By Julie Wertheimer
Pew Charitable Trusts
Cities and counties seeking to implement alternative response teams for mental health emergencies can support these efforts by improving other aspects of their crisis care systems, according to a recent report from the Texas-based Meadows Mental Health Policy Institute.
The analysis identifies six essential elements of a crisis care system that can aid multidisciplinary response teams (MDRTs). Those typically include a law enforcement officer, paramedic, and licensed mental health professional who identify and respond to emergencies involving people experiencing behavioral health issues. The goal of MDRTs is to connect people in crisis with quality care, outside of jails and hospital emergency departments.
The Meadows Institute, which received support from The Pew Charitable Trusts for this work, gathered information from Texas MDRT programs in Galveston and Dallas. Researchers identified the following as critical community investments that best support these teams:
- Licensed clinical support for 911 call centers.
- Same-day walk-in clinic and prescriber services.
- Specialized mental health training specific to assisting people who are unhoused.
- 24/7 community hospital bed capacity.
- Crisis medical care capacity for people with substance use disorders.
- Access to a housing referral network.
The findings reinforce the need for strong continuums of crisis care—systems that offer intervention or treatment at a variety of points and that take a comprehensive approach to helping those in crisis.
1. Licensed clinical support for 911 call centers
The Meadows Institute researchers found that 911 call centers with embedded mental health clinicians can support MDRTs through real-time mental health triage for people in crisis. Clinicians who are working directly in 911 call centers—whether virtually, as in Galveston, or in person, as in Dallas—can quickly identify mental health emergencies and dispatch response teams. The call center clinicians can help manage those in crisis until response teams arrive on the scene. Clinicians also can access existing health records that may help them identify important information about an individual’s health history. A separate survey from Pew shows that only 13% of respondents were aware of the 988 Suicide and Crisis Lifeline and its purpose nine months after the July 2022 launch. With so many people still relying on 911 for behavioral health emergencies, call centers must be staffed to handle such crises.
2. Same-day walk-in clinic and prescriber services
The ability to connect individuals experiencing a mental-health crisis with same-day, walk-in clinic care, including any necessary medication, enables MDRTs to connect people with the treatment they need immediately. That helps them stay in their communities and avoid emergency room visits. Dallas improved its ability to connect people with same-day care by collaborating with an area mental health care provider that has multiple clinics, many with pharmacies on-site.
3. Specialized mental health training specific to assisting people who are unhoused
The Meadows Institute found that MDRTs were most successful when team members supplemented their credentials with additional training specific to the unique needs of unhoused people. Specialty training on identifying and de-escalating emergencies involving people without stable housing, particularly those who are experiencing long-term housing instability, helps MDRTs better respond to their needs and connect them with care.
4. 24/7 community hospital bed capacity
The Meadows Institute found that the availability of sufficient hospital beds to help stabilize individuals is key to keeping individuals in crisis out of jail and connecting them with appropriate care (for those who need observation or in-patient care). MDRTs often have limited options for places to take someone in crisis, as hospitals may not always have the capacity or needed services. In addition, psychiatric facilities are scarce and those that do exist are often either full or far away. Dallas addressed this by partnering with a hospital system to increase observation unit capacity, providing more options for MDRTs and people in crisis.
5. Crisis medical care capacity for people with substance use disorders
MDRTs respond to emergencies related to mental health and substance use disorders, but have few options for places to take individuals experiencing a substance use emergency, or a co-occurring disorder. Facilities that are equipped to handle substance use disorders—and removing the medical clearance issues that can impede access to them—can help. The Meadows Institute noted that Galveston MDRT members had found that the region needed more facilities for those with substance use issues who may require a higher level of care than is available in the community but may not qualify for hospitalization.
6. Access to a referral housing network
Lack of safe, stable housing can be a barrier to mental health care. The Meadows Institute found that MDRTs need the ability to address the housing needs of people experiencing mental health crises. Housing not only provides stability, but also helps with continuity of care. Both the Galveston and Dallas response teams cited the need for additional housing resources and more detailed information on existing resources, such as local shelters and their ability to accept clients experiencing mental health issues.
Effective emergency response must be a critical part of the crisis care continuum and can determine whether individuals get the services they need. MDRTs have shown promise in bolstering that system of care. A 2021 report evaluating Dallas response teams found that 40% of calls resulted in a connection to a community service, and 29% were resolved on the scene, with no additional services needed.
Policymakers can take steps to ensure such promising approaches continue to grow. The research shows that these teams are most successful when the communities they serve have strong systems that truly support individuals in crisis.
Julie Wertheimer directs research and policy for The Pew Charitable Trusts’ mental health and justice partnerships project.
This article first appeared on PewTrusts.org and is reprinted with permission.