Mobile Crisis Team Research Articles

“They made me feel like I mattered”: a qualitative study of how mobile crisis teams can support people experiencing homelessness

BackgroundMobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.MethodsWe conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent’s self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.ResultsNearly all respondents preferred the MCT model over traditional first responders, highlighting the team’s person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.ConclusionsIn this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT’s effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey.

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.

State Policies Associated with Availability of Mobile Crisis Teams.

Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.

HHS approves New Mexico's community‐based care expansion

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, has approved a proposal from New Mexico for community‐based mobile crisis intervention teams to provide Medicaid crisis services, a cms.gov news release stated. The Feb. 6 announcement is the latest in HHS' ongoing efforts to support President Biden's whole‐of‐government strategy to transform mental health services for all Americans — a key part of the President's Unity Agenda, the news release stated. New Mexico is the 15th state to expand access to community‐based mental health and substance use crisis care through President Biden's American Rescue Plan. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. This work builds on HHS' broader work to expand dramatically the full continuum of mental health crisis services, including through the nationwide launch of the 988 Suicide & Crisis Lifeline and expansion of Certified Community Behavioral Health Clinics under the Bipartisan Safer Communities Act, providing crisis services 24 hours a day, 7 days a week, regardless of a person's ability to pay.

Alcoholmisuse/dependence carepathway in and outside the general hospital. Detecting, motivating and treating the whole person.

Problematic alcoholuse is a common problem, frequently missed , as somatic medicine and mental health services are seperated/siloed. Patients admitted to a general hospital have an increased probability of a comorbid alcoholproblem (and other mental health problems like depression and anxiety) which is not adressed due to the separation of mind and body, which leads to greater costs for society , poor patient experience and discomfort with the somatic team.
 Comorbidity within the general hospital is largest for the patient with gastrointestinal (GI) problems, which is why we opted to roll out our approach here, gradually expanding to other patient groups in a later stage.
 To tackle this problem, the mental health department of the hospital contacted the GI-team (i.e. nurses, doctors, social services), the psychological services, management, general practitioners and service users (AA).
 After consultation of the existing literature, we chose a collaborative care approach mixed with population based screening and a proactive approach. In the past, a care pathway for alcohol was developed with first line actors (general practitioners, social services, psychologists, AA and mental health services), which was used to determine the level of care in the hospital and after discharge. The team comprises a fulltime psychiatric nurse and 0.3 full time employee (FTE) psychiatrist (trainee) embedded in the somatic GI team.
 Patients are screened for alcohol and psychiatric issues within 48 hours. If necessary, the appropriate detoxification scheme is started and followed up by the somatic team, aided by the mental health team. The patient is assessed and encouraged to stop drinking, depending on the stage they are in. Motivational interviewing techniques are used, along with psycho-education and other (pharmacological) interventions. A care plan is developed together with the patient and is then communicated with the primary care provider. 
 After discharge, psychiatric follow-up is scheduled with the primary care provider, mobile crisis team or psychiatric nurse when pt comes for follow-up visits to the ambulatory GI service if needed.
 Teammembers are trained in mental health issues so they become able to recognice and handle mental health issues, making them much more comfortable with comorbid psychiatric problems and optimizing workflows.
 
 We have since expanded to the AE department and planned surgery. 
 Since the program started there were fewer cases of delirium tremens. Due to a merger with an other hospital while the pathway started we have no exact data. Over a period of 1 year 235 patients were included in the project and 143 were followed-up after testing positive on intake for planned surgery.
 We want to further expand to the entire hospital and develop a digital care support plan which follows the patient after discharge, with all the information about the patient for future care-givers, with their care plan , controlled by the patient.
 Due to COVID, involvement of partners outside the hospital was delayed. This is now top of the agenda.
 As a proof of concept this integrated pathway was well received and initiated a new pathway , integrating mental health into perinatal care.

Mobile Crisis Services: A Clinician Survey of Current Suicide Prevention Practices and Barriers to Care Delivery.

Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.

Het aantal en de aard van de aanmeldingen bij de psychiatrische crisiszorg tijdens de COVID-19-pandemie: een retrospectieve observationele studie

The number and nature of admissions to psychiatric crisis care during the COVID-19 pandemic: a retrospective observational study. Aim: The aim of this study is to describe and evaluate the admissions to the University Psychiatric Emergency Unit of University Hospital Ghent (UPSIE) and the Mobile Crisis Team (MCT) of the Gent-Eeklo-Vlaamse Ardennen region during the COVID-19-pandemic. Method: A retrospective observational study was conducted, analyzing data from UPSIE and MCT from 2018 to 2021. We compared the clinical and socio-demographic characteristics of admission in 2020 and 2021 with those in 2018 and 2019. Results: During the COVID-19 pandemic, we observed a decrease in admissions at UPSIE. There was an increase in suicidality and requests for involuntary hospitalization in 2020 and 2021. The proportion of female admissions increased during the COVID-19 pandemic. As for MCT, we observed an increase in admissions in 2021, with a rise in the proportion of anxiety disorders in 2020 and mood disorders in 2021. Conclusion: We found changes in the number and nature of admissions to UPSIE and MCT during the COVID-19 pandemic. Further research is needed to clarify the impact of COVID on psychiatric crisis care.

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.

Ending a Treatment Relationship

Ending a Treatment Relationship

A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care

On July 16, 2022, the 988 mental health crisis hotline launched nationwide. In addition to preparing for an increase in call volume, many jurisdictions used the launch of 988 as an opportunity to examine their full continuum of emergency mental health care. Our goal was to understand the characteristics of jurisdictions’ existing continuums of care, identify factors that distinguished jurisdictions that were more- versus less-prepared for 988, and explore perceived strengths and limitations of the planning process. We conducted 15 qualitative interviews with state and local mental health program directors representing 10 states based on their preparedness for the 988 rollout. Interviews focused on 988 call centers, mobile crisis response, and crisis stabilization, as well as strengths and limitations of the 988 planning process. Data were analyzed using rapid qualitative analysis, an approach designed to draw insights on evolving processes and extract actionable findings. Interviewees from jurisdictions that reported that they were more-prepared for the launch of 988 tended to have local 988 call centers and already had local access to mobile crisis teams and crisis stabilization units. Interviewees across jurisdictions described challenges to offering a robust continuum of crisis services, including workforce shortages and geographic constraints. Though jurisdictions acknowledged the importance of integrating peer support staff and serving diverse populations, many perceived room for growth in these areas. Though 988 has launched, efforts to bolster the existing continuum will continue and hinge on efforts to expand the behavioral health workforce, engage diverse partners, and collect relevant data.

How to Reach a Mobile Crisis Team: Results From a National Survey.

Back to table of contents Previous article Next article DatapointsFull AccessHow to Reach a Mobile Crisis Team: Results From a National SurveyRachel Odes, Ph.D., R.N., Deepa Manjanatha, M.P.H., Preston Looper, M.S., L.P.C.-S., Megan McDaniel, B.A., Matthew L. Goldman, M.D., M.S.Rachel OdesSearch for more papers by this author, Ph.D., R.N., Deepa ManjanathaSearch for more papers by this author, M.P.H., Preston LooperSearch for more papers by this author, M.S., L.P.C.-S., Megan McDanielSearch for more papers by this author, B.A., Matthew L. GoldmanSearch for more papers by this author, M.D., M.S.Published Online:20 Mar 2023https://doi.org/10.1176/appi.ps.20220449AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The rollout of the 988 Suicide & Crisis Lifeline in July 2022 has raised urgent questions surrounding the infrastructure available to support callers during and after a call for help (1, 2). Currently, 988 callers are routed to their local National Suicide Prevention Lifeline (NSPL). From there, call-takers may provide counseling or initiate a referral. Should a caller urgently need in-person support, deployment of a mobile crisis team (MCT) would be a useful option (3). MCTs comprise behavioral health providers, medical staff, and sometimes law enforcement (in co-responder models) (4). MCTs are widely used, but a systematic description of their deployment and functioning is needed.Data Source and MethodsDuring 2021–2022, we conducted a survey of U.S. MCTs, defining an MCT broadly to include co-responder models, clinician-led teams, and teams including medical personnel. We recruited a convenience sample of participants who led or worked in an MCT through national Listservs, social media, and personal invitation. We asked participants about their program’s key features and then calculated descriptive statistics. After analysis of missing and duplicate data, we included 554 responses. Respondents could skip questions and respond anonymously.ResultsRespondents were in 45 states, and most described their roles as either MCT program director (N=237 of 501, 47%) or MCT clinician (N=105 of 501, 21%). Figure 1 depicts responses to the question of how respondents’ MCTs can be deployed. Of the 474 respondents who answered the question, nearly one-third (32%, N=154) reported that their MCTs could be deployed by calling the NSPL. The most commonly reported channel for reaching an MCT was to call teams directly (N=306, 65%), and the second most common was calling 911 (N=256, 54%).Figure 1. Phone number or agency that community members could call to deploy a mobile crisis team (MCT) in respondents’ programs (N=474)aaRespondents could choose more than one option.ImplicationsAlthough access to MCTs is an essential component of emergency mental health services, MCTs in many communities cannot be reached via 988. As federal and local agencies continue to implement 988-related changes, they should consider linking call centers to MCTs. The national 988 implementation sets the stage to establish a simplified point of access for mental health support and will hopefully streamline the process of connecting clients to services (5). As communities continue to integrate 988 calls into their service continuum, it should be recognized that current services are frequently fragmented and that it is important to communicate to community members how they can reach an MCT when needed.National Clinician Scholars Program, University of California, San Francisco, San Francisco (Odes); San Francisco Department of Public Health, San Francisco (Manjanatha, McDaniel, Goldman); Full Tilt Strategies, L.L.C., Colleyville, Texas (Looper); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman).Send correspondence to Dr. Goldman ([email protected]). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.Dr. Goldman is a paid research consultant to the National Council for Mental Wellbeing, Peg's Foundation, the University of California, Davis, and the Research Foundation for Mental Hygiene, Inc. The other authors report no financial relationships with commercial interests.

Peer Support Specialists Can Play Important Role in Patients’ Lives

Peer Support Specialists Can Play Important Role in Patients’ Lives

After 988’s Launch, Experts Emphasize More Work Needed

After 988’s Launch, Experts Emphasize More Work Needed

Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic.

To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8months of the COVID-19 pandemic. Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition. Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year. The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.

Responding to persons in mental health crisis: A cross-country comparative study of professionals’ perspectives on psychiatric ambulance and street triage models

People with mental illness can experience mental health crises (MHCs) that manifest in behaviours risky for the affected persons and for others, often resulting in unwanted police encounters and detention. Mobile crisis teams employing the psychiatric ambulance model (PAM) have shown positive effects when responding to MHCs, including diverting patients from police custody. However, the literature contains few reports about PAM. The emerging model of street triage (ST) is more frequently used and better researched. This study explored and compared facilitators and barriers of PAM and ST from the perspective of professionals from different countries. We conducted 12 semi-structured interviews with key PAM stakeholders in Sweden and the Netherlands and ST stakeholders in England, then performed comparative thematic analysis. Participants believed that PAM and ST led to better care for persons in MHC, reducing stigma and use of force. The main facilitators for Swedish participants were that PAM is a specialty with highly experienced and autonomousstaff. For Dutch participants, the more generalized medium-care ambulance led to success. Street triage enhanced overall safety and interagency collaboration. A common barrier was the lack of (emergency) treatment options and funding to meet the high demand for mental health care. Future research should explore collaboration between mobile crisis teams and community care to improve MHC response, and the perspectives of persons with mental illness on mental health emergency response models. Careful assessment is recommended to determine which mental health emergency response model best suits a specific local or national context.

Task Force on Psychiatric Beds Produces Model for Determining Need in Any Community

Task Force on Psychiatric Beds Produces Model for Determining Need in Any Community

988 is Coming, But Most Localities Still Not Prepared

988 is Coming, But Most Localities Still Not Prepared

Centering equity in mental health crisis services.

Centering equity in mental health crisis services.

Tucson Shares Blueprint for Crisis System Success

Tucson Shares Blueprint for Crisis System Success

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.