Since the implementation of the Mental Health and Disability Services (MHDS) Region system on July 1, 2014, Regions have been working diligently to either build from scratch or expand existing county crisis services systems to all counties in Iowa. Emphasizing “no-wrong-door” access to a continuum of care, crisis services systems connect individuals experiencing a mental health crisis with the appropriate level of care and support services in the community, while simultaneously diverting them from unnecessary emergency department visits, hospitalizations or periods of incarceration in local jails.
Mobile Crisis Response is one type of crisis service implemented in counties throughout the state to facilitate access to care. In National Guidelines for Behavioral Health Crisis Care—A Best Practices Toolkit, the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies Mobile Crisis Response as an “essential element within a no-wrong-door integrated crisis system” (p. 12). With the passage of HF2456 into law in 2018, implementation of Mobile Crisis Response, and other crisis services, as a component of Access Centers became a legislative mandate.
According to Iowa Administrative Code 441—24.36(225C), Mobile Crisis Response is an “on-site, in-person intervention for individuals experiencing a mental health crisis. Mobile Crisis Response staff provide crisis response services in the individual’s home or at other locations in the community.” On-site services may include assessing individuals in crisis for intention to harm themselves or others, developing a safety plan with individuals if appropriate, stabilizing or de-escalating the crisis on site if possible, transporting individuals to the appropriate level of care if stabilization in the community is not possible, and connecting individuals with supports and services to prevent future crises.
Access
Understanding how Mobile Crisis Response operates across the state of Iowa can be challenging. As this article goes to press, Mobile Crisis Response services are available in seventy-five Iowa counties, financially supported by thirteen MHDS Regions, and provided by fourteen service providers. In most Regions, a single service provider delivers Mobile Crisis Response Services to all counties; however, in three MHDS Regions multiple service providers deliver Mobile Crisis Response Services to different counties within the region.
Although the services provided on-site to individuals in crisis are generally similar, the method used to access Mobile Crisis Response is a significant point of differentiation among programs. Access to Mobile Crisis Response occurs through one of two approaches: dispatch through requests for support from law enforcement and other agencies/institutions, and dispatch through crisis counselors.
In five regions (twenty-one counties), Mobile Crisis Response teams are dispatched to the location of an individual in crisis through a request from law enforcement. In three Counties (Dallas, Polk, and Pottawattamie), Mobile Crisis Response was implemented as a component of Alternatives to Incarceration Initiatives that predated the formation of the MHDS Region system. When the Regions formed, the service was expanded to additional counties within the Region maintaining dispatch through law enforcement. In some counties using this approach, Mobile Crisis Response also responds to requests for service from other institutions such as hospitals, medical clinics, jails and schools.
In eight regions (fifty-four counties), counselors operating crisis call lines dispatch Mobile Crisis Response to the location of an individual in crisis. Under this approach, anyone can call the crisis line and request Mobile Crisis Response services. When this occurs, crisis counselors screen the situation for safety before dispatching a one- or two-person team to the location of the individual in crisis. The defining feature of this approach is that anyone in the community is able to call and request services. This includes law enforcement officers, as well as other institutions such as schools or hospitals.
Mobile Crisis Response in Southwest Iowa
In the Southwest Iowa MHDS Region, Heartland Family Service provides Mobile Crisis Response services throughout nine counties. The Mental Health Crisis Response Team (MHCRT), made up of licensed mental health practitioners, responds to requests from law enforcement, jails, pre-committal screenings, court orders and hospitals.
In FY20, MCHRT completed 97 law enforcement-initiated assessments. During the same period, MHCRT completed 55 jail-initiated assessments in FY20.
Pre-committal assessments occur when citizens who are considering filing civil commitment paperwork are provided with information about the service at the courthouse and contact the MHCRT to request an assessment. The purpose of the assessment is to determine the appropriate level of care in an attempt to avoid unnecessary civil commitments. In FY20, MHCRT completed 25 pre-committal assessments.
Court-ordered assessments occur when a judge is concerned that a civil commitment may not be the appropriate course of action in cases brought before them. MHCRT completed 27 court ordered assessments in FY20.
During the last quarter of FY18, the Region and MHCRT piloted telehealth MHCRT assessments in the emergency department of one rural critical access hospital. Since that time, hospital-based assessments have expanded to four additional hospitals. There were 132 assessments completed in four hospital emergency departments in FY20. This service continues to expand to additional hospitals during the current fiscal year.
Of the 336 individuals assessed by the MHCRT during FY 2020, the recommended disposition in 79 percent of cases overall involved the individual not requiring civil commitment. The percentage assessments in which commitment was not recommended varied by assessment source as the graphics below indicate.
