A reporter learns the limits of what mobile crisis response teams can achieve

For my recent reporting project, I wanted to embed with a mobile support team in Sonoma County in order to better understand the challenges and successes these units face in responding to mental health and other crises.

This wasn’t my first foray into mobile support teams. In 2023, I reported and produced a series on an Oakland program that served as an alternative to police response, called MACRO. One of my main takeaways from the series was that despite its origins in the summer of 2020 and national calls for defunding the police, MACRO was essentially a homeless outreach program. They were not replacing the police. In fact, they coordinated with law enforcement when necessary, and had no impact on Oakland’s police budget, which has steadily increased since 2021. 

With support from the 2024 California Health Equity Fellowship, I thought a story about Sonoma County’s alternative response program would be similarly straightforward. Instead, I ran into obstacle after obstacle. 

Navigating concerns around patient privacy proved a huge hurdle. Sonoma County’s Mobile Support Team, funded in part through Medi-cal reimbursements, often assists people who are dealing with very intense and personal moments of crisis. This meant that, for months, I had to negotiate with the program’s communication lead and managers about how I would be allowed to tag along on their calls. Again and again, they brought up HIPAA, a landmark federal law designed to protect the privacy of health information.

Kris Rouse, a clinician I shadowed, put it like this: “It's weird because we're so ingrained and trained like: Confidentiality, confidentiality, confidentiality. And then one day someone says, ‘Hey, there's gonna be a reporter.’ You know, we're like, ‘How? How, how, how, how?’ Every bit of education that we've ever received is ‘You will not repeat these stories.’ And now we have a reporter in the back of our car.” 

Team members were terrified of violating their clients’ right to privacy, and potentially losing their jobs. They had no idea how they were supposed to do their work with a journalist around, especially one who was carrying a microphone. I understood their dilemma, but I was frustrated. How are we supposed to keep health care and mental health professionals accountable — especially ones who are receiving government funds — if journalists can’t observe their work? 

Eventually, after many meetings and promises about maintaining clients confidentiality, MST agreed that I could come observe their teams. But once I was there, the process was murky. 

On my first day with the response team, there were no calls for hours, and then there were four all at once. None of them required sending a team out. They were all either transferred or resolved over the phone, and I spent several anxious hours in the call center, praying the perfect call would come along.

It was a tricky task for the team: asking somebody in the middle of a crisis if it would be okay for a reporter to join them, record what happened, and maybe even ask the person in crisis a few questions. I worried I wasn’t going to meet a client of theirs, and that my story would be incomplete.

Eventually the team got a call they needed to respond to, but it was for something we all agreed wouldn’t be appropriate to record. I was invited to hang out in the car while they went into their client’s house, but I wasn’t allowed to meet the client. I was allowed to ask them how the team members were feeling before the meeting, how they prepared for these types of calls, and I was allowed to ask for certain details afterwards. But I didn’t get to see what mobile mental health support actually looks like up close. 

Day two started much like day one had. I spent a few hours in the office, talking to clinicians about their work. Then I headed over to the call center, to see what kind of calls were coming in, and how the dispatchers handled them. 

Then, Linda Alfano called. She was perfect in so many ways. She’d met the team before, so she trusted them, and barely hesitated when they asked if a journalist could tag along on their call. Even more importantly, she was unashamed of what she was going through. She told me later she was glad she could share her story, because she hoped it would help others. 

Linda’s case was complicated. It revolved around issues she was having with her partner. There were elements of domestic violence and substance abuse, and I found it hard to not get sucked into her world and instinctively side with her, which can be a mistake when you’re reporting. 

I’ve worked with a lot of vulnerable populations as a journalist. Unhoused people, formerly unhoused people, addicts who are actively using, and addicts who are in recovery, undocumented immigrants, and people dealing with severe mental health challenges. I always do my best to maintain a professional relationship with these individuals. But I also know that building trust with these individuals is critical to telling their stories. Sometimes that means revealing personal things about myself, and sometimes it means picking up the phone when they call at midnight. I spent a lot of time talking to Linda while I was reporting this story, checking in on her regularly to see how things were going, and listening to her cry when she needed to cry. 

At points it became overwhelming, and I had to figure out how to maintain boundaries as a journalist while still showing her she could trust me. It’s a balancing act I often perform when reporting, one that can always be honed. I did my best to keep our conversations limited to my working hours and to not get over involved in other parts of her life. But I wasn’t always good at this. At one point her home phone stopped working, and I found myself in her kitchen, reading an old AT&T home phone manual, fiddling with cables and buttons. I did not fix the phone, but I did help her find the phone number for a technician who could. 

This topic has felt particularly urgent to me since the summer of 2020. I was living in Oakland when protests about police violence erupted across the entire country, and widespread calls for alternatives to policing and its byproducts became part of a national dialogue. When I began looking into non-police response programs, I admit that I was naively optimistic about what they might be able to accomplish. I imagined a world without police and prisons, with less racial and socioeconomic inequity, with less suffering. 

But as I’ve spent more time with the mobile support team and programs like it, my optimism has faded. I believe non-police response programs are necessary to the health of a society, but I’ve been disappointed by their material impact. Police budgets continue to grow and police killings are still happening.

Some people think abolition is impractical. Some scoff at the idea of a world without police. But as non-police response programs pop up all over the country, I can’t help but hope that they’re indicative of a better future.