Taking CARE of Flagstaff: Mental health first responders reflect on first 4 of operation

The Flagstaff City Council approved a $2.5 million three-year contract with Terros Health in March, funding the creation of a mental health response team that could be dispatched through the ordinary 911 system, leading to the funding of the launch of the Community Alliance Response and Engagement — or CARE team.

Today, that team is out on the streets responding to incidents and providing community outreach.

On weekdays from 9 a.m. to 7 p.m., a mental health professional pairs with an EMT from the Flagstaff Fire Department. They prepare their patrol vehicle, an unassuming white Toyota minivan, for the day. They clean and sanitize the back seat, which is divided from the front seat by a black mesh barrier. The team makes sure their van is fully stocked with everything from water bottles, sandwiches (provided by Flagstaff Family Food Center), candy (typically Smarties), and dog food to T-shirts and Narcan.

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There are identical red and green backpacks in the backseat — the red is stocked with the tools an EMT might need to monitor blood glucose, blood pressure, and other vital signs. The green bag carries a portable oxygen tank.







CARE Unit

Saira Ayres (left), James Devenney (middle) and Mariel Gonzalez stand in front of the specially equipped van for The Terros Community Alliance Response and Engagement (CARE) unit at Fire Department No. 3 last Thursday. The CARE Unit provides community outreach and responds to behavioral and medical nonemergency situations around Flagstaff.




The team will meeting people where they are. They go on outreach patrols — a process that sends the van squeezing through the alley behind the Highway 89 Safeway, past a truck delivering bagels, lines of shopping carts, and stacks of black milk crates. Next, they head to Bushmaster Park. These places are “hot spots” where the team is often dispatched and people without shelter often congregate.

During outreach, they’ll approach people on the streets. Crisis Response Specialists, such as Saira Ayrers, might hand a T-shirt to a person who only has long-sleeve or cold weather clothing on a hot July day. EMT Jimmy Devenney will ask if anyone needs water in a crowd gathered under a shelter at the park. Mariel Osorio, the lead crisis clinician on the CARE unit, might offer a chalky roll of round candies to someone recovering from drinking alcohol, or someone with low blood sugar.

Ultimately, the team will perform welfare checks and address situations before they become emergencies or prompt bystanders to call 911.







CARE Unit

The Terros Community Alliance Response and Engagement (CARE) team stands in front of its van in east Flagstaff on Thursday afternoon. The CARE van is equipped with many items to help the people around Flagstaff who are in need but are not involved in emergency situations.




“Sometimes people don’t want any help, and we’re like, ‘OK, we’re here if you need us.’ Sometimes just offering support to somebody can help a lot,” Ayers said.

She recalled a time when that proved to be the case.

“There was a client who we met multiple times who needed assistance. Often intoxicated. Mental health issues. Didn’t want any help. Just wanted transportation. Then one day they said, ‘I want to get sober.’ Which was amazing,” Ayers said. “They wanted to go to detox and get clean and get help and get back up on their feet. I was able to coordinate with the guidance center from there. I haven’t seen them sense on the street. We don’t know what happens to people, but I have a good feeling. It was amazing to see the influence and transformation.”

Sirene Lipschutz, CARE unit clinical manager, said typically they’re not going to make contact with a person in need and change their life in the same day. The process is more about offering resources and being a “safe face” in the community.

“Sometimes, we’re just helping a person feel worthy,” Lipschutz added.

Calls come in on a lime green radio from the same dispatchers who send police, fire, and ambulatory units to crime scenes and medical emergencies. Dispatchers are trained to route calls to CARE when the situation is not a medical emergency and/or might involve a person experiencing a mental health crisis.

When the radio chirps to life, the team responds to calls that reference a “man-down” (when a caller spots someone who might be asleep or unconscious in a public space) or code “omega” (which calls for responders to drive normally through traffic, as opposed to a “delta” call that prompts first responders to use lights and sirens to more quickly reach a scene). About 19% of the time, the CARE team is dispatched to give a person in need a ride to Flagstaff Shelter Services, or another safe location of their choosing.

“What’s really great is it diverts these nonemergent calls so that a whole engine and ambulance don’t go out to the scene for somebody who might not need that. So then, they’re saved for emergencies, and we’re able to help those people,” Ayres said.

If the team is dispatched to help someone lying down, the EMT will make sure they’re medically stable and safe. If they end up needing an ambulance, the EMT works with dispatch to have a Guardian team sent to the scene.

The CARE team has been responding to calls for four months now, and they’ve gotten more than 435 of them. Only 16% of the calls the team has received needed to be passed on to police, fire or emergency medical response teams at Guardian.

“We’re decreasing the load on the system, and we’re decreasing the number of people who need to go into the system,” said Lipschutz. “Whether it’s jail or a hospital.”

On the other side of the coin, police officers will call the CARE team if they find a person who is experiencing a behavioral or mental health emergency or someone who needs a compassionate ride to a shelter or food kitchen.

“It is helpful to have the right resources going to the calls for service,” said Sgt. Odis Brockman, the public information officer with the Flagstaff Police Department. “Our dispatchers are able to triage these calls and determine what response is most appropriate. All of our officers have at least some training in responding to calls where someone is in a behavioral health crisis, but there is no substitute for someone who has more training and time to provide the needed services.”

The reaction to the CARE work has been resoundingly positive since they’ve been in the field, but Lipschutz says it wasn’t always that way.

“There was some community resistance,” Lipschutz said. “I think some of that was about, ‘Oh, you’re going to be attacked. You’re going to be in danger.’ That is not a thing. It hasn’t happened. We haven’t felt unsafe.”

Now, the only complaint police have about CARE is that they wish there were more teams. More staffing.







CARE Unit

Mariel Gonzalez (left) and Saira Ayres carry water and snacks to people in need at Bushmaster Park last week. Gonzalez and Ayres work The Terros Community Alliance Response and Engagement (CARE) doing community outreach and responding to nonemergency situations around Flagstaff.




“During especially busy times, the community would likely benefit from having additional resources out there. There have been several times that an officer will recognize that a call is better suited for the CARE team, and the CARE team is unavailable or busy on another call,” Brockman said.

Right now there is only one CARE van out at a time. That van is based in Flagstaff’s east side, and occasionally the team has to drive back and forth across the city to provide resources. They want to expand their outreach too — ideally launching another team on the west side, and expanding hours into the night.

For now, they’re planning to keep showing up as staffing and funding allow.

“We’re showing up in a minivan!” Osorio said. “We’re wearing T-shirts. We’re just here to care.”

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