It was a snowy afternoon in Bozeman, a city of nearly 60,000 nestled among the mountains of southern Montana. Temperatures hovered in the mid-30s.
The city鈥檚 mobile crisis team had just gotten a call about a man walking around outside without shoes. The man鈥檚 family told the team he was having a mental health crisis and wouldn鈥檛 come inside.
As they drove down the highway toward the city鈥檚 outskirts, team member Evan Thiessen spoke with the relative who had reached out.
鈥淵ou鈥檙e doing the right thing, and we鈥檙e going to make sure he gets help today, OK?鈥 he said.
They pulled up the man鈥檚 police record on a laptop and saw that he did have a record of some previous encounters with police, including some that had turned violent.
, a licensed therapist, had that in mind as they pulled into a neighborhood of single-family homes. He stepped out of the Ford Bronco and headed toward the front door.
A Funding Problem
Many communities around the country send out teams like this one to help people in psychiatric crisis, rather than dispatching regular police.
A found there were at least 1,800 mobile teams nationwide in 2023. But financial support for them is often inadequate and inconsistent, leaving many communities struggling to keep the teams operating.
Two programs 鈥 one in Great Falls, in central Montana, and one in Billings, in south-central Montana 鈥 recently shut down. Six units remain in Montana.
The strategy in Eugene, Oregon, but gained momentum nationally over the past 10 years.
Recent about police killing people who are experiencing a psychiatric crisis have sparked conversations about how to safely and effectively respond. Most police officers are not trained to deal with people experiencing delusions or hallucinations, nor to de-escalate situations involving threatening behaviors to themselves or others.
An across 27 states found that about a third of the victims showed signs of being in crisis. Another study found that people with a serious mental illness were at least to experience use of force by police as those without.
By contrast, crisis response teams have been trained to de-escalate such situations and provide appropriate therapeutic care.
When the team arrived at the house in Bozeman, the man had already gone back inside. The team then talked with the man鈥檚 family for about half an hour and helped them devise a plan to keep him at home 鈥 and safe. Before they left, team members determined the man wasn鈥檛 a threat to himself or others.
Also, they planned to follow up within a few days to connect him with ongoing mental health care. After an encounter with the team, some clients might need follow-up therapy, assistance with psychiatric medications, or help finding treatment for substance abuse.
The Bozeman team is available 12 hours a day, seven days a week, and costs roughly $1 million a year to run.
Police departments are generally funded by local taxpayers. Mobile crisis teams don鈥檛 have a single, reliable source of funding.
Some, despite successful operations and , are or have closed entirely. One that shuttered was Oregon鈥檚 .
Most crisis calls end with people staying where they are, avoiding a trip to the emergency room or going to jail, according to , which runs the mobile crisis program in Bozeman.
Beyond police and firefighters, members of the public can call the team directly.
鈥淚鈥檝e been out on calls where individuals have barricaded themselves in residences or in their vehicles with a firearm. So, helping to assist not only law enforcement, the negotiators, but consulting on the behavioral health side of that,鈥 said Ryan Mattson, who leads the Bozeman crisis team.
The program has reduced the time that Bozeman police officers must spend on mental health calls by nearly 80%, according to Mattson, and prevented unnecessary ER visits.
Residents and political leaders see that value, he said, but finding a way to pay for the service has been difficult.
鈥淚鈥檓 confident we鈥檒l be here through next fiscal year. That鈥檚 about as confident as I am at this point,鈥 Mattson said.
Mobile crisis programs in Montana, which began operating about five years ago, have cost more than the state originally projected.
Health insurance is sometimes a revenue source for mobile crisis teams. That鈥檚 because a crisis call is a type of mental health service, provided by trained professionals such as therapists or crisis intervention specialists. Still, many private insurance companies don鈥檛 reimburse for mobile crisis services.
What Medicaid Pays For 鈥 And Doesn’t
Medicaid, the government-funded insurance program for low-income and disabled Americans, is another funding source. Two-thirds of states allow Medicaid reimbursement for such calls, but rates vary.
In Montana, Medicaid reimburses the team only for the time they spend responding to a call in the field. Additional time spent on a case 鈥 documenting the encounters, or waiting for the next call 鈥 isn鈥檛 reimbursed.
鈥淵ou need to pay for the capacity to be at the ready, just like we do with fire or police, regardless of whether somebody is going to be called out,鈥 said of Inseparable, a nonprofit that advocates for mental health policy reform.
It鈥檚 not feasible for mobile crisis teams to rely solely on reimbursement from insurance companies, she said.
To deal with the shortfalls, many mobile teams rely on a patchwork of grants and other funding, according to , who studies Medicaid policy at KFF, a health information nonprofit that includes 杨贵妃传媒視頻 Health News.
Some state governments have stepped in to help.
Eight states, including New Jersey, California, and Washington, mandate that private insurers cover the cost of mobile crisis calls for people on their plans, according to Kimball. At least 10 states have implemented fees on cellphone bills to help pay for service.
Montana hasn鈥檛 followed suit.
The state provides about $2 million annually in supplemental funds to help the mobile teams pay for service calls that aren鈥檛 reimbursed through Medicaid, according to an emailed statement from Jon Ebelt, a state health department spokesperson.
But program managers counter that the paperwork to access that funding is complicated and often isn鈥檛 worth the staff time.
Will Montana Step In?
Despite this state support, mobile teams are still struggling to stay afloat, Ebelt acknowledged. He said Montana officials are considering boosting what Medicaid reimburses for each service call.
In Missoula, the mobile crisis team turned to local taxpayers for additional help. Their annual expenditure is $1.4 million, but Medicaid reimbursements were covering only about 20% of the cost, according to program manager John LaRocque. Even with local tax dollars, the program faces a $250,000 shortfall, so LaRocque is looking for grants.
Mobile crisis is still a relatively new concept, and growing pains are to be expected, said Sierra Riesberg, director of the .
Still, abrupt closures create instability and lead some patients to the ER, placing financial pressure on another distressed part of the local health system.
鈥淎 much-needed service is available and then not available, available and then not available. These things need to be taken into consideration when developing programs in communities,鈥 she said.
If more mobile crisis teams shut down, that might interfere with Montana鈥檚 recent efforts to overhaul an outdated and underfunded mental health system. The state鈥檚 only psychiatric hospital hasn鈥檛 kept up with the to the facility.
Later this year, Montana hopes to join a federal pilot program to open a new type of clinic: , or CCBHCs. Those clinics will receive boosted levels of federal funding, but they are required to offer round-the-clock mobile crisis services as well as other crisis care.
That could be a tall order for rural communities, said , an executive at in Great Falls.
Alluvion used to operate the mobile crisis team in Great Falls before it shuttered the service. One major reason it closed was that the expected Medicaid payments covered less than anticipated. Before Alluvion would consider getting involved again, the state would need to 鈥渃ompletely revamp鈥 the way the service is funded, Schreiner said.
鈥淚s it a priority for our state or not?鈥 he asked.
This article is from a partnership with and .
