Three Things To Read This Weekend
(1) “San Diego County’s Mobile Crisis Response Teams Are A Success.” San Diego Union-Tribune
For context: San Diego County has 16 mobile crisis teams responding to calls involving acute mental health crises. Each team includes a mental health clinician and two other healthcare experts. The two authors of this opinion piece are the director of the city’s Health and Human Services Agency and the director of the agency’s Behavioral Health Services Division. They help oversee the county’s mobile crisis response program.
“From their launch through late July, the Mobile Crisis Response Teams have responded to more than 2,245 referrals. Of those, 40 percent have resulted in the individual in crisis being able to remain in the community without the need for more acute care or law enforcement involvement. More than 515 individuals have been connected to behavioral health resources and services for the first time …. Typically, when someone is experiencing a crisis of any kind, it can be second nature to call 911. Yet we know not every call to 911 requires a law enforcement response. Providing this new crisis response option has been a win-win for clients and emergency personnel, not only freeing up law enforcement, but emergency medical providers who might have otherwise been dispatched to nonviolent, nonmedical emergencies.”
(2) “5 patients cost $4 million in ambulance rides,” San Francisco Chronicle.
For context: Cities waste millions of dollars cycling people with acute mental health needs in and out of emergency rooms, creating a strain on hospital resources and providing suboptimal care to people in desperate need of mental health services. Mobile crisis response teams can help.
“Five individuals alone over the past five years had at least 1,781 ambulance transports, possibly up to 2,000, which costs $4 million … The five struggled with alcohol use disorder, possibly self-medicating due to an undiagnosed mental illness …. The city’s only psych emergency department capped its capacity at 19 beds at the start of the pandemic and still diverts all patients to its emergency room for COVID testing. Although the department is licensed for 18 patients, census routinely rose into the mid-20s before the pandemic. A third of patients are discharged directly from the emergency department, while two-thirds come back … To reduce the burden, the city has turned to a slew of alternative programs, including a psychiatric urgent care clinic, the Street Crisis Response Team and a drug sobering center.”
Related: In Connecticut, where a variation on the street team has existed for years, researchers from the Child Health & Development Institute found that “mobile crisis response is associated with a 25% reduction in emergency department visits.”
(3) National Governors Association Report On Behavioral Health Equity
For context: The NGA, a bipartisan organization composed of all the governors in the country that shapes best practices on policy across states, released a report with granular guidance on how states can leverage federal dollars to improve the quality of mental health services.
First, the report contains a section highlighting federal resources, including:
“The American Rescue Plan Act of 2021 (ARPA) established a new state Medicaid option to provide community mobile crisis intervention services with a three-year period of an enhanced federal matching rate” and “The Bureau of Justice Assistance has launched Connect and Protect: Law Enforcement and Behavioral Health Response, a new funding opportunity to help communities reduce unnecessary law enforcement contact, connect people to treatment and supports and improve public safety.”
Second, the report highlights a (very) partial but important answer to the staffing issues that mobile health crisis teams face, especially around hiring an adequate number of senior healthcare professionals:
“[Medicaid] authorizes telehealth assessment and screening by mobile crisis providers, a shift which has the potential to expand access to emergency assessment services. Communities have begun to leverage telehealth technology to support more appropriate and responsive care for individuals experiencing behavioral health emergencies: Many states, including South Carolina, South Dakota, Montana and Oklahoma, have expanded behavioral health assessment capacity by supplying computer tablets to first responders (law enforcement or emergency medical services), allowing them to connect directly with behavioral health clinicians. These efforts support rural communities in accessing behavioral health supports, reduce unnecessary hospital transports and allow for direct consultation with psychiatrists.”
