Adult-focused mobile crisis teams are interdisciplinary teams of health care workers who support individuals experiencing behavioral health crises in their homes or other community-based locations. These teams de-escalate behavioral health crises and connect individuals to other health services. Mobile crisis teams are distinct from crisis intervention approaches that involve law enforcement. They are a core component of a comprehensive behavioral health crisis system, which also includes regional crisis call centers and crisis stabilization programs.
As the United States faces high rates of behavioral health conditions and unmet behavioral health needs, crisis systems, including mobile crisis teams, can expand behavioral health service capacity and reduce reliance on law enforcement to address behavioral health crises. Building robust behavioral health crisis systems is also an important strategy for reducing racial disparities in access to behavioral health care, police violence, and incarceration. Behavioral health crisis services seek to: enhance access to care, support improved health and social outcomes through care tailored to individual needs, prevent inappropriate use of emergency department and inpatient services, and address the disproportionate jailing and incarceration of individuals with behavioral health conditions.
How do mobile crisis teams work?
While the specifics of mobile crisis teams vary, they typically operate at regional or county levels with availability 24/7. It is best practice for mobile crisis teams to include at least two professionals: a licensed or certified behavioral health clinician who can appropriately assess and diagnose mental health conditions, and a peer support specialist with lived experience of behavioral health conditions who can build rapport with the individual in crisis.
Mobile crisis teams can be engaged through a variety of pathways such as through 911 and 988 Suicide and Crisis Lifeline calls or connections from providers or other first responders. Once contacted, teams conduct initial behavioral health screenings and determine whether the mobile crisis team is the most appropriate personnel to respond (as opposed to law enforcement or other emergency health services). At the scene, mobile crisis teams seek to assess and de-escalate the crisis. As appropriate, the teams connect the individual in crisis to other health services (e.g., crisis stabilization facilities, community-based services, inpatient services, etc.) and follow up post-encounter to ensure needs are being addressed.
What is the policy landscape for mobile crisis teams?
At least 33 states provide some Medicaid coverage for mobile crisis services. Beginning in 2022 and through 2025, the American Rescue Plan Act (ARPA) provides additional support and incentive for Medicaid to support mobile crisis teams by offering an increased federal funding match of 85 percent for three years. To be eligible for enhanced federal funding, mobile crisis programs must meet federally defined criteria related to availability, staffing, training, and services offered. As of 2023, 28 states either were using this ARPA funding opportunity or planned to in the future.
Additionally, mobile crisis teams are one component of the Certified Community Behavioral Health Clinic (CCBHC) model, which aims to enhance access to comprehensive, coordinated behavioral health services. Eighteen states currently participate in the Section 223 Medicaid CCBHC Demonstration program, in which Medicaid supports CCBHCs through a cost-based payment model, and more states will be able to apply for the opportunity going forward. The Substance Abuse and Mental Health Service Administration also provides grants for individual CCBHCs in both demonstration and non-demonstration states.
In addition to mobile crisis team-specific financing opportunities, other policies support implementation of crisis systems more broadly. Most notably, federally mandated 988 Suicide and Crisis Lifelines were implemented in 2022 and states continue to refine implementation. Ongoing rollout and funding of 988 and other crisis service will likely impact implementation and outcomes of mobile crisis services.
What is the evidence behind adult-focused mobile crisis teams?
The body of evidence on mobile crisis teams for adults is limited, at least in part, due to variation in model implementation across programs. Emerging evidence suggests that these programs align with how individuals experiencing crises prefer to receive care and may support outcomes such as reduced hospitalizations and reduced crime. Below are select studies that may be of particular relevance to stakeholders supporting development or implementation of adult-focused mobile crisis programs in the U.S.
- Crisis Response Model Preferences of Mental Health Care Clients with Prior Misdemeanor Arrests and of Their Family and Friends - Researchers interviewed individuals with serious mental illness and a history of arrest and their family and friends about their preferred crisis response model. Most interviewees chose a non-police response (i.e., the mobile crisis team model) as the preferred crisis response type.
- A Community Response Approach to Mental Health and Substance Abuse Crises Reduced Crime - This study evaluated the impact of a mobile crisis response pilot in Denver. Precincts participating in the pilot showed declines in reports of “less serious crimes (e.g., trespassing, public disorder, and resisting arrest)” reflecting the impact of “health-focused first responders” in the mobile crisis approach.
- Assessing the Impact of Community-Based Mobile Crisis Services on Preventing Hospitalization - This 2001 study compared outcomes of adults experiencing behavioral health crises who received mobile crises services to those who sought care at a hospital-based psychiatric emergency department. The study found that individuals receiving mobile crisis services were less likely to be hospitalized than those who sought hospital-based crisis care.
- Assessing the Impact of Mobile Crisis Teams: A Review of Research - This evidence review describes the mobile crisis team model, variations in implementation across programs, and an overview of research on the impact of mobile crisis teams.
What do mobile crisis teams look like in practice?
The following resources offer insights into how mobile crisis team programs are designed and implemented:
- National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit - This Substance Abuse and Mental Health Service Administration toolkit defines national guidelines, provides tips, and includes tools for implementing crisis services, including mobile crisis teams.
- Enlisting Mental Health Workers, Not Cops, In Mobile Crisis Response - This case study describes the Crisis Assistance Helping Out On The Streets (CAHOOTS) model, operated by the White Bird Clinic in Eugene, Oregon, its impact, and how other localities are adopting similar models.
- Mobile Crisis: Maximizing New Medicaid Opportunities and State Innovations in Medicaid Managed Care for Mobile Crisis Services - These blog posts provide considerations and examples of how Medicaid can support access to and implementation of mobile crisis services.
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