Developing Collaborative Community-Based Programs for Mental Health Crisis Response

In the United States today, many of us do not view mental health crisis services as an essential community service as we view police, EMS, fire, and emergency medical care. Typically, the problems of people with mental illness or substance use disorders are considered to be things that happen to “other people” and, as such, are “someone else’s” responsibility. Fortunately, there is a growing recognition that mental health crises can happen to anyone, just like crime, fire, and emergency medical events. Communities are coming to understand that these mental heath crises require special attention to ensure an appropriate response, on par with that provided for crime, fire, and emergency medical response. 

As a leading advocate of mental health crisis response, the National Alliance on Mental Illness (NAMI) has asked communities and policymakers to reimagine crisis response. Simply put, an ideal crisis response involves someone to talk to, someone to respond to, and somewhere to go.

 On July 16, 2022, this country took a giant leap forward in behavioral health crisis response by activating the 988-crisis line. Anyone in the U.S. can now call, chat, or text 988 and access resources and support during mental health, suicide, or substance use crisis. The crisis line follows the format suggested by NAMI:

  • Someone to talk to – 24/7 Local Crisis Call Centers
  • All calls to 988 will be answered by well-trained staff experienced in responding to a wide range of behavioral health issues
  • Call centers can connect people to local services
  • Someone to respond – Mobile Crisis Teams
  • Staffed by mental health professionals, including peers
  • Trained to de-escalate a crisis and connect people to stabilization programs or other services
  • Somewhere to go – Crisis Stabilization Programs
  • Facilities that can provide short-term observation and stabilization. May include a “warm hand-off” to follow-up care

Funding for 988 will provide opportunities to expand crisis care services and reframe community policy initiatives. In this article, we will focus on the “someone to respond” aspect of crisis response that can transform mental health crisis response by developing collaborative community-based programs.

 Those programs include expanding civilian-based mobile response, integrating co-response and specialized police response, crisis call triage, and engaging community partners to provide timely, accessible treatment options. 

Civilian-Based Mobile Response in Mental Health Crises

Individuals experiencing a mental health crisis need a mental health response that involves compassion, care, and support. Unfortunately, in most jurisdictions in the U.S., the response involves law enforcement, who are often ill-equipped to provide that type of care.

Thankfully, an increasing number of jurisdictions are implementing civilian-based mobile response programs. The programs are staffed by unarmed teams of mental health professionals, peers, and other specially trained civilians. They successfully demonstrate that the teams can safely function as an alternative to police and only involve them as a last resort. 

In January 2021, the city of St. Petersburg, Florida, approved the Community Assistance and Life Liaison (CALL) program. The program is staffed by mental health professionals from Gulf Coast Jewish Family and Community Services. 

When a call is received involving a mental health crisis, help can be obtained from a licensed social worker over the phone, or two mental health professionals, called “navigators,” who can be dispatched to help in person. According to Megan McGee, who helped develop the CALL program, since the program’s inception, the number of suicides in the city decreased by 17%, with almost 80% of suicide calls being diverted to the team’s mental health professionals. 

Integrated Co-Response and Specialized Police Response

Across the U.S., cities, and counties are adopting the co-responder model to improve engagements with people experiencing a behavioral health crisis. Though the models vary, they generally include an integrated co-response and specialized police response. Roughly defined as the pairing of law enforcement and mental health professionals, the team structure varies to meet the needs of individual communities. 

Variations of the program generally center around the type of health professional that is paired with law enforcement. These can include mental health clinicians, EMS, and peer support. In many communities, specialized police and mental health professionals respond together to the scene. In others, police may respond initially and request that mental health professionals be involved either at the scene or by phone or video call. 

In Arizona, the Pima County Sheriff’s Office and Tucson Police Department’s Mental Health Support Team (MHST) pair an MHST officer with a licensed mental health clinician. They ride together to calls for service in an unmarked car and in civilian clothes to help defuse situations quickly.

In Springfield, Missouri, the Police Department and Burrell Behavioral Health have combined to form the Virtual-Mobile Crisis Intervention (V-MCI) program. In real-time, CIT (Crisis Intervention Team) officers can connect with behavioral health specialists via iPads. The specialist then conducts an intervention and provides appropriate dispositions, including follow-up case management.

Results show that approximately 87% of the team’s contacts were diverted from inpatient psychiatric hospitalization, few were incarcerated, and about 16% were referred to an Emergency Department for medical or psychiatric assessment. 

With the advent of technology solutions like Julota, co-responder teams across the nation are experiencing comparable results. For example, in 2019, Pitkin County, CO, launched the Pitkin Area Co-Responder Team (PACT). The program follows the co-responder model of pairing a specially trained police officer with a mental health clinician to respond jointly to the scene where a mental health challenge exists. 

Like many other jurisdictions, Pitkin was experiencing information-sharing challenges across its emergency response system. They chose Julota’s cloud-based platform, allowing partners to securely share information across organizations to track patient encounters and referrals to services. Law enforcement and mental health professionals can access data on the go with tablets, smartphones, or computers. 

Effective Crisis Call Triage

Effective crisis call triage is vital to transforming mental health crisis response. Typically, community responder programs receive and allocate calls through 911, 24/7 crisis lines like 988, or non-emergency numbers such as 211 or 311.

The triage process is then used to determine whether it is appropriate to dispatch a community responder team for calls involving mental health or substance use crises. Many emergency and non-emergency communications centers use standard call triage protocols.

These protocols generally involve screening questions that can help identify the appropriate response needed. The Justice Center of the Council of State Government (CSG) developed a brief that details recommendations on how call triage can be utilized to inform and dispatch community responders. 

Connecting Community Responders through calls beginning with 911

The most common way of calling for help is by dialing 911. Thus, the call triage process used to connect people to community responders should involve 911 operations. In addition, 911 Dispatchers should use screening questions to determine whether the call involves mental health or substance use.

The call taker then decides whether to forward the call to a co-response team that includes law enforcement or a community response team. Community response teams generally comprise behavioral health clinicians or civilians like peer support specialists. When a person is experiencing a behavioral health crisis, it may be challenging to understand what they need correctly. Therefore, call takers should be adequately trained to understand and recognize words and actions signifying a mental health or substance use crisis.  

Engaging Community Partners to Provide Timely, Accessible Treatment Options for Mental Heath Crisis Response

Jurisdictions across the country are learning that meaningful engagement with community partners is key to transforming mental health care crisis response. As a result, collaborative community-based programs are being established to ensure that timely, accessible treatment options are available to anyone who needs them, anytime, for as long as they need them. In their report “Bolder Goals, Better Results,” the National Association of State Mental Health Program Directors (NASMHPD) proposed bold goals to produce better outcomes for those suffering from mental illness. Included in those goals were 100% availability of early screening, identification, and timely response after the onset of mental illness, 100% access to medication and therapies, and 100% access without delay to the most appropriate 24/7 psychiatric care available.

While these are not the only steps needed to produce improved outcomes, NASMHPD states: “…they are steps of such magnitude that achieving any of them would transform and save countless lives. The combined effect…would be incalculable.”

To develop this type of care continuum, an efficient technology solution must be implemented to facilitate and enhance these critical services. Julota’s robust platform enables community-based programs to meet the goals mentioned by NASMHPD. 

Communication is quick and seamless between community responders and mental health professionals to provide early screening and identification of mental health issues. Once a decision as to the needed care is made, individuals can be taken to an appropriate care facility or referred to other services that can include medication and therapy. 

CONCLUSION: Developing Collaborative Community-Based Programs for Mental Heath Crisis Response

Collaborative community-based programs are transforming mental health care crisis response more than ever. Cities and counties are recognizing that mental health, community, public health, and safety are interconnected and are working together to adopt and refine policies that will ensure that individuals in crisis have someone to talk to, someone to respond, and somewhere to go.