For many people who are homeless or who have behavioral health issues, the right medical care is too far out of reach. Often folks turn to emergency services for basic healthcare—which can be both expensive and ineffective.
Santa Fe is just one of a dozen cities across the U.S. to try out a new program that brings meaningful help to people who frequently call 911.
Rollin Jones is a firefighter and EMT with the Santa Fe city fire department. He’s on duty, visiting the home of Carol Garcia and her husband Joaquin. But there’s no emergency here—not today.
Jones has responded to scores of 911 calls at her house over the years. Her severe schizophrenia makes her prone to outbursts of anger, and her husband would call emergency dispatch for help, even though it wasn’t necessarily an emergency.
"We gotta get consistent," Jones said to Garcia as she nodded in agreement. "We need to find a nice balance that works for you to where you feel good and you’re happy."
She recently switched doctors, and Jones is worried she’ll miss her next round of medication. For someone in Garcia’s condition, that could mean a run-in with the police or a trip to a psychiatric hospital—things that could do more harm than good.
Jones took on Garcia’s case as part of the Mobile Integrated Health Office, a new program at the fire department that’s trying to get help to frequent 911 callers before they have a real emergency.
Each morning, the mobile health team meets to figure out what kind of help each patient needs—whether it’s a ride to the clinic, or repairs to the stairs in an apartment where an elderly patient can fall down.
Jones usually spends his time with Garcia smoothing out doctor visits, talking about counseling options, or even having picnics in the park.
"I think it's helped Carol a lot, to get out like that," said Garcia's husband Joaquin.
Garcia and her husband say those efforts have made things a lot easier for them. And it turns out there are a lot of people in the same kind of situation. People like Garcia make up less than one percent of Santa Fe’s population, but account for 15 percent of the city’s 911 calls.
Those non-emergency 911 calls cost a lot of money. They can have real consequences for emergency responders, too. Andres Mercado, who runs the Mobile Integrated Health program, remembers one instance that stuck in his mind.
"We were transporting an intoxicated individual who we knew very well, we had transported him many times in the past, and a structure fire came in on Palace Ave. We were the first due ambulance to the fire and we weren’t able to go," Mercado said.
This kind of interference in emergency response services happened almost 4,000 times in 2014 alone.
Mercado says even more frustrating was the fact that the people calling 911 weren’t getting the help they needed from EMS visits.
"These are people who have a really hard time navigating the healthcare system and who have some really complicated issues, and some really complicated life stories sometimes," he said.
Right now, the mobile health program is focusing on the 20 Santa Fe residents who call 911 most frequently—people the program calls “high utilizers”—and trying to get those people the help they need to get back on their feet again. In a few months, they’ll reach out to another group of frequent callers.
"It is a matter of life and death," said Kristen Carmichael, a social worker with Christus St. Vincent Regional Medical Center who advises the firefighters in the mobile health program. "We don’t see a lot of high utilizers over the age of 55 because they’re dead."
Carmichael says even though Santa Fe’s most frequent 911 callers are the most vulnerable people in the city, they’re also a group that that shows a lot of promise.
"These folks are incredibly resilient, and with the right kind of approach they can make incredible gains," she said.
And it does look like some impressive gains have been made. Over the couple of months the program has been up and running, the average number of monthly emergency calls from the people the team has been working with has dropped 85 percent. Now, fire and EMS departments in Albuquerque and elsewhere are looking to see if the mobile health model could work for them, too.
Public Health New Mexico is funded by the Con Alma Health Foundation and the W.K. Kellogg Foundation.