How to Build a Mobile Crisis Team

In this article

The current state of crisis systems

The field of mental health crisis response has expanded dramatically in recent years due to a variety of factors, including the passing of the National Suicide Hotline Designation Act. This solidified the Biden administration’s focus on mental health, and the increase in identified mental health needs during the pandemic.¹

Today, all states have some form of crisis system with most states having at least one mobile crisis program that provides real-time, face-to-face mental health crisis response with community members.² Mobile crisis teams come in a variety of forms and employ different types of responders, technology and areas of specialty focus. This can lead to difficulty identifying the best type of crisis response for a geographic area.

Optum® Behavioral Health Solutions has reviewed crisis service capabilities across the country, examining both current studies and our own national utilization data. Based on this review, we offer the following recommendations for MCTs.

Mental health crisis response and prevention

The most effective means of reducing the frequency and impact of mental health crisis episodes is to invest in prevention and ongoing care. Optum focuses on supporting individuals from all populations by tailoring programs to meet their unique needs. This includes:

Prevention through peer support
Emotional support crisis lines
Best practice guidelines
Coordination of care
Post-crisis follow-up care

Optum works to strengthen the relationship between individuals and their care teams by equipping them with data and financial support to improve their care delivery.

Benefits of mobile crisis teams

MCTs provide several benefits to individuals, communities and the healthcare system at large. These benefits can be adding value and/or decreasing the likelihood of negative consequences. For example, all MCT programs reviewed here play an important role in decreasing rates of arrest and incarceration.^2,3 This is largely due to the decreased presence of law enforcement and the greater focus on de-escalation and stabilization of the crisis episode. This is especially important given the overrepresentation of individuals with serious mental illness (SMI) in the justice system.

One study found that 71% of individuals diagnosed with an SMI had been arrested in the past, with the average frequency of 8.6 lifetime arrests.⁴ This gap significantly impacts Black, Native American and people of color (BIPOC) communities. For instance, studies show that Black youth are arrested 11 times more often than their white peers, even though they engage in less illegal behavior.⁵

Numerous studies have also documented the reduced system expense that comes from leveraging the less costly crisis response model rather than hospitals and emergency rooms for immediate care.^4,5,6,7 SAMHSA illustrated the powerful return on investment for using crisis services by estimating the cost of an emergency room (ER) and inpatient stay combined (on average $10,233 per person per episode) and comparing it to the average cost of an MCT intervention ($360).⁸

Avoiding the economic costs of entering the justice system are even more significant, with the average cost of arrest surpassing $13,000 and a detention costing more than $134,000 per person.⁹

MCTs consistently reduce ER visits and behavioral health inpatient admissions.^10,11,12 Optum has observed these decreased system costs firsthand as a result of directing individuals to engage with mobile crisis teams in lieu of ERs and inpatient hospitals by leveraging an up-to-date database of mobile crisis providers throughout the country.

On average, this action can lead to savings of approximately $6,820 per mobile crisis episode when ER and inpatient care are avoided.¹³ This is especially important given the dramatic rise in ER visits for mental health complaints and the corresponding psychiatric ER boarding challenges.

MCTs also achieve better rates of individual engagement with community resources after a crisis than hospital-based programs.^4,10 This can lead to better connection and adherence to ongoing outpatient support and community engagement, both protective factors for mental health. Because of the wide number of documented benefits provided by MCTs, many communities are working to build or add these services to their existing service array.

In January 2022, Optum launched the Integrated Crisis Support tool within our clinical platforms to provide a seamless crisis experience for our members. Optum staff who interface with members are trained on crisis response options for situations that require very urgent mental health interventions. Now, when Optum team members determine that callers would benefit from an MCT in lieu of ER or inpatient services, they can be connected to this option immediately.

Over the last 2 years of using this intervention, Optum consistently sees that about two-thirds of individuals are stabilized at home with community resources and do not require ER or inpatient stays.¹³ This is a dramatic decrease in utilization of ER or 911 services.

Mobile crisis team models

MCTs come in a variety of formats. Each approach achieves the benefits outlined above at different rates, but all programs show community and healthcare system benefits.³ The experience Optum has with various MCTs shows that they consistently help, with over 60% of crisis cases not needing higher levels of care.^13,14

The Types of mobile crisis teams and descriptions table on this page summarizes the main types of MCTs and identifies common subcategories of these programs, along with a brief description of the model and a program example.^3,10 Most communities benefit from having more than one type of MCT, as these programs may target different populations and receive referrals through different mechanisms.

There isn't clear evidence to suggest that one method of MCT is superior to all others, given the amount of customization needed to fit local constraints of funding, population characteristics, geography and involuntary commitment laws, which often require a peace officer to detain or transport an individual to care.^15,16 In addition, research has been unable to successfully compare differing models of MCT while controlling for other variables.

Selecting and building a mobile crisis team

When a community is determining which mobile crisis team would be beneficial for their residents, there are several factors to consider. These include:

Population size
Funding availability
Geographic area
Existing crisis services
Goals for the program to achieve

It is important for stakeholders and crisis providers to collaboratively review these different factors and determine priorities.

The best model for a community is the one that has the most buy-in and support from those they intend to serve. Crisis providers note that the biggest barrier to providing crisis service is workforce issues, followed by funding, the difficulty of solutioning for rural environments and meeting the 24/7 need.^29,30

Additionally, there will be elements that go beyond the direct control of the stakeholders that would require further work and often legislative action to change. These can include Medicaid rate setting, availability of state general funds, and statutes that determine involuntary commitment procedures that often rely on law enforcement to fulfill.

The Form of mobile crisis team paired with favorable community factors table on this page lists the various types of MCTs and the environments or conditions where they are most effective. Not included in this table are specialty programs that focus on homelessness, high utilizers and other specialty populations. These MCT programs often are beneficial value-adds after core crisis services have been identified. The goal of the table is to assist with identifying types of programs that may be good additions to communities.

Individual communities will need to determine their priorities and unique needs. Some mobile crisis solutions work better in some environments than others. For example, a rural environment that also has inconsistent broadband, workforce challenges and limited funding may benefit most from an MCT that provides in-person response at a lower cost and lower workforce need. In this case, leveraging a co-responder model that builds upon the existing public safety services who currently respond in person may be the best fit.

In a more urban setting, the focus may be on supporting diverse populations with tailored responses, such as those for youth, LGBTQ+ and communities of color, while also leveraging better access to technology. These communities may benefit more from the traditional SAMHSA best practice of clinician-led, in-person response teams, including those that support youth with stabilization services.

The ability Optum has to log and validate all current mobile crisis providers shows national trends. For example, rural and frontier areas tend to have fewer resources. They are also more likely to have restrictions, such as hours of operation and populations served. At times, they may lack the ability to provide in-home response services, opting instead to meet residents at the hospital.

When building or adding an MCT, there are elements to keep at the forefront to ensure a successful community program. These elements include collaboration, a data-driven approach, transparency and sustainability. The first element of collaboration is vital to developing a program. MCTs need to complement any existing crisis services in the community.¹¹

Collaboration

Crisis providers must work together to support a continuumof services to meet the needs of all individuals. This requiresinclusion of key partners such as first responders, outpatientmental health providers, individuals with lived experiences,underrepresented groups and ER staff. By involving these stakeholders from the beginning and shaping the services that the community desires, MCTs are more likely to be well-utilized.

Data-driven approach

Leveraging existing data on current community needs is critical to understanding who and where the service should be focused. One method of doing this is to engage the local Public Safety Answering Point (PSAP) call center, heavily utilized ERs and managed care organizations to understand where the individuals are located who are using emergency care.

Heat mapping is an effective way of doing this to better illustrate the geographic areas of need and project future utilization numbers. As the MCTs are developed and begin providing service, data must be collected on individuals served including demographics, clinical reasons for the service, and resolution. Tracking this data at the outset will be helpful when analyzing trends or future areas of needs.

Transparency and shareability

Data transparency and easy shareability is key to engaging the community and garnering ongoing support. The state of Connecticut, among other crisis systems, regularly does this by publishing their monthly crisis system data on youth.¹⁹ This approach encourages the analysis of the data collected and an opportunity to engage in continuous improvement and reevaluation.

Disparities in populations served may be better identified, a necessary first step in addressing these disparities in resources and care. Optum believes in partnering with crisis providers to receive timely crisis data. These partnerships are present in several markets that improve understanding of crisis utilization and needs.

Optum also supports transparency in crisis service and posts all validated mobile crisis providers nationally to its public website, Optum Wellbeing. To support seamless connections, the Optum San Diego Access and Crisis Line transfers calls in real-time to the member’s MCO as appropriate for resolution and resource support. This enables other MCOs to support members with in-the-moment crisis support and determine any ongoing needs including care management.

Sustainability of funding streams

The final element that must be included in developing MCTs is a focus on the sustainability of funding streams. The most common method of funding crisis services is a braiding of state general funds, federal mental health block grant dollars, and reimbursement from Medicaid.² In particular, state general fund dollars are heavily utilized for startup needs including infrastructure and training.³¹ Currently, there is an opportunity for CCBHCs to receive an 85% federal medical assistance percentage (FMAP) for mobile crisis in certain scenarios for up to 3 years.^32,33 However, the availability of this funding and other mobile crisis planning grants offered by SAMHSA are currently set to conclude by 2027.

This time frame allows for a community to benefit from the unprecedented grant funding currently available to support startup costs but will require MCTs to transition to their own more sustainable funding methods in a few short years. Optum supports rewarding providers for achieving quality outcomes. Leveraging value-based care and alternative payment arrangements can be creative ways to support more sustainable financial success of crisis providers.

For those models that rely more heavily on law enforcement staff, funding often comes directly from a city or county budget. Grants may also be available through the Department of Justice, Community Oriented Policing Services (COPS), and the Justice Assistance Grant (JAG) Program.³⁴

Regardless of the funding sources, MCTs must make provisions to support ongoing operational and staffing costs including a significant amount of downtime, transportation time and services to uninsured individuals, all of which are not reimbursable by Medicaid but are required as part of the MCT approach to crisis care.²⁴ For this reason, the firehouse model of funding through local government budgets is often utilized. This supports the idea that funding needs to be available consistently if services are on-demand to support the surges and downtimes that are part of the crisis cycle.¹⁴

Optum also works with local partners to ensure that support is available to individuals after a crisis episode ends. The role of the health plan is to reengage the member in care and support their ongoing recovery. Optum has partnered with several organizations to support this post-crisis period and intends to expand further into this arena.

Stakeholder roles and resources

When building or improving upon crisis services, there are important roles for all stakeholders to work together, leveraging their strengths and areas of expertise. All stakeholders must ensure that they are embedding themselves in the larger community and have seamless communication is seamless between the different roles.

For example, crisis providers must work with behavioral health providers and community-based organizations to ensure that they can make effective referrals that will meet their clients’ needs. Behavioral health providers can play a preventive role by working with their clients on developing crisis plans, ensuring good knowledge of local crisis resources and creating processes for doing post-crisis engagement.

Similarly, community-based organizations that address health-related social needs can create policies on how they support individuals in crisis and maintain strong relationships with both behavioral health providers and the larger crisis system. The role of first responders includes making nationally recognized training like crisis intervention team (CIT) programs available to their staff. Additionally, they can analyze their data on mental health calls to determine if there are any geographical hot spots for crisis calls and equip these responders with additional training and resources.

Managed care organizations (MCOs) have a unique role in supporting local MCTs and behavioral health providers. This includes giving behavioral health providers data on any known crisis utilization to support follow-up or conducting outreach themselves. Optum does this in numerous markets, such as Washington, Kansas and San Diego for individuals receiving different forms of crisis care. MCOs may also offer alternative payment arrangements to reward both crisis and outpatient providers for meeting crisis quality standards.

National organizations such as the National Council for Mental Wellbeing and the National Association of State Mental Health Program Directors (NASMHPD) play a critical role as stakeholders developing policy and resource documents that discuss how crisis and behavioral health providers can enhance their services and improve collaboration across the system.

First responders can leverage the resources available by CIT programs and the Bureau of Justice Association (BJA) Organizations that provide grants for crisis expansion are also key to the development of future programs. SAMHSA and COPS are 2 examples of such organizations for behavioral health providers and first responder respectively.

Meeting local needs

Mobile crisis teams offer many significant benefits. They reduce the utilization of higher levels of mental health care, they are well-received by communities, and they provide appropriate crisis response in the least invasive way while also reducing the likelihood that individuals will enter the justice system. Not only are MCTs a better experience for the individual, but they benefit the system at large because of their lower cost.

However, it’s important to remember that MCTs are just one tool to support the overall crisis continuum. If a community only has an MCT program and lacks a crisis stabilization facility or easy access to outpatient mental health support, the rate of diversion from ERs and inpatient care will be lower. The presence of a Medicaid waiver, such as for home- and community-based services, is important for strengthening a local crisis system and ensuring its sustainability.

No factor is more critical than the analysis, planning and community engagement required to ensure the MCT meets local needs while helping providers and MCOs take positive next steps with crisis system expansion.

Related healthcare insights

White paper

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How to build a mobile crisis team