Crisis Response Systems Model

Crisis response systems are organized structures, processes, and services that seek to help address mental health crises quickly and effectively while enabling individuals to remain in their communities. Crisis response systems often aim to divert individuals from avoidable interactions with the criminal justice system.

The Substance Abuse and Mental Health Services Administration's (SAMHSA) National Guidelines for Behavioral Health Crisis Care identify three core elements of a crisis response system:

Mobile crisis teams
24/7 regional crisis call centers with crisis intervention capabilities through phone, text, and chat support
Crisis receiving and stabilization facilities that serve all people

In rural areas, mental health workforce shortages are a primary barrier to crisis response, leaving most crisis response efforts in the hands of law enforcement. This can lead to increased interactions with the criminal justice system. Many rural communities are implementing SAMHSA's Sequential Intercept Model to reduce over reliance on law enforcement and the number of individuals with a mental illness in jails. The Sequential Intercept Model outlines several opportunities to divert individuals experiencing a mental health crisis to community services. The Sequential Intercept Model includes six intercept points:

Intercept 0: Community services – Connect individuals with care before a mental health crisis occurs.
Intercept 1: Law enforcement – Establish mobile crisis teams and train law enforcement officers in crisis response.
Intercept 2: Initial detention/initial court hearings – Perform mental health screenings and connect individuals to care services.
Intercept 3: Jails/courts – Establish a mental health court and offer jail-based mental health services.
Intercept 4: Reentry – Develop treatment plans for reentry and coordinate with community healthcare providers.
Intercept 5: Community corrections – Maintain care on a consistent and continuous basis.

Examples of Rural Crisis Response Programs

The New River Valley Crisis Intervention Team program covers four counties and one small city with 14 law enforcement agencies. This program trains law enforcement officers to deescalate mental health crises and established a crisis assessment center where officers can take individuals in crisis for immediate evaluation and care instead of a law enforcement facility.
The Crisis Intervention Team (CIT) Academy is a crisis response training serving various organizations in southwest Montana, including the Sheriff's Office of Gallatin and Park County. The 40-hour training equips emergency responders, detention staff, and others with the skills needed to support individuals experiencing a mental health crisis. The training covers topics such as suicide assessment, substance use, mental illness, and strategies for intervention.

Implementation Considerations

Crisis response requires a systemic approach. The National Guidelines for Behavioral Health Crisis Care offer best practices programs should consider when implementing the three essential components of a crisis response system — crisis call centers, mobile crisis teams, and crisis stabilization services. However, these guidelines can be difficult to implement in rural areas. To best support individuals experiencing a mental health crisis, rural mental health programs may consider using the Sequential Intercept Model to identify new programs, policies, or practices that are reasonable for implementation. Early intervention models at Intercept 0 and Intercept 1 may be the most feasible solutions. For example, rural mental health programs may consider implementing co-location strategies where mental health providers can share the same office space as law enforcement officials. This enables mental health providers to provide pre-arrest services, including screening and assessment, with the potential to prevent incarceration.

It is important to tailor crisis response systems to address the unique challenges in rural communities. Rural mental health programs can enhance crisis response services by encouraging partnerships between multiple jurisdictions and across large geographic areas. Partnerships enable the sharing of information and technological resources, such as tablets, laptops, phone lines, and Wi-Fi which may be limited in rural areas. In addition, rural mental health programs may consider training and certifying local community members to respond to a mental health crisis, connect the individuals experiencing a crisis to a mobile crisis team, and/or transport the individual to the nearest crisis stabilization setting.

Implementing crisis response systems in rural areas can be costly. Rural mental health programs may consider applying for funding through the American Rescue Plan (ARP) Act. The Centers for Medicare & Medicaid Services (CMS) issued guidance for state officials about reimbursement for mobile crisis services and the full crisis care continuum. Key factors rural mental health programs may consider to qualify for CMS crisis response funding include team structure, training, transportation policies, telehealth, and post-crisis support. Rural mental health programs may consider implementing a regional approach versus a county-focused approach to crisis response. By taking a more regional approach to crisis response, rural mental health programs can share resources like personnel and technology, boosting the sustainability and feasibility of crisis response services.

Resources to Learn More

Crisis Systems Response Training and Technical Assistance Center
Website
Supports states, territories, tribal organizations, and other community partners in the development of an integrated, equitable, and sustainable crisis care system.
Organization(s): Substance Abuse and Mental Health Services Administration

The Rural Behavioral Health Crisis Continuum: Considerations and Emerging State Strategies
Document
Describes the interventions and programs developed by states to strengthen rural behavioral health crisis care.
Author(s): Pearsall, M. & Wilkniss, S.
Organization(s): National Academy for State Health Policy
Date: 4/2023

State Innovations in Medicaid Managed Care for Mobile Crisis Services
Document
Describes the changes states are making to develop their mobile mental health crisis services to meet the criteria of the federal medical assistance percentage (FMAP) opportunity and maximize Medicaid managed care contracts for mobile mental health crisis team services.
Author(s): Manz, J.
Organization(s): National Academy for State Health Policy
Date: 3/2022