In April of 2021, The Center for Law and Social Policy (CLASP) reported findings on the effectiveness of mobile responses – “an alternative to using law enforcement to respond to mental health and social crisis.” This week CLASP started a letter to CMS to support these efforts (see following article for what you can do).
In the report, CLASP dissects successful mobile response systems in Connecticut, Oklahoma, and Oregon, shares principles for implementation, funding opportunities, and recommendations for the federal government to get involved.
CLASP reports individuals with untreated mental illnesses are 16 times more likely to be shot and killed by the police, and they are one in four of all individuals who are incarcerated. Additionally, people of color are susceptible at an increased rate. Black people with a mental health diagnosis are more likely to be incarcerated than any other race. It is likely this is caused by historical and generational trauma, leading to high rates of anxiety, depression, and suicidal thoughts and ideation in part due to racism and social inequities. To combat the adverse effects of poor mental health, CLASP provides these key principles for effective mobiles response programs:
- Invest in police-free mental health response
- Create their own point of entry
- Train all staff involved in mobile response
- Not require mental health responders to have professional degrees
- For mobile response to be effective and equitable, services must be Medicaid reimbursable for all organizations and providers
- Invest in a continuum of services to address the whole person.
Currently many states mobile response systems are funded using multiple sources, including Medicaid 1915 (b) and (c) waivers. CLASP also proposes that the federal government implement the National Suicide Hotline Designation Act, which assigns 9-8-8 as the national suicide and mental health crisis hotline telephone number, pass the Crisis Assistance Helping Out on the Streets (CAHOOTS) Act, which enhances the federal matching rate of 95% for mobile crises services, and changing the priorities of the Substance Abuse and Mental Health Services Administration (SAMHSA). Already, three states, Connecticut, Oklahoma, and Oregon, have enacted effective crisis services that provide some aspect of CLASP’s proposals.
Designed 12 years ago, Connecticut developed a statewide mobile crisis service, that uses 2-1-1 telephone number (open 24/7) as a point of entry for services. For funding, Connecticut has utilized federal block grants, philanthropy, Medicaid, private insurance, and State allocated funds.
Through this program, Connecticut has seen phenomenal outcomes, including 92-93 percent mobility rates, meaning providers were dispatched to a crisis over 90 percent of the time, when called.
In 2019, a survey conducted among Connecticut parents, showed an average of 8.8 percent improvement in child functioning and 10.8 percent decline in child problem severity following mobile crisis involvement. Connecticut’s program has shown many strengths like their high mobility rates, and their statewide system. Additionally, the implementation of their strong data system, allows them to run data analysis to track the demographics of their clients, has given them the tools for improvement.
Similarly, Oklahoma has successfully implemented an evolved Mobile Crisis Response and Stabilization system creating a positive impact on communities. Oklahoma’s original model only addressed acute mental health issues, requiring a criterion one must meet in order to receive care. The new model offers families the ability to define their own criteria, which in turn resulted in decreased suicide calls to the police, high rates of students receiving services and returning to class, reduction in Medicaid costs, and positive change in youth behavior and functioning.
Oklahoma’s Mobile Crisis Response and Stabilization service is funded through state and Medicaid funding, which allows staff to be adequately compensated for their time and free services for clients. Oklahoma’s service is based on a continuum of care, so it offers follow-ups for non-hospitalized clients, services for individuals up to age 25, de-escalation, restoration to pre-crisis level of stabilization, and prevention services for homelessness, detention, and hospitalization.
Individuals who call the crisis line are not barred to a time frame, they are able to request either an immediate response or an appointment in the following days. This flexibility helps prevent individuals from waiting until an emergency before they reach out for mental health assistance.
Oregon enacted a similar program, CAHOOTS, Oregon has struggled to reach a state-wide level because of the lack of funding. Currently, Medicaid and city grants pay for funding in Springfield and Eugene, which provides de-escalation and homelessness services. From the services, both cities were able to save $15 million from ER diversion and visit high schools for prevention services. CAHOOTS struggles with outreach and funding, so it is at a standstill of services.
CLASP recommends enactment of the Medicaid 115 Demonstration Waiver, Medicaid 1915(b) and (c), or Medicaid State Plan Amendment to improve these programs already in place and initiate the expansion to other states. Link to report: https://www.clasp.org/sites/default/files/publications/2021/04/Youth%20Mobile%20Response%20Services_0.pdf See following article to learn what your agency can do.