Mobile Support Team: Responding, Listening & Stabilizing
Oct 13, 2022Season 2Episode 23
Missoula County Commissioners
For decades, communities have relied on emergency services like law enforcement and first responders to handle people experiencing a crisis. Often these interactions led to a revolving door between a jail and emergency rooms, which left service providers, taxpayers and individuals without effective resolutions. The Mobile Support Team in Missoula was created in 2020 as a new approach to both divert people from hospitals and detention facilities while setting them on a path to stability by addressing the root cause of the crisis and connecting them to appropriate resources.
This week, the Missoula County commissioners sat down with three people who play an integral role in the on-the-ground operation of the Mobile Support Team: Becca Goe, director of innovation at Partnership Health Center (PHC); John Petroff, firefighter and operations manager for the MST; and Kiki Radermacher, behavior health manager at PHC. They discuss what it means when a person is in crisis, what resources are available, and the success stories they've experienced in the field.
For decades, communities have relied on emergency services like law enforcement and first responders to handle people experiencing a crisis. Often these interactions led to a revolving door between a jail and emergency rooms, which left service providers, taxpayers and individuals without effective resolutions. The Mobile Support Team in Missoula was created in 2020 as a new approach to both divert people from hospitals and detention facilities while setting them on a path to stability by addressing the root cause of the crisis and connecting them to appropriate resources.
This week, the Missoula County commissioners sat down with three people who play an integral role in the on-the-ground operation of the Mobile Support Team: Becca Goe, director of innovation at Partnership Health Center (PHC); John Petroff, firefighter and operations manager for the MST; and Kiki Radermacher, behavior health manager at PHC. They discuss what it means when a person is in crisis, what resources are available, and the success stories they've experienced in the field.
Welcome back to Tip of the Spear with your I'm Commissioner Dave Strohmaier, and I'm joined here yet again with my fellow commissioners, Juanita Vero and Josh Slotnick. We're also delighted to have with us today Becca Goe, Director of Innovation with Partnership Health Center and Kiki R adermacher, Behavioral health manager. We're also joined by John Petroff, a firefighter who is the operations manager for the mobile support team. Thank you all for joining us today.
Kiki Radermacher:
Thank you.
Josh Slotnick:
Yeah, we're psyched to have you. So, John, can you give us some background on the mobile support team? What does it do and what are the goals?
John Petroff:
Yeah, so we started back in September of 2020 actually November 16th of 2020. And our goal of our program was for jail diversions, emergency department diversions, and to take other responders off of scene of scenes that are anything from like mental health related to that kind of gray area stuff. So anything where it's not a criminal act, it's not a medical scene and it's not a fire, we're kind of that fourth response resource for that.
Juanita Vero:
Well, I have a question for Kiki then. So when you're talking about a person experiencing a crisis, what does that really look like?
Kiki Radermacher:
I think for any person experiencing a crisis, It also can be unique to the family or the supports of that specific person. And before really talking about what that looks like, I mean, defining a crisis I think is important in most simple terms. I think of a crisis of when a person is faced with a problem that feels insurmountable and they are lacking in supports, there's an aspect of powerlessness to it. And oftentimes that can lead to someone experiencing suicidal ideation can lead to homicidal ideation. And then there are other folks in our community that maybe they're experiencing a mental illness and it's causing them to be unable to meet their basic needs. So that can look really different to each individual person. Oftentimes these crises can arise when someone's experiencing a breakup or if they're facing an eviction and they don't have a lot of supports. A lot of the calls that we get that we respond to, 60% of the folks are actually housed individuals. And with the housing crisis that we're experiencing right now all over the United States, we're seeing more and more people who are being evicted or they're no longer able to afford their rent. And we get called on a lot of those folks who are just struggling to know what the next option is for them, whether that they're needing connection to resources, if they're becoming homeless, they may go to like the overflow center or the Johnson Street shelter during the winter months, and we can kind of help them with that process in not only getting them to a place that they have shelter, but also connecting them to resources afterward.
Juanita Vero:
Help me understand what resources means in
Kiki Radermacher:
Yeah, we have so many amazing resources in And on the flip side of that, there are also many gaps. And the resources that we do have is there are multiple different mental health clinics and different facilities that we have available that we can link people to. They can get offered psychiatric services or medication. They can see a therapist, they can get connected to a case manager who then can step in and really support them in getting their needs met in the community. Other resources that we have, like we have the the Poverello Center and the Johnson Street Shelter, which are both great facilities that help folks that are unhoused. And then of course, there's Partnership Health Center and absolutely amazing facility that we have in town. They offer really an integrative approach to both behavioral health and mental health. We help get people established as patients there so they have a treatment team that can offer some wraparound services.
Dave Strohmaier:
Kiki, maybe paint a picture for us in terms coming on scene, presumably prior to the more mobile support team coming into existence. It would be police, fire, medical, rolling up to one of these calls. How does your work integrate with law enforcement and emergency services today?
Kiki Radermacher:
I think about this traditional approach where fire, EMS. How we're different is that we don't have an agenda and we don't have time constraints. We're able to really meet people where they're at. We're able to offer that time and attention that many people need to be heard to feel like they're understood, and then building that relationship of trust with those people so we can also help them get connected to the different resources. We will get called out from an officer who is just at a loss of what to do. I had mentioned evictions earlier and there have been plenty of times where we have gone out. People have been served an eviction notice and they have no place to go and they have no family and they have no support. And our team really offers a different approach where we can make phone calls and link in with different resources or different sources of funding to make sure that they have. A safe place for shelter and that they also have follow up services after.
Josh Slotnick:
John, this is Josh and a question for you. Earlier, you mentioned jail diversion, diversion away from the emergency department. While we have these services, why divert people away from them? Shouldn't we send dangerous people to jail or hurt people to the emergency room?
John Petroff:
Yeah, that's a that's a good question. Get asked that a lot, actually. The costs associated with mental health and going to the emergency room or going to jail, the costs are pretty significant. So the average ID cost is $3,050 per visit. That's an average, you know, and that was done through our evaluation of our pilot program by one of our staff at FCW. And so we see significant cost savings through diversions. Over 60% of the people that we interact with stay in the environment we respond to. So where otherwise they would, you know, they would go to the emergency department and be utilizing the emergency staff and ambulance service and that we're able to stay on scene, come up with a plan to connect them with resources, connect them with safety, like making sure they're safe in their environment and really reducing the trauma to these clients, which is really important. It's like when we're talking about meeting people where they're at, we really are trying to find something that they're coming along for the solution themselves. It's not just us coming up with something for them. Over 70% of people that are incarcerated have mental illness. So we're seeing that if we can change that cycle of what they're going through, they can be a productive person in society and really be part of their own solution by giving them resources and treating them different, because we haven't done that in emergency services before. We are always solution based. We need to take them somewhere quickly and that's something this team can do different.
Josh Slotnick:
Wow. So do you have a sense of how much money
John Petroff:
Yeah. So actually we we had 169 emergency saving over $250,000. That was through our pilot program or pilot period.
Josh Slotnick:
That's incredible.
Juanita Vero:
And what was that period? What was that time?
John Petroff:
That was November of 2020 through June of
Juanita Vero:
Wow. So a quarter million dollars?
Josh Slotnick:
Yeah, it is really amazing.
John Petroff:
Yeah.
Josh Slotnick:
Our most of the folks that you are unhoused?
John Petroff:
No, actually, that's one of those questions Over 60% of the people are housed. You know, one in five Americans suffer from mental illness crisis throughout the year. And that's something that we're trying to reduce That stigma across the nation is like, this is everybody. This is our families, this is our brothers, our sisters, our friends. Somebody is suffering from a mental illness. Most likely that, you know, that's close. And a lot of times they are housed individuals. We do work with the unhoused as well because as a community, we're going to take care of anybody that calls in that nine on one system. But it's really important to recognize that like two thirds of our clients that we're working with are housed.
Dave Strohmaier:
Any specific success story come to mind?
Kiki Radermacher:
I mean, we have so many different success And just thinking over the last few years that we've been part of this program, there's been a lot of wins. One that really stands out to me. There was an individual that we were coming into contact with 911 was dispatching us. An unhoused individual really was struggling with alcoholism, but was very intelligent and insightful. He just was self medicating. And it went on for, I would say, almost a year where we were consistently trying to assist him and getting help and treatment as well as getting housing. The complication with finding someone housing when they're also struggling with addiction is it's usually short lived. We have follow up services, which is another aspect that makes our team different as we follow up with our clients. And one of our case facilitators was able to develop a really meaningful relationship, meaningful and trusting relationship with this person. Just today, she was talking on the phone with him and he's doing very well. He's been in treatment, he's sober, he looks really well. And the next step for him, once he's out of treatment, will be to get into housing. And that's something that has been put into place in the time that he's been in treatment.
Dave Strohmaier:
Wow. That's powerful.
Juanita Vero:
This is a question for Becca, building on does the team connect community members to the appropriate services?
Becca Goe:
I think that Kiki and John have done a really resources that we have here in Missoula. And I think what is really unique about our mobile support team is the case facilitator role which can follow up with people after the event to connect them with the resources available in our community and get them to a place where they feel more stable. And I think the partnership between PHC and the fire department has been really helpful, kind of being able to connect people with behavioral health and medical services and social work and community health workers and tenancy support back at PHC can help stable people over that longer haul. And with that said, though, I think we all know that crisis can take years to kind of develop and that as. We're looking at our mobile support team as just kind of a piece in this continuum of mental health care in Missoula, and that if we want as we start to look at some other things, I think one thing I'm really excited about is our crisis receiving center, which is in the currently in our development stages, which will give another place for people to go other than the E.R. or jail that will be more appropriate setting where they can stabilize better in the long term.
Dave Strohmaier:
Yeah, one thing that I've heard that's on great in the heart of Missoula, but if I live in East Missoula, Milltown, Bonner.
Juanita Vero:
...Up the Nine Mile and I'm in crisis.
Dave Strohmaier:
Yeah, well, just looking at the community and What is your service area?
John Petroff:
We are a county resource, so it is city and We spend about between 15 and 20% out in the county right now. Those calls do take a little bit longer. We do have a higher density of calls within city limits. But when we when we get calls from county Sheriff's department, if we get called from one of the other fire departments or MESI that's out in the county, like we do take that as a high priority because a lot of times...
Juanita Vero:
MESI is an acronym for...?
John Petroff:
Oh, Missoula Emergency Services Inc. Yes, it's the ambulance service here. When we get called out there, a lot of times we recognize as a team that those other agencies usually are calling us a lot of times out of the last resort. So those those take high priority as well. And they are a longer time frame. When we respond, those are averaging over 2 hours when we go out in the county. We're in town, we're about an hour and 15 minutes when we engage.
Josh Slotnick:
Yeah, thanks. People would probably want to answer part of that. And then we were able to get some COVID money, the federal government early on, and use that money to help stand up the mobile support team, help get crisis receiving underway and their handful of other programs in the same vein that are also funded. There's also a levy on the ballot this November called the Crisis Services Levy that would create continued funding for all these efforts. And if you are interested in learning more details about that, you can find out at Missoula County Voice.
Juanita Vero:
Well, before we close, can you share with us or nugget of wisdom you've come across that you could share with us and listeners.
Kiki Radermacher:
I'm really excited about this question.
Josh Slotnick:
All right.
Kiki Radermacher:
So I really enjoy teaching and training our I ran across a study that was done at UCLA where they talked about the importance of emotional labeling. So what they did with participants is they would measure the different activation areas of the brain while they were presenting them, pictures of individuals, faces with very strong emotions. And what they initially saw was that the amygdala was lighting up, which is our fight or flight response. And in the second part of the study, they would show the participants the same photos. But at this point they would ask them to label what emotion that they were seeing. What was very interesting to me was that when they presented that concept of let's label these emotions that we're seeing the activation mood back into the frontal cortex, which is responsible for our ability to plan to problem solve, to think through things by just that act of labeling the emotion, you will start to see people coming down and being able to be more reasonable and to have a conversation about what solutions are available.
Josh Slotnick:
Wow.
Kiki Radermacher:
John, do you want to talk about mindsets? Oh, okay, cool. I guess I'll be the only one to answer the best question.
John Petroff:
I can ask your answer question.
Juanita Vero:
No. Yeah. No. No. John. Yeah. Anything that you've come across? And Becca, you can't escape this. You have to share something.
John Petroff:
Yeah, I guess my little nugget of wisdom. I guess I've been I've been a responder for over 17 years, professionally as a firefighter, and kind of stuck in my way of thinking and all of that. And I think with this position in the city and working with city and county and working with other agencies, recognizing like we're siloed, even if we don't think we are taking in other people's perspectives is so important. And really actually listening to people and trying to understand is so important to relationships. And I think that's why, again, I feel like this program has been successful in like there's been a lot of difficult times, but it's been fun to build relationships across the city that we've never had before. And so I feel super appreciative of that and and of the team doing the work on the grounds. It's just really cool to to see a team that works so closely together in providing a customer service that hasn't been provided in this community in the past. And that's not for anybody doing anything wrong. It's just a different type of team.
Juanita Vero:
Is there a story or an example where you can now I listen? This way. What's that look like?
John Petroff:
Yeah, I bet Becca could probably tell those Like, Yeah. No, I guess, you know, before I used to listen with. With an opinion. Before I heard somebody, I would always have an answer before the words words came out. And now I honestly feel like I can be in a room and listen to people's opinions and and not have a judgment and and really sit and think on that and not really have a reaction. So just being emotionally intelligent a little little more than I have been in the past. I have been a hothead in the past. And so, so changing that has been life changing for my relationships from personal life to work life.
Becca Goe:
I think mine actually kind of is similar to back to that quote. I think it's what "Change happens at the speed of trust," or something like that. And I think that speaks really well to all the work that the mobile support team does, both with their patients at an individual level, like building relationships is really what you need to do to help someone move on and get hopefully find the support that they need in their community, but also at the systems level, like because you were talking about the police and relationships. And when we first started, I think that's what John and everyone else did really, really well was going in and just building trust. And that has been huge for the success of the program.
Juanita Vero:
That's so much better than the change quote at a time," is what my grandfather always used to say. So you're just way more positive.
Dave Strohmaier:
I was thinking, just outlive the bastards,
Juanita Vero:
Well, thanks so much, all of you, for joining Yeah. Keep up the great work and thanks.
Dave Strohmaier:
Great work. You guys are an asset to the
Josh Slotnick:
Thanks for listening to the Tip of the Spear If you enjoy these conversations, it would mean a lot if you were to rate and review the show on whichever podcast app you like. And if you know a friend who would like to keep up with what's happening in local government, be sure to recommend this podcast to them. The Tip of the Spear podcast is made possible with support from MKR, better known as Missoula Community Access Television and our staff in the Missoula County Communications Division. If you have a question or topic you'd like us to address on a future episode, email it to communications at Missoula County US and to find other ways to stay up to date with what's happening at Missoula County. Go to Missoula DOT CEO slash County updates. And thanks for listening.[outro music plays]