In the quiet city of Bozeman, nestled between majestic mountain ranges in southern Montana, a unique crisis response team is making a significant impact. This team, comprising therapist Luke Forney and responder Evan Thiessen, has revolutionized the way the city handles mental health emergencies. But their story is not just about success; it's a tale of financial struggles and the ongoing battle to keep these vital services afloat. 'Mobile crisis' teams, like the one in Bozeman, are in crisis, and the reasons why are both complex and deeply concerning.
The team's mission is clear: to provide a safe and effective alternative to law enforcement when dealing with individuals experiencing psychiatric crises. This strategy, which gained momentum in the late 1980s in Eugene, Oregon, and has since spread across the nation, aims to de-escalate situations and provide appropriate therapeutic care. However, the financial reality of these teams is far from ideal.
In Bozeman, the team operates 12 hours a day, seven days a week, at a cost of approximately $1 million annually. Yet, their funding is not consistent or reliable. While local taxpayers fund the police department, mobile crisis teams often struggle to secure the same level of support. This inconsistency has led to the closure of programs in Great Falls and Billings, Montana, leaving only six units across the state.
The team in Bozeman has been remarkably successful, reducing the time police spend on mental health calls by nearly 80% and preventing unnecessary ER visits. However, their work is not reimbursed by private insurers or Medicaid, which means they must rely on a patchwork of grants and other funding sources. This financial instability is a significant challenge, as it requires them to constantly seek additional funding to keep their doors open.
The issue is not unique to Bozeman. Across the country, many mobile crisis teams are shrinking or closing due to inadequate funding. In some states, private insurers are mandated to cover the cost of these calls, but Medicaid reimbursement rates vary widely, and many teams struggle to cover their expenses. The situation is further complicated by the fact that the majority of crisis calls end with people staying where they are, avoiding a trip to the ER or jail, which means the financial benefits of these services are often not immediately apparent.
Despite these challenges, there is hope. Some states, like New Jersey, California, and Washington, have mandated private insurers to cover the cost of mobile crisis calls. Ten states have even implemented fees on cellphone bills to help fund these services. However, Montana has not followed suit, and the state provides only about $2 million annually in supplemental funds to help the mobile teams pay for service calls that aren't reimbursed through Medicaid.
The future of mobile crisis teams in Montana is uncertain. While the state is considering boosting Medicaid reimbursements, the financial pressures remain. The abrupt closures of these teams create instability and place financial pressures on other parts of the local health system. As the state works to overhaul its mental health system, the fate of these vital services hangs in the balance.
'Is it a priority for our state or not?' asks Casey Schreiner, an executive at Alluvion Health in Great Falls. The answer to this question will determine the future of mobile crisis teams in Montana and the lives of the individuals they serve. The story of these teams is a powerful reminder of the complex interplay between public health, funding, and the human impact of these decisions.
