This is part one of a two-part series. Click here to listen to episode two.
Over the last few years, non-police response programs have been popping up all over the Bay Area. There’s MACRO in Oakland, SCRT in San Francisco, and the AQCRT in Antioch. They’re relatively new to the cities they serve, and are still learning how to best run their programs. Up North, Sonoma County has had several mobile support teams, all with different acronyms and priorities, for years.
Last year, Sonoma County got state funding to expand one of their existing mobile support teams so that their crisis responders could operate 24 hours a day, seven days a week. But 24/7 crisis intervention isn’t always what you’d expect.
A warning to listeners: the following story contains descriptions of intimate partner violence, substance abuse, and suicidal ideation.
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When I was shadowing Sonoma County’s Mobile Support Team, I expected to meet somebody in crisis, but I didn’t picture a crisis like Linda Alfano’s. When we show up to her place, she isn’t crying or yelling at anyone, she’s calm and friendly, and putters around for a while, making space for us.
“Linda, I'm gonna move this knife, okay?” Someone from the Mobile Support Team says.
“Put it in the sink thing here,” she responds, casually.
Linda’s place is small, but comfortable. It’s full of Coca-Cola memorabilia, old family photos, and lots of little trinkets. It feels like we’re visiting someone’s grandma.
“I really love your Coca-Cola seats,” says another team member. “These are very cool.”
“Alright,” she says. She sounds tired.
A Slower Pace
Sonoma County’s Mobile Support Team — or MST — is a group of therapists and drug and alcohol counselors who respond to mental health crises in Sonoma County.
If you want a visit from MST, you have to call a number, separate from 911, that gets answered at their call center in Santa Rosa.
Steve MacDonald is one of two people manning the phones today. He’s worked as an addiction specialist in Sonoma County for over a decade. I spend a few hours with him in the call center, listening to the process he has to go through when screening calls. He spends a lot of time repeating himself, and clarifying things.
Calls to MST aren’t like calls to 911. You have to answer a long and pretty detailed series of questions to get a team sent to you. And — just like our visit to Linda’s — the pace of it took me by surprise. It’s slow and repetitive. But they have to do it this way, because they have to make sure MST is the right team to send out.
How slowly things move feels counterintuitive to me, but it’s working exactly how it’s supposed to. These aren’t — technically — medical emergencies, they’re mental health issues that require a slower, more nuanced strategy.
The Gray Area
Wendy Tappon is the program manager for MST, and she says there isn’t a one-size-fits-all approach to their work.
“We work a lot in the gray areas,” she tells me. “Where people aren't sure how to help or how to support. We kind of go in there and see what we can do to support in those areas.”
“Gray areas” are usually related to mental health or substance abuse issues. They’re where the black and white solutions we as a society tend to turn toward — prison, a psychiatric care facility, or rehab — aren’t always effective. I ask for an example of a recent call.
“We went to somebody who was having some vague thoughts of suicidal ideation,” she says. “It was mostly related to their housing situation. They were having to be moved along and unable to stay in the place that they were.”
Losing their housing was a crisis, certainly, but not an emergency in the lights and sirens sense. Police, and firefighters wouldn’t have been appropriate. And though they could have called a suicide hot line, the help that hot line offers is limited to what they can do for you over the phone. It was a perfect call for MST.
“We started looking at how we could offer support and other things that we needed to look at,” says Wendy.
Eventually they made a referral to a local agency that helps people get housing and other types of assistance. A lot of visits by MST end like this — with a referral to a shelter, a drug treatment program, or a hospital.
Linda’s Call
When Linda Alfano — the woman we met at the beginning who seemed more like someone’s grandma than someone in crisis — called MST, she didn’t have to go through the usual litany of questions. She’d already met the team.
Two weeks earlier, she’d gotten into a fight with her partner, but she didn’t want to call the police. So Kris Rouse and Lauren Gamble — two clinicians here — went out to see her. After a quick conversation, Steve transfers Linda over to MST.
I leave the call center, and head to the MST office. When I walk in, Lauren is talking to Linda on the phone.
“I totally understand Linda, I do, I understand,” Lauren says. You can hear what sounds like crying on the other end of the line.
“So I will say that we cannot remove him from the house, but we can come and help you, but we cannot remove him from your house. That's not — MST can't do that, but we will come and help out,” Lauren tells Linda.
“Do we need law enforcement there right now?” Asks Matthew Taylor, another clinician at MST. “Is she safe right now?”
Lauren mouths a ‘Yeah’ to Matthew, Linda is safe. She wanted help, but not the kind you’d get from emergency responders. She wanted the Mobile Support Team.
“Okay, we will be up there, um, I'd say about 20 minutes or so, okay? Absolutely. Yes. We'll see you when we get there. Alright. Bye Linda.”
Lauren and Kris take off in one car and Matthew and I get into another.
“Is this like a domestic violence situation?” I ask him.
“We don't know what it is. All we know is that she's wanting help,” he responds. “We don't know what kind of help. We know she doesn't want law enforcement and we know per her report, there are no safety concerns.”
Linda’s House
By the time we get to Linda’s, her boyfriend — whose name is Stephen — is gone. For safety reasons we aren’t using his last name. It’s peaceful outside her place, and the inside is small, but comfortable. We crowd around a small, square, dining room table.
Linda’s short, and sassy, with blonde hair that’s twisted into a bun on the top of her head. She seems stable, but as we settle in I remember she’s in the middle of a crisis.
“So what happened today?” Asks Lauren.
“Well, it's not just today,” Linda responds.
“Oh, I know that. Yeah.”
“I mean, it started last night.”
“Mm-Hmm.”
“And when he gets mad, he grabs my arms.”
There are several bruises on her arms, and some of them look bloody.
“He's not, listen, he's not a bad guy.” She takes a deep breath, “It's just that I can't take it. I'm at my wits end now. I just can't take it anymore.”
Linda’s 71, Stephen’s 63, and they’ve been together, on and off, for more than 20 years. Linda says the violence in their relationship started when Stephen began using drugs.
“He grabs me and his nails dig into me here and then here,” she gestures to the marks on her arm. “And then it's causing it to bleed.”
Linda says this isn’t the first time Stephen has hurt her. But when she went to the police, the only solutions they offered her were to either press charges, or get a restraining order.
“And I didn't wanna get a restraining order because I felt that I couldn't abide by it,” she explains. “Because if he would've showed up at the door like he does, okay, I would've taken him in.”
For the most part, Lauren and Kris are familiar with the situation. Once we’re settled, they launch into their follow up questions.
“So Linda, I know, I remember last time we were here we had talked about boundaries right? And kind of setting those boundaries with him. And I know that you, the two of you had come to some good agreements, right?” prompts Lauren.
“Do you remember what they were?” Linda asks, almost sarcastic. Kris and Lauren laugh.
“I remember, I do. I do remember what they were. They were that…”
They start to review the strategies they’d come up with last time they were here.
“Did he follow through with any of those things?” asks Lauren.
“Uh, some of them.”
This is the gray area: a conflux of domestic abuse, mental health issues, and addiction, and an approach to solving those issues that doesn’t rely on incarceration or punitive punishment. It’s not a new approach to mental health care, but it feels novel, the five of us sitting at her table, trying to figure it out together.
“My concern though is that things have really escalated. This is not what it was like when I was here last time,” Lauren says. “And I worry because I know you care for him.”
MST spends more than an hour here. They listen to her go back and forth about what she wants. And again, we bump up against a gray area. Not even her feelings about him are black and white. She wants him back home, but she just can’t stand taking care of him anymore.
“But clinging to what, you know, you know, holding onto what used to happen with him, what he used to do—”
“He’s not the same person. He’s not the person that I fell in love with.”
“Exactly,” Lauren agrees. “I know he's not, and sadly drugs do that.”
Over the last few years, rates of addiction, homelessness, and mental health issues have spiked in the U.S. One in five Americans are living with a serious mental health issue. More than 17 percent of Americans have some kind of substance abuse disorder. And rates of homelessness continue to increase dramatically all across the U.S., especially in California.
Rates of intimate partner violence in the U.S. are even higher: Data from a national survey found that more than 40 percent of women and 26 percent of men experienced some kind of intimate partner violence in their lifetime.
But domestic violence victims don’t always want to involve law enforcement. There are lots of reasons for this: Fear of retaliation from the abusive partner, fear of breaking up their family, or fear of not being believed by the police.
These intersecting issues are what the Mobile Support Team is trying to address. But — as you’d expect — it’s not always easy to figure out what’s best.
“As long as you keep opening your door and allowing him to be here. He's going to be here,” Matthew tells her.
“He has no other place to go,” Linda cries. “I can't help it.”
“He does, he has other places to go where he has other people to help him.”
“Where?” She asks, almost angry.
“There are shelters, there are hospitals, there are post-hospitalization programs. There are our post-crisis programs.”
Linda doesn’t like these options, she says she’s taken him to shelters before, and he never stays long. But Matthew, Kris, and Lauren are here to help Linda, and so they ask her, again, and again, what she needs.
“So I want to know,” Matthew starts, “Because right now what you're telling us is how you think we could help him, right? What I'm interested in—”
“You asked me that question,” Linda interrupts.
“I asked, how can we help you?”
“By finding him housing.”
“By finding him housing,” Matthew repeats.
“It's the same thing, it's the same thing.”
It’s not as simple as just letting Linda talk, to help Linda, they have to help Stephen too. They figure out that he’s at a nearby hospital, and say they’ll go talk to him about getting help. But Linda doesn’t seem satisfied by this. She asks if she should go to the hospital to see him, but Kris and Lauren say no.
They gesture to the swimsuit under Linda’s blouse.
“You should swim,” says Lauren.
“Yeah,” says Kris. “Go swim and have a day. Relax, eat your sandwich and then get some sleep.”
But, even after all this, Linda is still worried about what’s gonna happen to Stephen.
If you, or someone you know is suffering from Domestic or Intimate Partner Violence, you can call the National Domestic Violence Hotline at 800-799-7233.
Also, if you have harmed or are thinking about harming an intimate partner or family member, there’s a hotline for you. It’s called A Call for Change. It’s anonymous and confidential, a trained operator will listen and help you come up with solutions and find resources. Their number is 877-898-3411.
Sonoma County’s Mobile Support Team can be reached at 1-800-746-8181
This series was produced as a project for the USC Annenberg Center for Health Journalism’s 2024 California Health Equity Fellowship. '
This story aired on the November 18, 2024 episode of Crosscurrents.
Click here to listen to episode two.
