Opinion | I’m an N.Y.C. Paramedic. I’ve Never Witnessed a Mental Health Crisis Like This One.
Hospitals are overwhelmed, so they sometimes try to shuffle patients to other facilities. Gov. Kathy Hochul has promised 50 extra beds for New York City's psychiatric patients. Often, a patient is examined by hospital staff, given a sandwich and a...
I’m a Mental health worker at a large health system in Manhattan. East Harlem to be exact.
The mayors plan needs the following:
-Injectable psychotropics. Injectables are having a massive hype right now in the area of HIV care and prevention. This is because essentially you only need a one a month injection and you can go on your way. There are active discussions about using HIV injectables to target the street homeless and mentally Ill who can’t take HIV meds. Pharmaceuticals need to continue to evolve psychotropics to include more injectable options.
-Along with injectable’s, we need to bring the hospital into the community. I don’t mean opening up a clinic and letting people come to you. I mean setting up tables at parks, sidewalks, mobile vans, etc. the traditional medical model of having someone go to the hospital has to stop. You need real and proactive engagement with the community where you bring the care to them in a preventative way.
-We need more of this https://onpointnyc.org This is all built on a harm reduction model. You need to move away from wanting to immediately start treatment to stop the addiction. This approach works for some but not all. There needs to be room for people to reduce the harm at their pace.
-Police Officers need better training. I’ve worked in non profits where we needed to hospitalize someone due to mental illness. Sometimes NYPD would get there before EMS. More often than not the cops would make things worse. Their approach, attitude and demeanor is just not trained to deal with mental illness at this level. Sorry if this pisses anyone off and I’ll take the downvotes. Training is key, and training that is transparent and built around best practices.
-EMS has to get a pay raise. They start at 36k for fucks sakes. Enough of this shit. You want good service, you gotta pay. You want more people in the field, you gotta pay.
-The schools have to be brought in. For example; Can’t tell you how many MSW students from NYU have come through our unit thinking they’re going to psychotherapy their way to a private practice 2 years after graduation. Most public health programs focus on monitoring and evaluation (think statistics) with a little public health sprinkled in for show and publishing, or Social work programs too focused on the traditional model of having someone go to an office for therapy. The schools need to get their students and faculty into the streets and try new things.
-Neighborhoods are too fragmented and disconnected. I’m not going to argue the merits or curses of gentrification, but I grew up in the Bronx in the late 80s/90s. We knew who was homeless and mentally ill and we would take care of them. Sometimes they would disappear for a few weeks if they went through a particularly rough patch but they would come back to the neighborhood. I’m in Kew Gardens now and the neighborhood is thc shops, restaurants, banks and urgent cares. My local bodega guys change every couple of weeks so I can never really build a relationship with them. Generally it’s harder to build these neighborhood relationships now and maybe that’s having some effect on this?
I could go on and on…
The whole article is definitely worth reading, but this sentence is outstanding:
We have burned down the house of mental health in this city, and the
people you see on the street are the survivors who staggered from the
A huge factor which isn't being talked about enough is the mass introduction of meth to NYC's drug user community. We have never seen as much meth as we have in recent years on the streets. And the meth being used today is massively more likely to cause psychosis and violence than meth in years before. This article goes over it very well.
Meth is a whole different ball game in terms of how propensity towards psychosis and mental degradation. Its hard to even begin to describe just how bad meth is for communities, mostly because previously it was largely only found in isolated rural communities which didn't get as much attention. But it has exploded in NYC and other cities since 2018, and especially just since the pandemic. Even Burlington, VT is seeing a massive surge of violence caused by meth.
If fentanyl was the 'next step' in terms of how bad our drug problem is in America, killing off hundreds of thousands of us, the urban meth epidemic is another big leap, causing an unprecedented mental health and crime crisis. And its likely only going to get worse before it gets better.
By Anthony Almojera
Mr. Almojera is a lieutenant paramedic with the New York City Fire Department Bureau of Emergency Medical Services and the author of “Riding the Lightning: A Year in the Life of a New York City Paramedic.”
There are New Yorkers who rant on street corners and slump on sidewalks beside overloaded pushcarts. They can be friendly or angry or distrustful. To me and my colleagues, they’re patients.
I’m a lieutenant paramedic with the Fire Department’s Bureau of Emergency Medical Services, and it’s rare to go a day without a call to help a mentally ill New Yorker. Medical responders are often their first, or only, point of contact with the chain of health professionals who should be treating them. We know their names and their routines, their delusions, even their birthdays.
It is a sad, scattered community. And it has mushroomed. In nearly 20 years as a medical responder, I’ve never witnessed a mental health crisis like the one New York is currently experiencing. During the last week of November, 911 dispatchers received on average 425 calls a day for “emotionally disturbed persons,” or E.D.P.s. Even in the decade before the pandemic, those calls had almost doubled. E.D.P.s 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 crushed.
Now Mayor Eric Adams wants medical responders and police officers to force more mentally ill people in distress into care. I get it — they desperately need professional help, and somewhere safe to sleep and to get a meal. Forceful action makes for splashy headlines.
People with mental health challenges can be victims of violence. I’m also painfully aware of the danger people with serious mental illness and without access to treatment can pose to the public. Assaults on E.M.S. workers in the New York City Fire Department have steadily increased year over year. Our medical responders have been bitten, beaten and chased by unstable patients. A man who reportedly suffers from schizophrenia has been charged with fatally stabbing my colleague, Capt. Alison Russo-Elling, in Queens on Sept. 29.
But dispatching medical responders to wrangle mentally disturbed people living on the street and ferry them to overcrowded psychiatric facilities is not the answer.
For one thing, the mayor is shifting more responsibility for a systemic crisis to an overworked medical corps burned out from years of low pay and the strain of the pandemic. Many E.M.S. workers are suffering depression and lack adequate professional mental health support, much 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’ve gone down the road of despair myself. The spring and fall of 2020 left me so empty, exhausted and sleepless that I thought about suicide, too. Our ambulances are simply the entrance to a broken pipeline. We have burned down the house of mental health in this city, and the people you see on the street are the survivors who staggered from the ashes.
Those who are supposed to respond and help them are not doing well either. Since March of 2020, the unions that represent the Fire Department’s medical responders have been so inundated with calls from members seeking help that we set up partnerships with three mental health organizations, all paid for by the E.M.S. F.D.N.Y. Help Fund, an independent charity group founded and funded by medical responders and the public through donations to help us out in times of crisis.
We need to sift through the embers and see what we can salvage. Then we need to lay a new foundation, put in some beams to support the structure and start building.
What New York, like so many cities around the United States, needs is sustained investment to fund mental health facilities and professionals offering long-term care. This effort would no doubt cost tens of millions of dollars.
I’m not opposed to taking mentally ill people in distress to the hospital — our ambulances do this all the time. But I know it’s unlikely to solve their problems. Hospitals are overwhelmed, so they sometimes try to shuffle patients to other facilities. Gov. Kathy Hochul has promised 50 extra beds for New York City’s psychiatric patients. We need far more to manage those patients who would qualify for involuntary hospitalization under Mr. Adams’s 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 might offer a “banana bag” — an intravenous solution of vitamins and electrolytes — and time to sober up. Chances are the already overworked staff can’t do much, if anything, about the depression that led the patient to drink or take drugs in the first place.
Let’s say a patient does receive treatment in the hospital. Mr. Adams says that under the new directive, this patient won’t be discharged until a plan is in place to connect the person with ongoing care. But the systems responsible for this care — sheltered housing, access to outpatient psychiatric care, social workers, a path to reintegration into society — are horribly inadequate. There aren’t enough shelters, there aren’t enough social workers, there aren’t enough outpatient facilities. So people who no longer know how to care for themselves, who need their hands held through a complex process, are alone on the street once again.
A few days ago, I treated a manic-depressive person in his late 30s who was shouting at people on a subway platform in Downtown Brooklyn. The man said he’d gone two years without medication because he didn’t know where to get it. He said he didn’t want to go to a shelter, and I told him I knew where he was coming from: I was homeless for two years in my early 20s, and I 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’ll remember to take it, I don’t know.
While I don’t know how forcing people into care will help, I do see how it will hurt. Trust between a medical responder and the patient is crucial. Without it, we wouldn’t be able to get patients to talk to us, to let us touch them or stick needles filled with medications into their arms. But if we bundle people into our ambulances against their will, that trust will break.
Also, medical responders aren’t equipped to handle standoffs with psychiatric patients. In my experience, police officers are not keen to intervene with the mentally ill. They don’t have the medical knowledge to evaluate patients. So, who is going to decide whether to transport them? What if we disagree? Protocol has been that it is the E.M.S. personnel who make the decision. Will the police now order us to take them? I can only imagine the hours that medical responders and cops will spend debating what to do with a patient.
Rather than looking for a superficial fix, Mayor Adams should turn his attention to our neglected health care apparatus. We must heavily invest in social services, housing and mental health care if we want to avoid this ongoing tragedy. We need this kind of investment across the United States, where there’s a serious post-pandemic mental health crisis. My contact with New York City’s mentally ill population over the years and my own brushes with depression and homelessness have taught me we are all much closer to the abyss than we think.
I think Covid and social distancing pushed a lot of people over the edge. Some people couldn't deal with the stress and the loneliness.
While I don’t know how forcing people into care will help, I do see how it will hurt. Trust between a medical responder and the patient is crucial. Without it, we wouldn’t be able to get patients to talk to us, to let us touch them or stick needles filled with medications into their arms. But if we bundle people into our ambulances against their will, that trust will break
This is the narrative that the Times and its staff are pushing. When you ask what happens when the mentally ill person or drug addict continually refuses treatment because their condition basically prevents them from recognizing that they need treatment or from seeking it, you get shrugs. There are progressive people whose answer to that question is a shrug. While these people die in the street.
Their argument against this policy is generally that it's hard to properly fund, but many don't follow up with a desire to actually fund long-term care. Rather, they vehemently oppose involuntary care and simply don't have realistic solutions to offer. They prefer a delusional alternate reality.
EDIT: And they're getting hammered again in the comments on the article. The circle of people pushing this delusional view of homelessness is shrinking every day.
Hmmmmm best I can do is cut taxes and put armed guards everywhere. Best of luck, E. Adams.
Such a strange editorial. His job will not change one bit. He will continue to bring mentally ill people to the hospital. Well maybe he will bring s handful less people to the hospital as 50 people accross the entire city will be involuntarily committed. He complains now that most people are stabilized and sent on their way which is bad. Then he argues keeping them in the hospital is bad. He argues people in the hospital system do not know how to deal with mentally ill people at the end of the article but in the beginning says thousands of people a month are brought to the hospital. He does not want the city to keep an extra 50 patients at a time involuntarily committed which most likely will be people with schizophrenia but acknowledges someone suffering from this disease killed an EMS worker. This is exactly what the mayor is trying to stop. Yes the Healthcare system needs more funding. The question is where do you spend the money. How much is enough? How do you judge success. What is the balance between life and liberty. With mental health these sound like easy answers but they are not.
everyone wants to call it a “mental health crisis” because the laptop class can relate to having “anxiety” and going to therapy or “treatment” to get better.
the crazed people you see on the subway and streets almost all have psychosis and permanent brain damage from methamphetamine and fentanyl. The street trade in powerful new chemical synthetic drugs has unfortunately exploded at the same time as urban rents outgrew fixed welfare payments (SSDI etc) and as progressives have embraced “harm reduction” and criminal amensty for drug-dealing.
The governments response to all this is too slow, misdiagnosises the cause, and is not proportional to the depth of crisis.