Despite Their Successes, Some Mobile Crisis Response Teams Are in Crisis

It was a snowy afternoon in Bozeman, a city of nearly 60,000 nestled in the mountains of southern Montana. Temperatures hovered in the mid-30s.

The city’s mobile crisis team had just received a call about a man walking outside without shoes. The man’s family told the team he was suffering a mental health crisis and did not want to go inside.

As they drove down the highway toward the outskirts of town, team member Evan Thiessen spoke with the contacting parent.

“You do the right thing and we’ll make sure he gets help today, okay?” he said.

They looked at the man’s criminal record on a laptop and found he had a record of some previous encounters with police, some of which had turned violent.

Luke Forney, a licensed therapist, had that in mind as they arrived at a neighborhood of single-family homes. He got out of the Ford Bronco and walked toward the front door.

A financing problem

Many communities across the country send teams like this to help people in psychiatric crises, rather than sending regular police officers.

A recent survey found there were at least 1,800 mobile teams nationwide in 2023. But the financial support they receive is often insufficient and inconsistent, leaving many communities struggling to keep teams operating.

Two programs – one in Great Falls, in central Montana, and one in Billings, in south-central Montana – were recently closed. There are six units left in Montana.

The strategy began in the late 1980s in Eugene, Oregon, but has grown nationally over the past decade.

Recent national headlines about police killings of people in psychiatric crises have sparked discussions about how to respond effectively and safely. Most police officers are not trained to deal with people suffering from delusions or hallucinations, nor to de-escalate situations involving threatening behavior toward themselves or others.

An analysis of fatal police-involved shootings in 27 states found that about a third of victims showed signs of seizure. Another study found that people with serious mental illness were at least 11 times more likely to experience police use of force than those without it.

In contrast, crisis response teams have been trained to de-escalate such situations and provide appropriate therapeutic care.

When the team arrived at the Bozeman home, the man had already gone inside. The team then spoke with the man’s family for about half an hour and helped them develop a plan to keep him home and safe. Before leaving, team members determined that the man did not pose a threat to himself or others.

They also planned to follow up in a few days to connect him with ongoing mental health care. After meeting with the team, some clients may need follow-up therapy, assistance with psychiatric medications, or help finding substance abuse treatment.

The Bozeman team is available 12 hours a day, seven days a week, and costs about $1 million a year to operate.

Police departments are generally funded by local taxpayers. Mobile crisis teams do not have a single, reliable source of funding.

Some, despite the success of their operations and local support, are reducing their activities or have closed their doors completely. The one that was shut down was Oregon’s pioneering program.

Most crisis calls end with people staying where they are, avoiding a trip to the emergency room or a trip to jail, according to Connections Montana, which runs the mobile crisis program in Bozeman.

Beyond the police and firefighters, the public can call the team directly.

“I’ve responded to calls where individuals have barricaded themselves in residences or in their vehicles with a firearm. So, I’ve helped not only law enforcement, negotiators, but also counseling on the behavioral health aspect,” said Ryan Mattson, who leads Bozeman’s crisis team.

The program has reduced the time Bozeman police officers have to spend on mental health calls by nearly 80 percent, according to Mattson, and has avoided unnecessary emergency room visits.

Residents and political leaders see that value, he said, but finding a way to pay for the service has been difficult.

“I’m confident we’ll be here until the next fiscal year. That’s about as confident as I am at this point,” Mattson said.

Mobile crisis programs in Montana, which began operating about five years ago, have cost more than the state initially anticipated.

Health insurance is sometimes a source of income for mobile crisis teams. This is because a crisis call is a type of mental health service provided by trained professionals such as therapists or crisis intervention specialists. Yet many private insurance companies do not reimburse for mobile emergency services.

What Medicaid pays – and doesn’t

Another source of funding is Medicaid, the government-funded insurance program for low-income and disabled Americans. Two-thirds of states allow Medicaid reimbursement for such calls, but rates vary.

In Montana, Medicaid reimburses the team only for time spent responding to a call in the field. Additional time spent on a file – documenting meetings or waiting for the next call – is not reimbursed.

“You have to pay to be ready, just like we do with fire or police, whether someone is called or not,” said Angela Kimball of Inseparable, a nonprofit that advocates for mental health policy reform.

It is not possible for mobile crisis teams to rely solely on reimbursement from insurance companies, she said.

To address shortfalls, many mobile teams rely on a patchwork of grants and other funding, according to Heather Saunders, who studies Medicaid policy at KFF, a nonprofit health news organization that includes KFF Health News.

Some state governments have stepped in to help.

Eight states, including New Jersey, California and Washington, require private insurers to cover the cost of crisis cell calls for people enrolled in their plans, according to Kimball. At least 10 states have implemented fees on cell phone bills to help pay for the service.

Montana did not follow suit.

The state provides about $2 million a year in additional funds to help mobile teams pay for calls for service that are not reimbursed by Medicaid, according to an emailed statement from Jon Ebelt, a spokesman for the state health department.

But program officials counter that the paperwork to access that funding is complicated and often not worth staff time.

Will Montana intervene?

Despite this state support, mobile teams still struggle to stay afloat, Ebelt acknowledges. He said Montana officials are considering increasing what Medicaid reimburses for each call for service.

In Missoula, the mobile crisis team turned to local taxpayers for additional help. Their annual expenses are $1.4 million, but Medicaid reimbursements covered only about 20 percent of the cost, according to program manager John LaRocque. Even with local taxpayer dollars, the program faces a $250,000 shortfall. LaRocque is therefore looking for subsidies.

Mobile seizure is still a relatively new concept, and increasing challenges are to be expected, said Sierra Riesberg, director of the Behavioral Health Alliance of Montana.

Yet the abrupt closures create instability and drive some patients to emergency rooms, putting financial pressure on another struggling sector of the local health care system.

“A much-needed service is available then unavailable, available then unavailable. These elements need to be taken into consideration when developing programs in communities,” she said.

If more mobile crisis teams close, it could interfere with Montana’s recent efforts to reform an outdated and underfunded mental health system. The state’s only psychiatric hospital has not tracked the number of patients admitted to the facility.

Later this year, Montana hopes to join a federal pilot program to open a new type of clinic: certified community behavioral health clinics, or CCBHCs. These clinics will receive increased federal funding, but they will be required to offer 24-hour mobile crisis services, as well as other crisis care.

That could be a big challenge for rural communities, said Casey Schreiner, an executive at Alluvion Health in Great Falls.

Alluvion operated the Mobile Crisis Team in Great Falls before closing the service. One of the main reasons for its closure was that expected Medicaid payments covered less than expected. Before Alluvion considers getting involved again, the state would have to “completely revamp” how the service is funded, Schreiner said.

“Is this a priority for our state or not? he asked.

This article comes from a partnership with Montana Public Radio And NPR.