Rural crisis teams bridge mental health gaps

(NewsNation) — In rural communities, people in crisis may be more likely to encounter a badge and a gun instead of scrubs and treatment.

At best, the incidents are a waste of time and resources for police and ER staff and at worst, they escalate to violence.

But mental health crisis teams are different. This model funnels patients into health care instead of a drawn-out encounter with the criminal justice system.

A network including law enforcement, private and public health care systems, nonprofits, and advocacy organizations work together to de-escalate crises, get people treated and then provide follow-up care. 

“It really has to be a community-oriented service where all the players who touch on this problem are brought into the same room,” said John Gale, a researcher at the Maine Rural Health Research Center. “No one side can solve it.”

Taking the pressure off

Similar models have existed in larger cities for years. Yet experts say they may have an even greater impact in rural areas where resources are limited and law enforcement responds to a variety of emergency calls.

“For someone who is in a bit of a crisis, who might be in a panic mode, and (to) have the police show up … it creates an anxiety that sort of exacerbates the situation,” Gale said. “They may not have any experience (dealing with a mental crisis). So what do they do? They do their best to calm the situation down, oftentimes not well.”

Gale is a part of a group of behavioral health experts across the country who believe rural crisis teams can fill in the gaps in care left by a rise in safety-net hospital closings and doctor shortages.

Take, for example, a Nebraska mother found her son after an attempt to die by suicide in 2018. She did what many would do and called 911.

The man, who had a history of depression and anxiety, was put in a Nebraska jail cell for stealing pills from a pharmacy, according to a redacted email from the Lincoln Police Department.

Yet local police knew to reach out to the crisis team, providing background information as well as how to follow up.

Crisis teams’ makeup looks different depending on the mix of local resources available. Some deploy specially-trained workers to respond to 911 calls. Other times police officers refer patients to mental health teams.

Julia Hanneken, a licensed clinical social worker for Frontier Health’s team serving rural Tennessee and Virginia, does telehealth evaluations after getting called by local schools or ERs. 

“It takes pressure off of other areas of the healthcare system,” she said. “(Doctors) are able to concentrate on medical emergencies, and they’re able to lean on us for the mental health.”

Solving problems

Studies of programs across the country have shown significant success. The average length of stay in an Indiana ER dropped from 18 hours to only 40 minutes after creating a 24-hour response line where trained crisis staff could do assessments over the phone, Gale said.

An Oklahoma program that diverted calls from law enforcement to a community health center saw startling results. Mental health clinicians increased the number of adults seen by more than 76% while reducing inpatient visits by 80% between 2015 and 2019. The program also saved $718,000 in local law enforcement costs. 

Another Nebraska program refers people with mental illness to a group of trained volunteers with lived experience of mental illness or substance abuse. This peer-to-peer program significantly reduced the number of mental health calls over time — at least 30% by year three of its implementation. 

Proponents attribute these achievements to more than just in-the-moment care. Workers build relationships with people with chronic mental illness over time, helping reduce loneliness that can exacerbate symptoms. 

While the technology enabling these teams are important, “the magic” is the process, John Cantwell told researchers studying the Oklahoma program. “Calls have to be answered every time and quickly,” he said. “And the caller has to get help. It can’t be empathy; it has to be problem-solving.”

Still, all involved in these teams said worker shortages, lack of internet access and transportation barriers keep them from helping everyone. 

“Unless we believe we can get the providers we need in the near future and afford to do it, we don’t have a solution,” Gale said. “Crisis response is critical. … And every community needs it.”