Anthony Almojera: I’m an NYC paramedic. I’ve never witnessed a mental health crisis like this one

A New York City paramedic’s view of his mayor’s new policy

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.

Anthony Almojera is a lieutenant paramedic with the New York City Fire Department Bureau of Emergency Medical Services, vice president of the Uniformed EMS Officers Union, Local 3621, and the 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.