When someone is in crisis, they will often need multiple services. From 988, 911, mobile crisis, or law enforcement. They may also require transportation and access to a stabilization facility or an outpatient provider. Each service can function correctly, yet leave the person’s experience feeling disjointed.
A lot of time is spent thinking about how to provide better care for someone in crisis, but far less on what happens between services. That gap is where interagency service coordination lives, and it’s where the focus needs to be. Who is responsible during the handoff? How does the next service get the information it needs? How quickly can transportation arrive? Will a stabilization facility take the client? What does the family need to do next?
As the article “Alternatives to 911 for a Mental Health Crisis: What They Look Like Heading Into 2027” notes, more alternatives are needed, but adding teams or lines will not create a continuum of care. There are many variables to consider when designing these systems. Each new service requires additional coordination.
Interagency Service Coordination Means Focusing on What Happens Between Services
When running an agency, you want to think about your staff, how quickly you respond to calls, documentation, training, and your clients’ outcomes. However, what does the client experience when they need help from multiple services?
For example, a mother calls about her paranoid son. Dispatch sends out a team, and after speaking with the son, the team can deflect him from law enforcement and an ED placement. A stabilization facility agrees to take the client. All good decisions at this point.
However, transportation is unavailable, and 90 minutes pass. The client becomes anxious, the mother grows scared, and the facility’s intake window is closing. Law enforcement must stay longer than planned, and the situation unravels.
Each of those services did its job, but the handoff between them failed. There needs to be a greater focus on how communities can be better supported with service coordination.
Have No Dead Ends
When in crisis, you shouldn’t have to navigate the system. If you reach the wrong door, someone should guide you to the right one.
You don’t need every agency to know everything, but they should know where to send someone when it’s not their service. Know when to engage 911 and how to connect someone to mobile crisis. Know which locations can provide the level of care needed. Know where your transport will take the patient, and make sure the facility knows to call if anything changes.
SAMHSA’s guidelines for crisis care systems call for three things: someone to contact, someone to respond, and a safe place for help. Ensuring there’s no gap in between is crucial.
Who Is Responsible During a Handoff?
There are times when someone seems to have been handed off, but did the next service accept the referral? Has the transport been dispatched? Will the facility accept them? Does anyone know whether they made it to their appointment?
Closing the loop on handoffs keeps someone accountable for the client, even if only for a brief time.
There’s a big difference between “they were referred” and “they connected with the next service.”
These types of handoffs are very common when agencies work to divert from law enforcement or the emergency department.
How Long Do Clients Wait After a Decision Is Made?
Most teams can tell you how quickly they responded to a call or arrived on scene. But can they tell you how long the client waited once it was decided they needed another service?
That is a very different number. Say the team decides at 7:15 pm that a client needs transport. Transport shows up at 8:42, and the client gets into intake at 10:03. Who was responsible for that person during those nearly three hours?
Creating a continuity clock helps track the time from when a decision is made to when the person actually receives the next service. It shows where clients spend their time and which services delay them. Is it transport, a bed opening up, or medical clearance? There are many variables to look at when tracking this time.
Don’t Make Your Clients Your Service Coordinators
Someone in crisis will likely have to repeat their story multiple times. When you hand the client off to another service, you should be able to share basic information about the person.
This doesn’t mean giving the next service full access to the client’s file. Just share enough basic information for it to take the person in and understand what’s happening.
Do they have suicidal thoughts? What if they need an EMS ride? Do they have communication needs? Are there any medical considerations? Where are they going, and who should be called if that changes?
For more, read about ways 988 can assist with service coordination and Julota’s mental health crisis software.
Transportation Should Be More Than a Ride
Transportation is often overlooked in crisis system design. It’s usually treated as just one task on the chart, but the ride itself can escalate or de-escalate the client’s situation.
Maybe they’re having suicidal ideation or just came out of psychosis. Perhaps they overdosed and are meeting in a vehicle with strangers. How will you transport them, and what happens during that ride?
If you use a transport company in your crisis system, you need to understand that the company is playing a role in the client’s care.
Have Plans in Place for Different Situations
What if they need an EMS ride? What type of transport can be used? Can they be transported by family or peers? What happens if none of those options are available?
Plan for these scenarios and know what steps you can take to get the client to where they need to go.
Play Out Your System on a Bad Day
Tabletop exercises are a great way to play out your ideal scenario. But what if the stabilization facility is full? What if a mobile crisis team isn’t available, or your client crosses a city limit? What if your receiving facility decides it can’t take them, or you can’t reach your transport company?
Play out what happens if things don’t go according to plan. Who will take responsibility for that person?
If your plan depends on one person’s cell phone number or an inside favor, you’re not resilient; you’re just hoping, and that’s not a strategy.
Here are some challenges that arise when coordinating across jurisdictions.
Find Your Coordination Debt
Just like technical debt, there’s coordination debt. When you build a system, you’ll hit these situations. Mobile crisis, peer teams, and stabilization facilities all create new gaps.
Perhaps you know someone who can help get the client to a facility. Or you can get that client in when normally you wouldn’t take them. Those workarounds are the debt.
Relationships matter, but your system shouldn’t rely on them.
Map Your System’s Friction Points
Instead of just mapping your resources, take a common journey and see where clients spend most of their time. Where are they assessed multiple times? Do they have to travel far? Who is responsible for follow-up?
By finding these friction points, you can see where to improve service coordination in your community.
What Can You Do to Improve Service Coordination?
Here are some things you can do in the next 90 days.
Days 1-15: Map One Journey
Pick a common scenario and see how far clients get. Where do they spend most time? Where are they assessed multiple times? Who hands them off and who takes them in?
Days 16-30: Create Ownership of Each Handoff
Once you know where your clients are being handed off, assign someone who will be responsible for each handoff. This could be as simple as ensuring they reach the next service.
Days 31-45: Decide on Your Minimum Useful Story
Determine what information to pass along to the next service. How do you ensure they get the information they need? Share as little as possible while still giving the next service enough to take the person in.
Days 46-60: Begin Tracking Your Continuity Clock
Measure the time from decision to when the person receives care.
Days 61-90: Play Out Failure Modes
Now that you know your friction points, play out scenarios that could fail. What happens if the facility is full? What do you do when the transport company is unavailable? What if no one can cover a shift?
The Better Question to Ask
Agencies need to collaborate to provide the best care. But what does optimal service coordination look like?
It’s not a single system or service that every agency uses. Nor is it going to be every agency providing the same service. It’s about knowing what you can do to ensure the person gets the care they need.
How do you know the next service will take them? How do you ensure they get the information they need? What happens if the service doesn’t take them?
That’s when interagency service coordination becomes part of the service.
