A Cleveland EMS union leader wants Cuyahoga County’s new plan for non-police crisis response to include paramedics. 

At a recent community meeting, Timothy Sommerfelt, secretary of the Cleveland Association of Rescue Employees (CARE), the union for emergency medical technicians (EMTs) and paramedics, said the proposed plan won’t be as efficient as it could be. He said mental healthcare facilities won’t accept someone without medical clearance from a paramedic or other qualified medical professional. As a result, he said, people in crisis will continue to be taken to a hospital instead of being connected to the psychiatric care they need. 

“If you walk up to the crisis stabilization unit right now and say, ‘I’m feeling suicidal, I’d like to check myself in,’ they will not accept you,” he said. “They will call 911 and they will call an ambulance and tell you you have to go to the emergency room before you can go in.” 

But officials from FrontLine, which handles mental health crisis calls, said they don’t often hear from people with medical emergencies. So there is no need for a paramedic, they said.

Rick Oliver, director of crisis and trauma services with FrontLine, said the organization’s current mobile crisis teams don’t refer calls back to 911 or EMS often. There’s a thorough screening process to make sure FrontLine is only responding to calls where a person’s mental health crisis has not escalated to a level where they may harm themselves or others, Oliver said. 

But existing mobile crisis team members are taking suicide hotline calls (988 or 216-623-6888) and can take hours to respond in person, Oliver said. 

‘This approach works within the existing system’

The Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County plans to launch a non-police mental health crisis response – or care response – pilot program later this year. The program will include teams made up of a licensed behavioral health professional and a peer support specialist, who is someone with lived experience with mental health or substance use disorder who has been through training and certification.  These will not include an EMT or paramedic.

FrontLine will provide and manage the initial five teams that will serve two ZIP codes — 44105 and 44102 – which cover the Union Miles and Mt. Pleasant areas and the West Side neighborhoods between Clark-Fulton and Edgewater, respectively.

The goal of care response is to get people the help they need more immediately and add mental health crisis response to the list of emergency responders like EMS, fire and police.

Clare Rosser, chief strategy and performance officer with the ADAMHS Board, said the care response program they’re putting together emphasizes peer support. Rosser emphasized that the existing FrontLine teams don’t come across a lot of medical emergencies. 

“This approach works within the existing system,” she said. “And we hope it will provide an important new option within our current system.”

Rosser didn’t rule out changes to the program after the initial pilot project. 

“We’re going to learn about what works and if there are modifications as it proceeds,” she said.  

Angela Cecys, senior strategist for public safety and health with the Cleveland Department of Public Health, said the city’s role is to support the alternative response program the ADAMHS Board is introducing. But that doesn’t mean the city’s EMS Department is entirely being left out, she said. 

“There will be coordination with EMS,” Cecys said. “That’s not off the table. We are going to make sure that our new care response teams are trained to understand when and if to call EMS to a scene. And then we also want EMS to be aware of how these teams are going to function.” 

For Cecys, it’s not an either-or situation where the city and county have to choose between including peer support specialists or paramedics. As the city and the ADAMHS Board look at the data from the pilot program, they will make adjustments based on Cleveland residents’ needs, she said. 

‘A person with an isolated mental health issue … is a unicorn’

In Sommerfelt’s experience, mental health and physical health have for too long been treated in silos. In reality, someone experiencing mental health issues often also experiences substance abuse or physical health issues. 

“A person with an isolated mental health issue who has no concurrent substance abuse and no concurrent medical issues is a unicorn,” Sommmerfelt said. 

He points to other non-police response teams that have included paramedics, such as those in Cincinnati, Denver, New York, and Oregon’s CAHOOTS, one of the oldest such programs. 

But some cities are offering crisis response teams that don’t include paramedics and are still serving communities seemingly well.   

Sommerfelt and his colleagues have seen the same 25 people call 911 more than 2,000 times in a year. What they don’t want to see with care response is yet another group that takes people to hospitals instead of getting them the mental healthcare they need, he said. 

“Our members want better options for helping the people that we serve,” Sommerfelt said. “Because we see everybody’s trying, everybody’s doing the best that they can. There’s definitely a need for better options to actually solve some of our patient’s problems.”