By Zoë Buchli
Missoulian
MISSOULA, Mont. — On a sunny Thursday in Missoula, emergency medical technician Nick Stahler passed a football back and forth with a young woman outside of the Johnson Street Shelter.
The client, just 20 years old, was thinking of hurting herself. In plain clothes, carrying just a radio and some basic supplies, Stahler and Colin Roberts, a licensed clinical social worker, responded to the shelter and spent several minutes with the woman throwing the football back and forth, assessing her needs and going over the tailored safety plan the woman already had in place.
Stahler and Roberts are two of 16 people that make up the Mobile Support Team, Missoula’s crisis response unit dedicated to mental health and substance abuse issue calls. The team is part of the Missoula Fire Department but functions as a behavioral response service. It replaces a traditional police response that’s available through calling 911, said John Petroff, MST operations manager.
“We’re trying hard to offer something different,” Petroff said.
When Roberts and Stahler arrived at the Johnston Street Shelter, there were no police present. If MST hadn’t been dispatched, law enforcement likely would have responded to the call.
“We’re capable of responding to our own calls,” Quinn Mawhinney, another MST licensed clinical social worker, said. “We don’t always have to respond with fire and police.”
But the team’s future is uncertain.
Since its formation in 2020, MST has been supported through grant funding and the federal American Rescue Plan Act, also known as ARPA. But those ARPA dollars, which have also been parceled out to the Temporary Safe Outdoor Space and other services in Missoula, are drying up. In August, city officials introduced a mill levy that would have given $1.2 million to MST’s annual operating costs. It was booted from this fall’s ballot over widespread tax bill concerns.
Last November, Missoula voters shot down the crisis services levy which would have in part funded the MST. The levy passed in city limits, but failed among county residents.
How the team worksThe team starts its shift at 10 a.m. and wraps up at 8 p.m. The work they do in that time frame varies widely day to day. MST, which is part of the Missoula Fire Department, responds to a range of calls. Many are for people unable to meet their basic needs because they’re experiencing houselessness, a mental health crisis or illness. Often it’s a combination of all three.
At their headquarters located in central Missoula, MST members keep a close eye on tablets that log the same information for active calls that other first responders (like fire and police) use to track incidents around Missoula. MST teams were sent to an average of 225 calls a month in 2022.
Later that Thursday afternoon, Mawhinney and Stahler climbed into their van and headed to the Poverello Center for a client possibly in need of medical care. Mawhinney spotted the person in question at the shelter’s garden space, surrounded by pigeons. She picked up some bird food and started slowly approaching the client, getting a sense of what kind of assistance the woman might be comfortable with.
“If we can give (clients) back some sort of control in that moment, that’s half the game,” Mawhinney said.
Missoula’s team pairs EMTs with clinicians so MST can dispatch duos with the capacity to field a crisis and also offer medical care. Stahler said he can provide basic first aid, and bandage and wrap people for minor injuries. But the EMTs are also trained to recognize signs of whether someone is in need of serious medical care. The vans have space in the back for hospital transports.
They also offer grief counseling in the wake of car crashes, homicides and other traumatic events.
Petroff said a question the team is constantly reevaluating is, “How can we do this better for our clients?”
It’s clear the group on Thursday’s shift know, and genuinely care, about their clients. As they bounced between calls, Roberts, Stahler, Mawhinney and EMT Erika Gotcher recalled recent client interactions off the top of their heads. It’s common for Missoulians to have multiple encounters with the MST, which the team said gives them a sense of rapport when responding to people they’re familiar with.
“We know that guy, don’t we?” Gotcher asked her co-workers at their office when a call came in. They recognize a one-and-done approach often doesn’t work. The team delegated work between fielding incoming calls and clearing them, getting hold of people needing MST support and following up with clients from previous days’ interactions.
For example, finding safe spaces for people to detox is a challenge after someone’s initial contact with MST. There’s limited bed availability around Missoula for substance detoxing, Petroff said, which sometimes creates a cycle of people relapsing while they wait for treatment.
“If we put up those barriers to make people wait, it’s really difficult,” he said.
This is why the team works to give people follow-up support, something Roberts described as “the installation of hope.”
Lilian Kennedy is the team’s case facilitator. After clinicians and EMTs go on a crisis call, Petroff explained, Kennedy works on long-term care strategies for whatever resources a person might need.
“That follow-up is really important for us,” Petroff said. “To follow through with that person is breaking that cycle of trauma they’ve experienced and helping navigate difficult systems.”
Sometimes, that looks like just reminding people about a medical appointment or getting people to the Missoula library to use a free phone or computer.
“It’s all the stuff we take for granted,” Petroff said.
DiversionThe team’s success is well documented in Missoula. People who work in Missoula’s criminal justice and first-responder fields call it a valuable piece of the city’s emergency response puzzle.
“We know this program is a benefit for this community,” Petroff said. He added that without fire, police and emergency medical services, MST couldn’t function.
Call data collected by MST staff showed they diverted 783 emergency department visits in 2022.
The team also recorded 123 people for the same year who avoided going to jail because the MST found another way of resolving their crisis. Missoula’s jail is teetering just over its capacity right now. In the first half of October 2023, the county jail averaged about 228 adults in custody and 224 available beds, according to data provided by the Missoula County Sheriff’s Office. A single night at the Missoula County jail costs $118, so those diversions alone saved taxpayers about $14,514 in 2022, according to MST data.
“It’s been a great relief to have them on board,” Missoula Police spokesperson Whitney Bennett said, adding the support team alleviates MPD’s call volumes as they pertain to mental health.
“If someone is just having a mental health crisis, MST is going to be that solution,” Bennett said. “MPD was going to every call before (MST’s implementation) no matter what.”
Mawhinney said in Missoula, it made sense for MST and law enforcement to be separate entities.
The team also found shelter for about 55 people experiencing homelessness in 2022.
Poverello Center shelter services director Clair Bopp and her staff work with MST frequently. Prior to the team’s implementation, Bopp said shelter staff had two options to aid people in crisis if shelter resources were exhausted: connecting clients with a crisis line, or calling police to see if an officer could advocate for a mental health evaluation.
“With MST, it’s like a third option,” Bopp said, adding it’s often the more appropriate route.
“If the Pov or (the Johnston Street Shelter) isn’t appropriate in that moment for somebody, the MST has ideas and relationships with other agencies that might be more appropriate,” Bopp said.
Future of MSTFor this recent Thursday’s calls, both clients stayed at the shelters. Mawhinney, Stahler and Roberts were able to build on those relationships just with simple check-ins.
The group agreed they wish MST could run 24/7 but said the capacity isn’t there right now. Their call numbers have steadily increased since the unit got started in 2020.
“It’s really important that we look at funding that’s sustainable,” Petroff said.
This fall, the Missoula City Council proposed, but then scrapped, a ballot measure that would have levied up to $7 million a year for a permanent line mostly for the fire department, including about $1.2 million for the MST.
He said the team is looking at other funding avenues that wouldn’t raise taxes for Missoulians. Outgoing Mayor Jordan Hess strongly encouraged the city council to keep fire department and MST resources a high priority after the council voted to take the levy off this fall’s ballot.
“Our program in Missoula is at the table with legislators and the Department of Public Health and Human Services and talking about how we do this and not burden any more systems,” Petroff said.
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