By the time Kiki Radermacher, a mental health therapist, arrived at a Missoula, Montana, home on an emergency 911 call in late May, the man who had called for help was backed into a corner and yelling at police officers.
The home, which he was renting, was about to be sold. He had called 911 when his fear of becoming homeless turned to thoughts of killing himself.
“I asked him, ‘Will you sit with me?’” recalled Radermacher, a member of the city’s mobile crisis response team who answered the call with a medic and helped connect the man with support services. “We really want to empower people, to find solutions.”
Missoula began sending this special crew on emergency mental health calls in November as a pilot project, and next month the program will become permanent. It’s one of six mobile crisis response initiatives in Montana — up from one at the start of 2019. And four more local governments applied for state grants this year to form teams.
Nationwide, more communities are creating units in which mental health professionals are the main responders to psychiatric crises instead of cops, though no official count exists of the teams that are up and running.
More support is on the way. The COVID relief package President Joe Biden signed in March offers states Medicaid funding to jump-start such services. By July 2022, a national 988 hotline, modeled on 911, is slated to launch for people to reach trained suicide prevention specialists and mental health counselors.
Protests against police brutality in the past year have helped propel the shift across the United States. While one rallying cry has been to “defund the police,” these crisis intervention programs — the sort that employ therapists like Radermacher — are often funded in addition to law enforcement departments, not drawing from existing policing budgets.
Studies suggest such services enable people in crisis to get help instead of being transported away in handcuffs. But the move away from policing mental health is still a national experiment, with ongoing debate about who should be part of the response, and limited research on which model is best. Even then, not all communities can afford and staff separate mental health teams.
“I don’t know that there’s a consensus of what the best approach is at this point,” said Amy Watson, a professor of social work at the University of Wisconsin-Milwaukee who has studied such crisis intervention. “We need to move towards figuring out what are the important elements of these models, where are the pieces of variation and where those variations make sense.”
The federal Substance Abuse and Mental Health Services Administration sets minimum expectations for teams, such as including a health care professional and connecting people to more services, if needed. Ideally, the guidelines suggest, the team should include a crisis response specialist who has personally experienced mental health challenges, and the team should respond to the calls without law enforcement.
Still, crisis response teams vary significantly in their makeup and approach. For more than 40 years, the Los Angeles Police Department has deployed teams in which police officers and mental health workers respond together. It boasts the program is one of the nation’s earliest to do so. A program out of Eugene, Oregon, which has been copied across the U.S., teams a crisis intervention worker with a nurse, paramedic or emergency medical technician. In Georgia, 911 emergency dispatchers steer calls to a statewide crisis center that can deploy mobile units that include professionals with backgrounds in social work, counseling and nursing. In Montana, teams are based within law enforcement departments, medical facilities or crisis homes.
“Mobile crisis response, in whatever format it looks like, is becoming more and more the norm,” said Kari Auclair, an area director for Western Montana Mental Health Center, a nonprofit treatment program. “In some communities, it’s going to be the church group that’s going to be part of a crisis response, because that’s who people go to and that’s what they’ve got.”
Defenders of the various models tout reasons for their teams’ makeups and match-ups: Medics can recognize a diabetic blood sugar crash that might mimic substance misuse or a mental health crisis; police can watch for danger if tensions escalate; and crews tethered to hospitals’ behavioral health units have a team of doctors on standby they can consult.
Many crisis teams still work directly with law enforcement, sometimes responding together when called or staying on the scene after officers leave. In Montana, for example, 61% of the calls that crisis teams handled also involved law enforcement, according to state data.
Zoe Barnard, administrator for Montana’s addictive and mental disorders division, said her state is still establishing a baseline for what works well there. Even after they’ve worked out a standard, she added, local governments will continue to need flexibility in how they set up their programs.
“I’m a realist,” Barnard said. “There will be parts of the state that are going to have limitations related to workforce, and trying to put them into a cookie-cutter model might keep some from doing something that really does the job well.”
In some areas, recruiting mental health workers to such teams is nearly impossible. Federal data shows 125 million people live in areas with a shortage of mental health professionals, a problem exacerbated in rural America. That lack of expertise and support can fuel the crises that warrant emergency help.
In Helena, Montana’s capital, for example, a crisis crew that formed in November must still fill two positions before services can run round-the-clock. All across the U.S., with these sorts of high-stress jobs often paid through cobbled-together grants, retaining staff is a challenge.
Being flexible will be key for programs as they develop, said Jeffrey Coots, who directs an initiative at John Jay College of Criminal Justice in New York City to prevent unnecessary imprisonment.
“We’re trying to figure our way out of historical inequities in mental health care services,” Coots said. “The best thing to do is to run that demonstration project, and then adapt your team based on the data.”
And for the people in these crises who need help, having an alternative to a police officer can mean a big difference, said Tyler Steinebach, executive director of Hope Health Alliance Inc., which offers behavioral crisis training for medics across Montana. He knows firsthand because he has both bipolar and post-traumatic stress disorders and has had to call 911 when his own mental health has plummeted.
“You know cops are coming, almost certainly,” Steinebach said, from his personal experience. “You’re trying to figure out what to say to them because you’re trying to fight for yourself to get treatment or to get somewhere where you can talk to somebody — but you’re also trying to not get hauled off in handcuffs.”
Gallatin County Sheriff Dan Springer also noticed the benefits after two mental health professionals started to respond to 911 calls in Bozeman and the surrounding area in 2019. Although deputies in his department are trained in crisis intervention, he said that goes only so far.
“When I hear deputies say the mental health provider is a godsend, or they came in and were able to extend the capabilities of the response, that means something to me,” Springer said. “And I hear that routinely now.”
Erica Gotcher, a medic on the mental health response team in Missoula, recalled a day recently when her team was wrapping up a call and received three new alerts: A man was considering suicide, a teen was spiraling into crisis and someone else needed follow-up mental health services. They knew the suicide risk call would take time as responders talked to the person by phone to get more details, so they responded to the teen hitting walls first and saw all three people before their shift was done.
Gotcher said being busy is a good sign that her team — and teams like it — are becoming just one more form of first response.
“Sometimes we roll up on a scene and there are three cop cars, an ambulance and a firetruck for one person who is having a panic attack,” Gotcher said. “One of the best things that we can do is briefly assess the situation and cancel all those other resources. They can go fight fires; they can go fight crime. We are the ones that need to be here.”
But gaps still exist, such as not always having somewhere to take a patient who needs a stable place to recuperate or get more help. The team’s shift also ends at 8 p.m., meaning, come nighttime, it’s back to police officers responding alone.
If you or someone you know is in a crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.