Mobile Crisis Research Articles

The Relationship of Dissociation Proneness to Secondary Trauma, Burnout, and Compassion Satisfaction in Mobile Crisis Workers

The Relationship of Dissociation Proneness to Secondary Trauma, Burnout, and Compassion Satisfaction in Mobile Crisis Workers

The Relationship of Dissociation Proneness to Secondary Trauma, Burnout, and Compassion Satisfaction in Mobile Crisis Workers

This study examined the relationship between general dissociation experiences (DES) and dissociation absorption experiences (DESAB) to secondary traumatic stress (STS), burnout (BO), and compassion satisfaction (CS). Mobile crisis workers in Maine (N = 30) anonymously completed the Dissociative Experiences Scale II and the Professional Quality of Life Scale; biographical data was masked. Results indicated high resiliency in this sample as 80% of scores reflected CS, while 24% of scores reflected STS and 7% reflected BO. Analysis produced moderate, statistically significant correlations between STS and DES (r = .31); STS and DESAB (r = .32); BO and DES (r = .44); and BO and DESAB (r = .43). CS and DES/DESAB did not yield a significant correlation. This suggests a previously unreported relationship between dissociation vulnerability and the experience of STS and BO. Findings warrant further study of STS as a manifestation of a primary trauma disorder and not a distinct category. Results can inform mental health provider training and burnout prevention efforts.

Podejście terapeutyczne oparte na Otwartym Dialogu – o fenomenie skandynawskiej psychiatrii

After twenty years of transformation of Finnish mental health care, in the late 80s and early 90s of the last century, incidence of schizophrenia in Western Lapland dropped from 35/100,000 to 7/100,000. This phenomenon is linked with Yrjo O. Alanen et al. who investigated schizophrenia treatment outcomes and psychosocial rehabilitation of people with schizophrenia. Investigators focused on an individually tailored psychotherapeutic recovery plan during patient's hospitalization, including care for patients' families. Within the "Finnish National Schizophrenia Project" the principles of the Need-Adapted Treatment were created and 50% of Finland's country gained access to mobile crisis intervention teams. Further studies were continued within "Acute PsychosisIntegrated Treatment Project" (1992-1993) which locally, in Western Lapland, proceeded into "Open Dialogue in Acute Psychosis Project" (ODAP) (1994-1997). In this approach, all important decisions regarding the patient, including hospitalization or pharmacotherapy, are discussed not only with the entire therapeutic team, but also with the patient and his family members. Two - and five-year follow-ups demonstrated high treatment efficacy as well as important cost reduction in mental health care spending. First two"Open Dialogue Method" training courses for representatives of the medical, psychological, nursing and social care have been completed in Poland in October 2014. Studies evaluating the therapeutic effectiveness of the described approach are being planned.

Table of Contents

AbstractIndiana Mental Health Workforce Shortage Reflection of Country WoesCenter Finds Rare Funding Source to Support Project for HomelessMore California Officers Need Training for MH Crisis ResponseVentura County Expanding Adult Mobile Crisis Support ProgramSAMHSA/NIMH Report Reveals Scope of Mental DisordersCMS Seeking Input on Delivery Models for Medicaid MCBriefly NotedState NewsComing up

Helping Persons with Mental Illness: Partnerships between Police and Mobile Crisis Units

People with mental illness (PMI) have increased dramatically, and these individuals are at greater risk for repeated contact with the criminal justice system. Mobile crisis units (MCUs) have been heralded as effective partners with law enforcement to provide appropriate interventions to PMI and reduce the possibilities of criminalization of this population. The purpose of this research is to examine a partnership between law enforcement and a county-wide MCU to determine (1) the nature of interactions between police-referred calls to the MCU and (2) to determine the outcomes of these calls and the factors that might influence the outcomes. Significant differences in the type of PMI calls from law enforcement–referred calls to MCUs are found; the PMI are twice as likely to be violent, intoxicated, psychotic, mood-order diagnosed, and in emergent need of care. The type of referral is no longer significant when the model includes risk factors. Policy implications of the partnership between law enforcement and MCUs are discussed.

Some Need Extraordinary Measures When Extreme Cold Strikes

Some Need Extraordinary Measures When Extreme Cold Strikes

Readiness Leads to Fast MH Response at Navy Yard

Readiness Leads to Fast MH Response at Navy Yard

The Need for Appropriate Use of Involuntary Commitment

Back to table of contents Previous article Next article LettersFull AccessThe Need for Appropriate Use of Involuntary CommitmentJeffrey L. Geller, M.D., M.P.H.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H.Published Online:1 May 2013https://doi.org/10.1176/appi.ps.640501AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In an article in the February issue, McGarvey and colleagues (1) reported the results of a study of factors that play a role in decisions to initiate involuntary commitment among emergency evaluators employed by community service boards in Virginia. The authors conclude, “The findings provide a sound empirical basis for the claim that investing in a continuum of crisis stabilization and other intensive outpatient services would reduce the need for involuntary interventions.” But the article does not provide data to support this conclusion.And what was this study? It was a questionnaire completed by emergency clinicians throughout Virginia after they had conducted an evaluation. The questionnaire asked whether certain currently unavailable services would have better addressed the individual’s needs. Well, sure. We didn’t need a study to find that out. This study basically says: “Here’s what you currently have for resources. Now fantasize about all these other possible resources. If one of them were available, would this have better met the needs of the person you evaluated?” Is nirvana better than reality?I have fantasized about, designed, and implemented services, and I have also evaluated the relationship between the conceptualized service and reality and examined outcomes (including outcomes in Virginia). And, like others, I know that it is a big stretch from conception (fantasy) to the delivered service.In the study by McGarvey and colleagues, respondents were not asked: “Would you actually have been able to access the service for the individual? What would have been the impediments to obtaining the service? If it took three to four times longer to obtain the service than to involuntarily commit the individual, would you have been able to wait? Would the patient have been willing to use a proffered service voluntarily? Would there be financial impediments to using some of the alternatives?”I am not saying that expanded, well-provided community services would not divert individuals from involuntary hospital admission to voluntary community services. But these community services might do such a good job at case finding that more individuals would end up being involuntarily admitted after the development of the community services than before. This was our conclusion when Massachusetts doubled its mobile crisis capacity with no subsequent decrease in inpatient hospitalization rates (2).Finally, if psychiatrists don’t figure out how to appropriately use involuntary services, others will tell us what we must do. In the wake of Seung-Hui Cho’s massacre at Virginia Tech in 2007, many thought that too few involuntary treatments were available (3). The same has occurred in the wake of Adam Lanza’s shooting spree at Sandy Hook Elementary School (4).We need to be at the table both to design effective involuntary interventions—those that we can actually use—in the hospital and in the community and to expand intensive community services. These can be complementary. They must be.Dr. Geller is facility medical director, Worcester Recovery Center and Hospital, and professor in the Department of Psychiatry, University of Massachusetts Medical School, Worcester.References1 McGarvey EL, Leon-Verdin M, Wanchek TN, et al.: Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatric Services 64:120–126, 2013Link, Google Scholar2 Fisher WH, Geller JL, Wirth-Cauchon J: Empirically assessing the impact of mobile crisis capacity on state hospital admissions. Community Mental Health Journal 26:245–253, 1990Crossref, Medline, Google Scholar3 Fisher M: When laws create barriers to care, the consequences should be no surprise. Washington Post, April 20, 2007, p A12Google Scholar4 Change law on mental health (editorial). New Haven Register, Jan 12, 2013. Available at www.nhregister.com/articles/2013/01/12/opinion/doc50f20aae873fc487952997.txtGoogle Scholar FiguresReferencesCited byDetailsCited ByNone Volume 64Issue 5 May 2013Pages 496-496 Metrics PDF download History Published online 1 May 2013 Published in print 1 May 2013

1769 – Psychotic disorder and hospitalization through mobile crisis unit

Introduction The utility of Mobile Crisis Unit (MCU) and its target population has been a controversial issue and many scientific articles have been writen about it (1,2). Objective The aim of this study is to identify the demographic and clinical features of patients diagnosed with psychotic disorder who have been hospitalized and have not required hospitalization in psychiatric unit through a Mobile Crisis Unit (MCU). Methods We collected retrospectively demographic and clinical variables. These include psychiatric rating scales of severity: Clinical Global Impression Scale (CGI) and Psychiatric Disease Severity (GEP); of functionality as Global Assessment of Functioning Scale (GAF); the aggressive behaviour and violence scale (AVAT) and psychopathology with the Positive and Negative Syndrome Scale (PANSS) of a total of 136 patients between June 2007 and July 2010. Results There have been found stadisticaly significative differences between patients who have been hospitalized versus patients who have not in the items of treatment adherence and security staff intervention (Table 1). There is a positive correlation between patients who required hospitalization and the clinical scales CGI, GEP, GAF, AVAT, SUMD, PANSS-P and PANSS-G (Table 2). Conclusions We can conclude that patients cared for by the Mobile Crisis Unit (MCU) that require of psychiatric hospitalization have poor adherence to previous treatment. A high frequency of cases require intervention of security staff for having a higher risk of aggressiveness at the moment of hospitalization. The presence of greater psychopathology and functionality severity in patients hospitalized through the Mobile Crisis Unit (MCU) is also considered. Variables No hospitalization Hospitalization p N % N % Sex Men 33 54.1 41 54.7 0.95 Cohabitation Alone 15 24.6 25 33.3 0.27 Toxics Yes 14 23 17 22.7 0.97 Psychiatric history Yes 45 78.9 54 77.1 0.81 Previous hospitalizations Yes 42 68.9 42 56 0.12 Treatment adherence Yes 14 31.1 2 3.5 Security staff Yes 1 1.7 39 57.4 Chi-square Variables No hospitalization Hospitalization p Age 45,3(17,02) 45,44(16,16) 0,96 CGI 4,24(0,82) 5,11(0,67) GEP 12,09(4,18) 15,96(3,82) GAF 47,16(14,21) 37,07 (23,72) AVAT 2,41 (1,98) 4,15 (2,45) SUMD 10,65 (3,29) 12,97 (3,08) PANSS P 22,28(7,02) 28,79(6,43) PANSS N 21,89 (8,44) 20 (8,09) 0,19 PANSS PG 38,8 (9,51) 45,28 (9,65) Mean(SD)–T-test

The “Usual Care” Quality Conundrum: A Call to Action

The synthesis of current knowledge about specialty outpatient children’s mental health care in this article provides a sobering reminder that we have effectively been ‘‘asleep at the wheel’’ when it comes to comprehensive evaluation of the quality of mental health services being provided to children and families. In this new age of health care reform, this is a travesty that cannot stand. We cannot be complacent and be steamrolled into accepting anything less than the rigorous evaluation of what is being provided to youth and families in ‘‘usual care’’ settings. The fact that this selective review focuses primarily on services provided in specialty outpatient mental health settings is precisely why readers should pay attention. It is of grave concern to me that this is exactly the type of care that will be supported by health care reform initiatives. A chilling pall comes over this reader as the authors detail the ineffectiveness of usual care. I can’t help but ask the question––If usual care is ineffective, what will be supported in health care reform? Actually, that’s a rhetorical question because it is precisely ‘‘usual care’’ that will likely be supported in health care reform. And if that doesn’t get your attention and make you want to review this article with great care and attention to the macro level of quality children’s mental health care, then you are in the wrong business. Usual care should be radically broadened to include a robust family partner component along with access to family-driven respite care and innovative mobile crisis response options, to name but a few key ingredients that go far beyond the typical outpatient care scenario. Garland, et al. shines a bright light into the dark corners of traditional mental health delivery. They note that 68 % of the care in the studies reviewed were clinic based. A sobering reminder of how fragile our current mental health services are is the finding that ‘‘a third of the directors with site-specific budget data indicated that their agency ran at a budget deficit.’’ This is so important for advocates to understand. For us, ‘‘what works’’ goes far beyond usual care. It involves the active participation of community groups and families and initially may cost more. Yet, a third of Clinic Systems Project (CSP) cited in the article ran at a deficit and the largest funding source was Medicaid, which has what I consider to be narrowly fundable criteria, i.e., ‘‘usual care.’’ Are you starting to get the picture? If we allow policy makers to just fund what we do now, (i.e., usual care) without doing rigorous quality checks, then we are doomed to a mediocre at best mental health service delivery system. We need a system that evaluates and supports services beyond usual care if we are going to make significant improvements. Garland et al. (2013) identify studies that show that the majority of children receiving community-based ‘‘usual care’’ do not show clinical improvement. We need much more research to find examples of excellence and promote them so that funders can see the impact––clinically, financially and overall improvement in the family and community. The article also talks about promising strategies, including integration of behavioral health with services such as primary care and education. Traditional outpatient care is dead in my opinion. It’s just that those practicing it Improving community-based mental health care for children: Translating knowledge into action, by Ann F. Garland, Rachel HaineSchlagel, Lauren Brookman-Frazee, Mary Baker-Ericzen, Emily Trask, Kya Fawley-King.

Crisis Intervention for People With Severe Mental Illnesses

Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. Objectives To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. Selection criteria We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. Main results The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. Authors' conclusions Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Crisis intervention for people with severe mental illnesses.

A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis intervention models of care were developed as a possible solution. To review the effects of crisis intervention models for anyone with serious mental illness experiencing an acute episode, compared with 'standard care'. We updated the 1998, 2003 and 2006 searches with a search of the Cochrane Schizophrenia Group's Register of trials (2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE, and PsycINFO. We included all randomised controlled trials of crisis intervention models versus standard care for people with severe mental illnesses. We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assumed that people who left early from a trial had no improvement. Three new studies have been found since the last review in 2006 to add to the five studies already included in this review. None of the previously included studies investigated crisis intervention alone; all used a form of home care for acutely ill people, which included elements of crisis intervention. However, one of the new studies focuses purely on crisis intervention as provided by Crisis Resolution Home Teams within the UK; the two other new studies investigated crisis houses i.e. residential alternatives to hospitalisation providing home-like environments.Crisis intervention appears to reduce repeat admissions to hospital after the initial 'index' crises investigated in the included studies, this was particularly so for mobile crisis teams supporting patients in their own homes.Crisis intervention reduces the number of people leaving the study early, reduces family burden, is a more satisfactory form of care for both patients and families and at three months after crisis, mental state is superior to standard care. We found no differences in death outcomes. Some studies found crisis interventions to be more cost effective than hospital care but all numerical data were either skewed or unusable. No data on staff satisfaction, carer input, complications with medication or number of relapses were available. Care based on crisis intervention principles, with or without an ongoing home care package, appears to be a viable and acceptable way of treating people with serious mental illnesses. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.

Sidebar: Crisis Intervention Teams and Mobile Crisis Management

The Crisis Intervention Team (CIT) model is a law enforcement-based jail-diversion program for those experiencing crisis as a result of mental health problems. The use of crisis intervention teams is growing across North Carolina. According to an email message from Bob Kurtz, PhD, of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services in the North Carolina Department of Health and Human Services, in February 2011, more than 4,000 (about 18%) of the state’s law enforcement officers were CIT-certified at that time. The first CIT initiative was developed in Memphis, Tennessee, in 1988 in the wake of a tragedy there. The Memphis CIT program now serves as a national model for taking a proactive approach to assisting individuals in crisis who might otherwise serve jail time [1]. To become CIT-certified, law-enforcement officers undergo 40 hours of training in which they are taught the signs of a mental health crisis and de-escalation skills; officers are also provided with resources for diverting people in crisis from jail by linking them to treatment when this can be done at little risk to public safety [2]. In many instances those in crisis are connected to treatment through the mobile crisis management system. Southeastern Center for Mental Health, Developmental Disabilities, and Substance Abuse Services facilitates CIT training in Brunswick, New Hanover and Pender counties. In southeastern North Carolina, the relationship of law enforcement officers to the local mobile crisis management system is integral to the CIT program and starts during training. A representative of the mobile crisis system attends CIT trainings to discuss the partnership between mobile crisis clinicians and officers and to explain how to contact mobile crisis dispatch and to access mobile crisis services. Calls received from CIT officers differ somewhat from other calls to mobile crisis dispatch. Heather Strickland, the mobile crisis management supervisor for RHA Behavioral Health Services in Wilmington, North Carolina, notes that these calls are generally about emergency situations and that specific information about the person in crisis is often not available. “We always have clinicians on call, so that these calls are responded to immediately,” says Strickland. A mobile crisis management clinician will meet the person in crisis and the CIT officer wherever they are for a face-to-face assessment. If involuntary commitment is not needed, the clinician can assist in transporting the person in crisis to an appropriate location for other assistance. Corporal Greta Mallard, CIT Coordinator for the Wilmington Police Department, says, “The development of the mobile crisis team has been a great asset to the officers of the Wilmington Police Department. Having the capability of getting a person in crisis assistance, without having to automatically take out involuntary commitment papers, benefits both the police department and the individual.” The success of the CIT and mobile crisis management programs is reflected in a number of outcomes. Success in Southeastern Center’s catchment area is particularly evident in a decrease in admissions of local residents to Cherry Hospital, the region’s state psychiatric hospital. Local admissions to Cherry Hospital have dropped: 65 people were admitted in the first quarter of 2011, but only 27 in the first quarter of 2012. Officer Lonnie Waddell of the Wilmington Police Department, who received the National Alliance on Mental Illness—Wilmington’s “CIT Officer of the Year” award for 2011, remembers one instance in which involuntary commitment was prevented. A man with suicidal ideation had contacted his mother in Ohio, who then contacted Wilmington police. When Officer Waddell arrived at the man’s home, he spent some time talking with him, gathering his medical history and learning that he had not been taking his medication. Concluding that there was no need for an arrest or involuntary commitment, Waddell then called mobile crisis dispatch. “Mobile crisis clinicians have resources that I don’t have,” he says. “Some people don’t need to go to the hospital or jail; the issue can be handled in their home, where they feel safe and comfortable.” Sergeant Mike Howell, CIT Coordinator for the New Hanover County Sheriff’s Office, summarizes the importance of the relationship between the mobile crisis management system and CIT officers: “Mobile crisis is a great resource for officers when assisting someone in crisis. Because mobile crisis can more appropriately respond to these types of calls, the relationship with law enforcement results in a better outcome for the consumers and the community at large.”

Mobile Crisis Management Teams as Part of an Effective Crisis Management System for Rural Communities

Mobile crisis management teams provide crisis prevention and intervention services in community settings. The Appalachian Community Services crisis management program shows how such teams can be used to effectively serve rural communities.

Psychiatrists Occupy Place in Protest Movement

Psychiatrists Occupy Place in Protest Movement

A Controlled Before-and-After Evaluation of a Mobile Crisis Partnership Between Mental Health and Police Services in Nova Scotia

A Controlled Before-and-After Evaluation of a Mobile Crisis Partnership Between Mental Health and Police Services in Nova Scotia

P03-325 - Profile of psychotic patients with social isolation

IntroductionSocial isolation is a factor associated to mortality and morbidity in general population.This symptom has been considered as prodrome in ‘high-risk mental states’ for a possible development of psychosis. Social isolation is a frequent problem in psychotic patients visited by mobile crisis unit (EMSE).ObjectiveTo describe the differences between psychotic patients with social isolation with patients without it.MethodsA descriptive observational and cross-linked study in patients with diagnostic of psychotic disorder visited by EMSE from 2004 to 2010. The sample was divided in two groups; present and absence of social isolation as the main problem. We evaluated demographic and clinical variables including the aggressive behaviour and violence scale (AVAT) and positive and negative syndrome scale (PANSS).ResultsN: 662 subjects (61.3% men; mean age 44+-16 years) with psychotic disorder. 15.1% present social isolation like the main problem against 84.9% who present others main problems: delusion/hallucination (44.7%), behaviour disturbance (18.1%) and agitation/aggressivity (14%).Patients with social isolation are mostly men (72%, p < 0.05), live with family (79.4%, p < 0.05), are less aggressive (AVAT 2.77 p < 0.05) than psychotic patients that are not isolated. The punctuation in subscale negative syndrome of PANSS is higher (26.19 versus 20.25, p0.001).ConclusionsThis study concludes that patients with psychotic disorder and social isolation are mainly men and they have less aggressivity and predominantly negative syndrome. These results are important to improve the multidisciplinary therapeutic approach.

Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled Trial

Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled Trial

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

A Controlled Before-and-after Evaluation of a Mobile Crisis Partnership between Mental Health and Police Services in Nova Scotia

Police are often the front-line response to people experiencing mental health crises. This study examined the impact of an integrated mobile crisis team formed in partnership between mental health services, municipal police, and emergency health services. The service offered short-term crisis management, with mobile interventions being attended by a plainclothes police officer and a mental health professional. We used a mixed-methods design encompassing: a controlled before-and-after quantitative comparison of the intervention area with a control area without access to such a service, for 1 year before and 2 years after program implementation; and qualitative assessments of the views of service recipients, families, police officers, and health staff at baseline and 2 years afterward. The integrated service resulted in increased use by people in crisis, families, and service partners (for example, from 464 to 1666 service recipients per year). Despite increased service use, time spent on-scene and call-to-door time were reduced. At year 2, the time spent on-scene by police (136 minutes) was significantly lower than in the control area (165 minutes) (Student t test = 3.4, df = 1649, P < 0.001). After adjusting for confounders, people seen by the integrated team (n = 295) showed greater engagement than control subjects as measured by outpatient contacts (b = 1.3, chi square = 92.7, df = 1, P < 0.001). The service data findings were supported by the qualitative results of focus groups and interviews. Partnerships between the police department and mental health system can improve collaboration, efficiency, and the treatment of people with mental illness.