This is the second part of a two-part series. If you haven’t already, we recommend listening to episode one before starting episode two. This story aired in the November 25, 2024 episode of Crosscurrents.
Last week, we got to tag along with the crisis unit of Sonoma County’s Mobile Support Team or MST. We saw what happens when someone calls, and how they support clients dealing with gray area issues, like homelessness, mental health, and substance abuse. One of their calls took us to a woman named Linda Alfano’s house. But Linda’s call about a fight with her boyfriend Stephen tested the limits of what a Mobile Support Team can do.
At the end of the last story, MST was headed to the hospital to talk to Stephen. In today’s story, we'll learn a little bit about the larger network of service providers that MST works with and what happens after the crisis.
A warning to listeners: the following story contains descriptions of intimate partner violence and substance abuse.
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It seems like a lot of work, driving to the hospital to visit Stephen, when he wasn’t even the one who called the crisis line. In the short car ride over, Kris Rouse and Lauren Gamble from the Mobile Support Team reflect on what just happened.
“So we are leaving the lovely-Linda's house,” Lauren updates her supervisor on the phone. “But we are heading over to the hospital to do some collateral slash resource helping things.”
They tell me this isn’t something they normally do, but again, there isn’t a one-size-fits-all approach to their work. They’re willing to visit Stephen if it means getting Linda’s call for help into the right set of hands.
“You know, this may have to happen a couple times before, she's like, ‘I am done’,” Kris says.
But they don’t expect to solve their clients' problems in one visit. Their job is to deal with an immediate crisis, and then pass their clients on to the next service provider. The people who call, like Linda, have to be willing to accept their help. But then the rest of the network — a network that includes rehabs, shelters, and hospitals — also has to play their role.
“We were able to at least provide her the room to talk it out,” Kris says. “And she clearly needed that.”
A Visit To The Hospital
Stephen’s half asleep when we walk into his room. There’s an IV dripping fluids into his arm and Kris and Lauren approach him gently.
They ask how he’s doing, and a few biographical questions. They have to explain more than once that they’re with the Mobile Support Team and that Linda called them for help.
They ask what his plan is once he gets out of the hospital. But he says he doesn’t have one. He wants to go back to Linda’s. They ask if he has somewhere, anywhere else to go, but he doesn’t.
There’s a team in Sonoma who might be able to get him temporary housing. But it’s Friday, and the other team doesn’t work on weekends, so he has three nights before he can get help. When we leave the hospital, Kris and Lauren seem certain he’s going back to Linda’s tonight.
The Limits of Mobile Support Teams
“It takes a long time,” Kris admits. “But there are avenues where, you know, he can start getting on a list of getting some real housing. The frustrating part is we know that it's not gonna be instant.”
But Stephen doesn’t just need housing, he needs medical care, mental health care, and — maybe most importantly — substance abuse treatment.
While we drive away, it strikes me that a call for help from Linda has turned into help for Stephen, and I wonder if there’s anything else they should do for her. I bring up the bruising on her arms. They’re concerned, yes, but because she doesn’t want to press charges, MST’s job is to file a report with Adult Protective Services — or APS — and move on.
“You know, we would love to be like, oh, you guys need to separate,” Kris tells me. “Here, we have this little apartment for you and a caregiver and food and all that stuff. That's not what we do, nor can we do that. But we can at least help get it started.”
After they make their referrals, MST’s work is done. Now, it’s up to the rest of the social services network to help Linda and Stephen.
The Network
In mid-August Linda dropped Stephen off at a shelter in Santa Rosa called Redwood Gospel Mission. They offer long term stays, and classes in addiction recovery. Linda felt hopeful that he was gonna get the help he needed. But Stephen didn’t stay long.
For a while Linda didn’t know where he’d gone. She was worried, but she didn’t know who to turn to. But APS hadn’t forgotten about her case.
Around the same time that Stephen disappeared, an APS social worker called a “multidisciplinary meeting.”
“It was APS, it was social workers,” Lauren explains. “It was people from hospitals. It was nurses, it was a social worker from there, it was us—MST was there, inResponse was there.”
Lauren says there were about 20 people talking about Linda and Stephen. But it’s not because their situation is unique. Rather, it’s because it’s illustrative of a larger trend in Sonoma County.
“There's a lot of older adults who are kind of using these services in this way at this point,” says Lauren.
According to data from MST, more than a quarter of their clients are 55 or older.
“And so — not everybody — but the majority of people at this meeting had encountered her, specifically. Had encountered Linda.”
Lauren tells me that meetings like this happen maybe once a month. It’s a way for everybody to make sure that they’re on the same page when it comes to certain cases or demographics they serve. That their work supports rather than undermines each other.
“I think the biggest thing that came out of it is that that social worker had information from every piece. Right?” explains Lauren. “It wasn't just like my little bit for an APS report. It wasn't like a little tiny report from the hospital. It was everybody there talking about it and kind of all getting on the same page.”
Stuck in the Cycle
Weeks pass, and then one day, Linda gets a call from another social worker. Stephen was in the hospital, getting treated for COVID and pneumonia.
He’d had a rough couple of weeks cycling in and out of shelters and hospitals. They were ready to discharge him so they called Linda and asked if she would take him in. But she said no.
I was surprised to hear that the hospital had called her. It was the opposite of the boundary-setting advice MST had given. Wasn’t everybody supposed to be on the same page about what these two needed? But Kris wasn’t surprised.
“Well, no. It's just the ER is desperate,” she says. “If he was ready to be released, then he needs somewhere to go and — that's a tough one, right? If you have nowhere to go, now what?”
After being shuffled from shelter to hospital to shelter to hospital — a cycle that often repeats with unhoused patients — Stephen was transferred to a post-acute care center in San Rafael. When I told Kris and Lauren what had happened, they seemed relieved. Here’s Lauren.
“There's so many different ways this could have gone, but the fact that she is taking those steps to put up her boundaries, and he is in a place where he's getting the help that he actually needs, you know? I mean, that's…” Lauren laughs softly. “We have to work within the limits of our system. And as far as that is concerned, this is a pretty big win.”
It’s important for a city to have a Mobile Support Team. But if there isn’t a robust health and social services system surrounding that unit — accessible healthcare, adequate public transit, and housing for everyone who wants it — then sending out crisis response teams can be a bit like using a bandaid on someone who needs stitches.
I ask Lauren and Kris what they would do to make the system better.
“If I had all the money in the world,” Lauren starts, “I would set up so much housing for people, like actual housing. And create programs to case manage as many people as we actually needed. Instead of having, you know, five case managers with a hundred cases, it'd be, you know, a hundred case managers with five cases. So they could really do what they needed to do.”
But that’s not the case, and it can often feel like governments are playing whack-a-mole with housing, health, and social issues.
“Do you feel like this is something that will be solved in your guys' lifetime?” I ask.
“No,” Lauren responds instantly.
“Nope,” says Kris, just as quickly. “I sadly do not. And I don't think we're jaded. I think that, yeah, that would be great. But again in our moments when we go out and help people, that feels good. But we don't walk away going, ‘Okay, problem solved.’ You know, we are helping in the moment and we can try and do more, but… we're helping in the moment.”
Kris and Lauren tell me they don’t get a lot of ‘happy endings’ in this work. And I’m not going to tell you that Linda and Stephen are an exception to that rule. But that’s not because MST did anything wrong, it’s because the system they’re working in is overburdened with need. And it’s gonna take a lot more than Mobile Crisis Units to address that.
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 anonymous and confidential, a trained operator will listen and help you come up with solutions and find resources. Their number is 877-898-3411.
This series was produced as a project for the USC Annenberg Center for Health Journalism’s 2024 California Health Equity Fellowship.
