When the Santa Monica Fire Department was founded in 1889 it was not created with the homelessness crisis in mind. Nor the ongoing explosion of methamphetamine use, nor the breakdown of the mental health care system or the skyrocketing rates of elder abuse and neglect.
Yet today, 133 years later, firefighters often find themselves as the primary responders to unhoused, substance dependent, mentally ill and elderly individuals who are experiencing a moment of crisis. Unfortunately, there is little they can do beyond transporting the individual to the emergency room, which typically does not resolve the underlying issue leading to the call.
In 2019, SMFD conducted a study on the costs of repeat callers with findings alarming enough to shock a firefighter.
In just 22 months one 35-year-old homeless man racked up $272,665 in costs from fire department responses, ambulance transports and emergency room visits for 62 calls to 911. Another 50-year-old homeless man generated $182,947 for 24 calls over the same time period, and a 54-year-old homeless woman cost $112,429 through 17 calls.
Unhoused individuals are not the only high utilizers of the 911 system. There are also many housed elderly residents who consistently call for health issues or assistance standing up after a fall.
While the Fire Department will always respond to individuals in need of assistance, traditional interventions are often unable to solve the problem that triggered the call.
Enter the Community Response Unit, or as it is more commonly referred to, the CRU. This specialized unit is a pilot program of the Santa Monica Fire Department designed to break cycles of 911 calls by creating a new response model for vulnerable populations.
The CRU is different from a traditional fire engine in several ways.
Firstly, its priority is not to address the crisis as quickly as possible and rush back into service for the next call, but rather to remain on scene as long as necessary to understand the subject’s underlying problems and identify the most appropriate resources to address them. By intervening in low acuity calls with elderly or homeless individuals, the CRU can free up other engines to respond to emergency incidents.
Secondly, CRU staff members are able to connect people to services other than the emergency room. Having received training from the Department of Mental Health, they are the only SMFD personnel authorized to bring subjects to mental health urgent care. CRU staff also keep bus and metro cards on their engine and direct individuals to other appropriate facilities for services such as the Venice Family Clinic, The People Concern, or WISE & Healthy Aging.
The last key difference is that members of the CRU keep tabs on their subjects long after their calls end. They check in with psychiatric care facilities, collaborate with the Police Department’s Homeless Liaison Program (HLP), follow up with service providers to see if people were able to get housed and even file adult protective service reports in instances of elder abuse or neglect. Outcomes from these collaborations are tracked and analyzed to evaluate the effectiveness of the CRU and better inform their efforts to break cycles of 911 calls.
The CRU was inspired by other alternative emergency response programs like the Homelessness Education and Response Team in Long Beach that connects homeless 911 callers to resources and the Los Angeles Fire Department’s Advanced Provider Response Unit, which has special clearance to treat and resolve medical issues on scene or to transport individuals directly to mental health urgent care, in both scenarios avoiding costly emergency room visits.
While the CRU shares similarities with these programs, it is a unique model.
“Our program is specifically designed for the needs of Santa Monica, it’s kind of like a Swiss army knife. We took a look at all of the issues and problems that we were trying to solve from a 911 fire based EMS perspective and developed the program around that,” said Fire Captain Patrick Nulty, who helped design the program with an emphasis on assisting unhoused and elderly individuals.
In the six months that the pilot unit has been in service it has recorded 263 responses, made contact with 166 people experiencing homelessness, provided 123 referrals to services and transported nine individuals to Exodus Recovery, which is a psychiatric health facility.
Impressively, all of this has been accomplished by just one firefighter paramedic, Aurora Paaluhi, and one firefighter EMT, Karis Schneider, who together staff the unit for 40 hours a week and are now training a new pair of firefighters to take over the unit.
Even more telling than the numbers are the stories that Paaluhi and Schneider have from their time on the CRU.
For example, they recently responded to a call for a chronically homeless female on the Santa Monica Pier, who was naked, in a state of mental health crisis, on drugs and chasing passersby with a stick.
The first engine company that arrived on scene was unable to approach her as she kept running away. Schneider was able to handle things differently.
She followed the woman from around 20 feet back and kept asking non-threatening questions, offering to provide help, telling the woman she was worried about her and saying she was not there to hurt her. Eventually these de-escalation techniques allowed Schneider to build trust with the woman who calmed down and agreed to be transported to Exodus psychiatric urgent care, where she was referred to long-term inpatient care.
“Part of the program is having one person approach someone, which is different than like four people in a badge and uniform,” said Schneider. “She got long term psychiatric help and hasn’t called 911 since… it (the call) was pretty sad; she was trying to fight me away with a stick, because she had been raped so many times.”
The CRU also worked with The People Concern’s C3 outreach teams and SMPD’s HLP teams to get a 31-year-old mentally ill man with a maggot-infested wound to Harbor-UCLA Medical Center on a 72 psychiatric hour hold. After healing in the hospital, the individual was able to get housed and off the streets.
In another success story, the CRU responded to a 32-year-old homeless man who had called 911 for body pain, was transported to the emergency room and then called five more times in a 48 hour period after being discharged. Recognizing that medical urgent care was not addressing his primary problem, the CRU brought him to Exodus psychiatric urgent care and he has not called 911 in Santa Monica since.
The CRU’s approach is also making inroads in the population of elderly repeat residential callers. The team recently experienced a breakthrough with an elderly disabled woman who called 911 43 times in 16 months, largely for assistance standing up.
The individual had a caretaker and family members who helped look after her, so the cause of the repeat calls was puzzling. Eventually the CRU deduced that the individual was unwilling to make changes to her apartment to assist her mobility such as replacing her bed with a hospital bed and her recliner with a chair she could move herself in and out of. After talking to WISE & Healthy Aging, Human Services as well as the other firefighters responding to her calls, Schneider and Paaluhi decided to file an adult protective services report.
This report lit a fire underneath her family who realized they needed to take more serious steps to intervene and assist this individual, even if she was resistant to the changes. The CRU also connected her to multiple senior services groups, which has further helped reduce her reliance on the 911 system.
“That was one of our cases where we were able to really get to the bottom of it and it took three months of continuously following up and going on her calls multiple times ourselves let alone all of the engine companies that were communicating back and forth with us about what information they got and then finally speaking directly to the son,” said Paaluhi.
While many of the CRU firefighters’ success stories are slow burns like this, the unit is an equally powerful tool in emergency situations.
On March 21, the CRU was part of a team of emergency responders that rescued a man who was threatening to jump from the California Incline pedestrian bridge by the PCH.
“A true success of that outcome was the extremely close partnership between SMPD’s HLP team, Crisis Negotiation Team and the CRU. They were able to formulate a plan that allowed for a seamless transition to patient care, medical assessment and ultimately a CRU transport to the psychiatric urgent care center,” said Nulty.
The CRU is something that Nulty and his fellow firefighters have been pressing the City to fund for years. Council initially declined to fund the pilot program in 2019, but as the homelessness crisis and its associated costs have only continued to rise, in July 2021 Council agreed to give SMFD $500,000 to launch a bare bones unit.
This is significantly pared down from the SMFD’s 2019 proposal for a $1.8 million program with six dedicated staff members and a data analyst intern. Nulty and his team are hoping that their data backed success stories, the City’s financial recovery and the ever growing problem of homelessness will convince City Council to expand the CRU during the next fiscal year.
