'Closer to the abyss than we think': NYC paramedic blasts lack of mental healthcare

Anthony Almojera, author of the 2022 book “Riding the Lightning: A Year in the Life of a New York City Paramedic,” has been with the New York Fire Department’s Bureau of Emergency Medical Services for almost 20 years. Helping homeless New Yorkers who are suffering from mental illness is one of the challenges of his job. And in an op-ed/guest essay published by the New York Times on December 7, Almojera stresses that the city is presently facing a “mental health crisis” unlike anything he has witnessed before.

“There are New Yorkers who rant on street corners and slump on sidewalks beside overloaded pushcarts,” Almojera explains. “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…. In nearly 20 years as a medical responder, I’ve never witnessed a mental health crisis like the one New York is currently experiencing.”

Almojera continues, “During the last week of November, 911 dispatchers received on average 425 calls a day for ‘emotionally disturbed persons,’ or EDPs. Even in the decade before the pandemic, those calls had almost doubled. EDPs 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.

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At a late November press conference, New York City Mayor Eric Adams — a centrist Democrat and former police officer — announced plans to force mentally ill people living on the streets into treatment in hospitals if they don’t voluntarily ask for it. And Adams noted that Emergency Medical Services will provide training to police, firefighters and others as part of the program. Amojera believes this approach has some major flaws.

“Now, Mayor Eric Adams wants medical responders and police officers to force more mentally ill people in distress into care,” Almojera writes. “I get it — they desperately need professional help, and somewhere safe to sleep and to get a meal. Forceful action makes for splashy headlines…. 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 EMS workers in the New York City Fire Department have steadily increased year over year.”

The veteran paramedic adds, “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 September 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.”

Almojera argues that Adams’ approach is “shifting more responsibility for a systemic crisis” to “an overworked medical corps” that is “burned out from years of low pay and the strain of the pandemic.”

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“Our ambulances are simply the entrance to a broken pipeline,” Almojera laments. “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…. 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.”

In an article published by the New York Post on December 1, journalist Nolan Hicks reported that New York City’s “embattled” Department of Homeless Services (DHS) was struggling “to connect needy New Yorkers living in city shelters with desperately needed mental health services.” Those problems, Hicks reported, are outlined in a “blistering 41-page audit” from New York State Comptroller Tom DiNapoli.

According to the report, “Based on DHS records, there is limited assurance that clients were being placed in and/or transferred to a shelter that could best provide the services necessary to help the individual move forward to permanent housing, independent living, or further treatment in a more appropriate setting if necessary.”

Hicks adds that DiNapoli’s report “also determined that DHS frequently gives scarce rooms in treatment shelters to New Yorkers without mental health issues — while failing to transfer drug abusers and the mentally ill to specialized facilities when beds open up.”

Almojera notes that he was homeless himself for “two years” when he was in his early twenties and slept in his car, which he considered preferable to homeless shelters. And the paramedic stresses that a major investment in mental health care in New York and other cities is going to be needed to adequately deal with the crisis.

“Rather than looking for a superficial fix,” Almojera advises, “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.”

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