Martin Kidston

(Missoula Current) As the Mobile Support and Crisis Intervention teams in Missoula enter another year, they continue tracking data to help right-size their response to calls involving a behavioral-health crisis, while working to better ingrate both 911 and 988.

They're also exploring new funding models that could take some program costs off the local tax base, experts told county officials last week.

In 2020, the City of Missoula entered into an agreement with Missoula County to use certain grant funds to hire a full-time program manager for the Crisis Intervention Team, which looks to assist and get care for individuals in crisis.

The city also launched the Mobile Support Team in a partnership that now includes the Missoula Fire Department and Partnership Health Center. The program looks to respond to calls involving a behavioral health issue in “a therapeutic manner.”

Both programs look to relieve law enforcement's response to a behavioral-health crisis as much as possible.

“Our team goes out to 911 calls for a mental-health crisis, along with a clinician and an EMT for the additional response,” said John Petroff, the team's operation's manager. “They'll respond in just a regular minivan. Their goal is to meet people where they're at with no agenda, and to really respond in a different way.”

The Mobile Support Team also includes a care coordination team, which provides the follow-up work. Petroff said that last year, the program's care coordinator provided more than 1,700 sessions after the Mobile Support Team intervened in a call.

“We deescalate and do everything we can for that day, and we follow up with each client afterwords,” he said. “It's a lot of work. We have one care coordinator right now who does that, so she did the majority of those calls.”

Call volume and program changes

When Petroff first began as operations manager in 2020, the Mobile Support Team was responding to as few as 20 calls a month. But with an investment from the city and county, service increased to seven days a week and the call volume began to rise.

So far this year, the team has responded to 1,794 calls and funding hangs over the program as a large question mark, Missoula Fire Chief Gordy Hughes told members of the City Council last week. The program has been largely funded by federal grants, which have since expired.

Hughes placed the Mobile Support Team's current budget at around $1.35 million.

John Petroff, operations manager of the Mobile Support Team.
John Petroff, operations manager of the Mobile Support Team.

“We all knew the funding for the Mobile Support Team was going to run out at some point, and we've been kicking that can down the road,” Hughes said. “Come June, if this (fire) levy doesn't pass and we don't have enough of the HB 872 dollars, I don't think we can sustain funding that program any longer.”

House Bill 872 was signed into law by Gov. Greg Gianforte last year, providing an investment to “reform and improve Montana's behavioral health” system.

While the funding amounts earmarked for Missoula's Mobile Support Team aren't firmly known, the program is also working its way through Medicaid reimbursement. Petroff said the shape of that effort also remains unknown, but it's prominent on the program's funding radar.

“The rules came out, so we're working through what that's going to look like,” he said. “We're looking at how we build this program to do that and take some of the burden off our local tax base.”

But Theresa Williams, the program manager for the Crisis Intervention Team at Missoula County, said that Medicaid funding alone won't be able to fully fund the Mobile Support Team, forcing them to explore other funding opportunities. Among them, she said, the program is exploring its ability to get reimbursed for non-Medicaid clients, which will require “a lot of data.”

Williams said the Crisis Diversion Grant could also help.

“But even once it happens, it's part of one of the reasons the Missoula Fire Department is asking for a levy as well,” she said. “They're going to need some additional funding to support things like the Mobile Support Team.”

Petroff added that the program is also exploring other options, like working with insurance companies.

“We're looking at a lot of other ways of doing this beyond normal stuff,” he said. “There's been a lot of good. We're learning a lot about money stuff. The team is working hard and the amount of calls they're going on is significant.”

Funding and data

While funding remains a hurdle, program leaders don't see it as insurmountable. And as the program continues to evolve, they're also looking to streamline operations, including how calls are received and dispatched.

Theresa Williams, operations manager of the Crisis Intervention Team.
Theresa Williams, operations manager of the Crisis Intervention Team.

Williams said that could eventually lead to an integration of the 911 and 988 call centers - the latter being the suicide and crisis lifeline. In the coming years, they'd like to see the two dispatch numbers co-locate, or at least have a mental health clinician embedded with 911. The entire program was launched in part to reduce a patient's interaction with law enforcement, and sending the Mobile Support Team out through 988 rather than 911 could help further that goal.

“We're working to build that trust between 911 and 988 and the Mobile Support Team so eventually, 988 can dispatch the Mobile Support Team,” said Williams. “Right now, 911 – and rightfully so – is nervous to send those calls to 988 until they have that trust. We're doing a lot cross training right now.”

As the Mobile Support Team looks to its future, the Crisis Intervention Team also continues its evolution. The newer efforts include tracking data across a number of areas, including the number of “deflections.”

Mary Parish, the research and evaluation specialist for the Crisis Intervention Team, said the program's first responders meet every-other week with a number of providers, including Blue Heron Place, Riverwalk, the Poverello and Dakota Place, to discuss recent successes and what could be improved.

The team also meets every other month with both Missoula hospitals and with the Missoula County Detention Center on a quarterly basis. As part of it all, deflection has become a powerful tool for a patient's after-crisis-care.

“It helps with continuity of care, and it also helps with form care in the clinical setting for that individual who was in crisis by giving the clinician the most comprehensive information about what was observed in the field that then might inform their care,” said Parish. “We know anecdotally that behavior can change once you're taken into a particular space. This helps ensure that the clinician has all the details from the field that are relevant to inform the next clinical steps.”