Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey.

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.

Emergency care to 'persons with confused behavior': Lived experiences of, and collaboration between, police and members of a mobile crisis team - A hermeneutic-phenomenological study.

BACKGROUND: Police officers and members of a mobile crisis team (MCT) are the two actors who respond to nuisance in Dutch society related to 'persons with confused behavior' and serious violent incidents. Their collaboration creates tension and dissatisfaction about roles and responsibilities. AIM: To explore the lived experiences of, and collaboration between, police officers and members of a MCT. METHODS: A hermeneutic-phenomenological study with unstructured in-depth interviews of eight police officers and eight members of a MCT. FINDINGS: The main findings in this study are that in the emergency care of 'persons with confused behavior' two very different professions are forced to work together, and that this collaboration is quite challenging. It becomes clear that different visions and expectations cause frustration in the collaboration. Police want the participation of the MCT as soon as possible after they are called in. The MCT wants to be easily accessible for police and can identify the great diversity of problems adequately but cannot solve all problems. There are shortcomings in adequate follow-up care provided by other health-care facilities. CONCLUSION: It turns out that it is extremely important for police officers that members of the MCT explain to them why a crisis assessment has a certain outcome. The exposed frictions and stagnation in the collaboration should be discussed openly as part of the process in order to acknowledge this and resolve it together. A recently started project called 'street triage', in which the police and MCT work together as one team and give a joint response, seems to remove a lot of the friction and stagnation. Further studies are needed to explore the effects of street triage by testing the validity of the hypothesis that street triage can close the gap between the two professions.

Emergency care in case of acute psychotic and/or manic symptoms: Lived experiences of patients and their families with the first interventions of a mobile crisis team. A phenomenological study.

PURPOSE: To explore the lived experiences of patients with a psychotic or bipolar disorder and their families with emergency care during the first contact with a mobile crisis team. METHODS: Open individual interviews were held with ten patients and ten family members. Content data-analysis was conducted. FINDINGS: Communication and cooperation was difficult in several cases. Personal crisis plans were not always used. Stigma was felt, especially when police-assistance was needed. A calm, understanding attitude was appreciated. PRACTICE IMPLICATIONS: Focus explicitly on communication with the patient, despite the acute condition, enhances the chance of cooperation. Taking time for contact is important.