Mobile Mental Health Crisis Teams Face Widespread Financial Instability
Mobile mental health crisis teams, designed to respond to individuals experiencing psychiatric crises as an alternative to law enforcement, are grappling with widespread financial instability. This instability has led to the reduction or closure of several programs despite reports of their effectiveness in de-escalating situations and reducing police involvement. Funding challenges stem from inconsistent sources, limitations in insurance reimbursement, and a lack of sustained financial models.
Background and Operational Model
Mobile crisis teams are specialized units that deploy mental health professionals as first responders to 911 calls involving individuals in mental health crises. This innovative approach originated in Eugene, Oregon, in the late 1980s and has since expanded nationwide, with at least 1,800 such teams now operating across the United States. The model aims to mitigate potential negative outcomes associated with police involvement in mental health incidents.
In Bozeman, Montana, a mobile crisis team exemplifies this operational model. The team operates 12 hours daily, seven days a week, with an annual budget of $1 million. Responders assess individuals, create safety plans, and connect them with ongoing mental health care. Program manager Ryan Mattson reported that the majority of calls conclude without police intervention. A significant outcome from the Bozeman program is a nearly 80% reduction in the time police officers spend on mental health calls.
Persistent Funding Challenges
The sustainability of mobile crisis teams is significantly challenged by inadequate and inconsistent funding sources. Unlike police departments, which typically receive consistent local tax funding, mobile crisis teams often lack a single reliable financial stream.
Key funding difficulties include:
- Private Insurance Reimbursement: Many private insurance companies do not reimburse for mobile crisis services. While some states have mandated coverage, this is not universal.
- Medicaid Limitations: Medicaid, a primary public insurance program, covers mobile crisis services in approximately two-thirds of states. However, reimbursement rates vary and often only cover the active time spent on a call, excluding essential activities such as documentation or periods when teams are on standby.
- Cost Overruns: In Montana, costs for mobile crisis programs have reportedly exceeded initial projections.
- Patchwork Funding: Many teams rely on a combination of grants and other short-term, temporary funding solutions, leading to financial instability.
Angela Kimball of Inseparable, a mental health policy reform nonprofit, has indicated that a reliance on a reimbursement-only model presents a significant obstacle. Heather Saunders of KFF, a nonpartisan health research organization, described the current funding landscape as a "patchwork."
Impact: Program Closures and Reductions
The pervasive financial instability has resulted in the closure or reduction of mobile crisis programs in several areas. In Montana, the cities of Great Falls and Billings have ceased their mobile crisis programs, reducing the state's total to six active units. Even the pioneering program in Eugene, Oregon, ultimately closed. Casey Schreiner, an executive at Alluvion Health, which previously operated the Great Falls program, has advocated for a comprehensive reform of the payment system.
Varying State and Local Responses
Some states and local communities have implemented measures to support mobile crisis teams:
- Insurance Mandates: Eight states mandate private insurers to cover mobile crisis calls.
- Cellphone Bill Fees: Ten states have introduced fees on cellphone bills to help fund these services.
- Local Tax Dollars: Certain communities in Montana have contributed local tax dollars.
- State Financial Assistance: Montana health officials acknowledge the challenges and provide approximately $2 million annually in supplemental state financial assistance. They are reportedly evaluating an increase in Medicaid reimbursement rates for service calls.
Demonstrated Benefits and Impact
Mobile crisis teams are trained in de-escalation and therapeutic care. Reported benefits include:
- Reduced Police Involvement: Programs can significantly decrease the time law enforcement spends on mental health-related calls.
- Crisis De-escalation: Teams provide immediate support, create safety plans, and facilitate connections to ongoing mental health care, potentially preventing unnecessary emergency room visits or arrests.
- Enhanced Safety: Studies indicate that individuals with severe mental illness are significantly more likely to experience the use of force by police; crisis teams aim to mitigate this risk by providing an alternative, non-law enforcement response.
Outlook and Future Considerations
The instability caused by program closures can place additional strain on other parts of the healthcare system, such as emergency rooms. Montana plans to participate in a federal pilot program by 2026 to establish Certified Community Behavioral Health Clinics (CCBHCs), which will require 24/7 mobile crisis services. However, concerns persist regarding the feasibility of sustained funding for these services, particularly in rural areas.
Alluvion Health has indicated that a complete revamp of the funding model would be necessary before considering re-engagement in providing such services.