treated a manic-depressive patient in his late 30s who was screaming at people on a subway platform in downtown Brooklyn. The man said he went without medicine for two years because he didn’t know where to get it. I told you, I was homeless for two years in my early twenties, and Bedford-Atlantic Armory was enough.
I persuaded him to come with me to the Brooklyn Hospital Center to get a prescription. I don’t know if he remembers to take it.
I don’t know how forcing people to care helps, but I do know how much it hurts. Trust between medical responders and patients is very important. Without it, you cannot talk to the patient, allow him to touch you, or insert a drug-filled needle into his arm. But that trust is broken when you put people in an ambulance against their will.
Also, medical responders are ill-equipped to handle a stalemate with a mentally ill patient. In my experience, police officers are reluctant to intervene with mentally ill patients. They don’t have the medical knowledge to evaluate patients. So who decides whether or not to ship them? What if we disagree? The protocol was that it would be her EMS representative to make the decision. Will the police order us to take them now? I can only imagine how many hours it will take the medical responders and the police to argue over what to do with the patient.
Rather than looking for superficial solutions, Mayor Adams should turn his attention to neglected medical devices. He must invest heavily in social services, housing and mental health care if he wants to avert this ongoing tragedy. We need this kind of investment across the United States, experiencing a severe post-pandemic mental health crisis. Years of contact with mentally ill people in New York City and contact with depression and homelessness have shown us that we are much closer to the abyss than we think.
Anthony Almohera is a Lieutenant Paramedic with the New York City Fire Department Emergency Medical Services Department, Vice President of the Uniform EMS Officers Union, Local 3621, and Riding the Lightning: A Year in the Life of a New York City Paramedic. Also an author. ” This article originally appeared on new york times.
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