Youth Mobile Response Services: An Investment to Decriminalize Mental Health
By Whitney Bunts
The year 2020 forced many Americans to evaluate the role of law enforcement and mental health systems in the United States and their relationships to racial justice. After investigating and understanding the long-standing history of both systems, we recognize that they have harmed communities of color. These systems have been complicit in racism and discrimination, perpetuating negative narratives about Black Americans, specifically young Black people with mental health conditions. In this report, we examine mobile response—an alternative to using law enforcement to respond to mental health and social crisis. Mobile response is one service in a continuum of crisis services for rapidly responding to youth and young adults who are experiencing a traumatic event, mental health symptoms, and/or crisis in their communities. While many states already have a mobile response system, they often lack the resources and structure to effectively and equitably engage communities of color.
In this report for federal, state, and local government entities, we offer examples of states (Connecticut, Oklahoma, and Oregon) that have created good mobile response systems, principles for implementation, funding opportunities, and federal recommendations.
Mobile response as a first responder model is only as good for safety and healing as its implementation. We have created the following key principles for effective programs. Mobile response systems must:
- Solely be handled by mental health professionals. Co-responder models with law enforcement are neither safe nor equitable.
- Create their own point of entry. Mobile response systems should use a different phone number than existing emergency lines such as 9-1-1. Creating their own points of entry will make the services more inclusive to Black and brown communities.
- Train all staff involved in mobile response. Everyone from the dispatch team to the EMTs should be trained on how to acknowledge and engage someone who is experiencing a crisis. This will alleviate the issue of police presence from the onset.
- Not require mental health responders to have professional degrees. Peer support specialists and community health workers are essential to the mental health system. Their knowledge and relatability cannot be replicated through a degree.
- For mobile response to be effective and equitable, services must be free for clients and reimbursable for all providers. Medicaid provides sustainability to many services, including mobile response in some states. However, peer support specialists and peer-run organizations are often ineligible to obtain Medicaid support because of their non-traditional treatment options. For mobile response to be effective and equitable, Medicaid must be reimbursable for all organizations and providers.
- Invest in a continuum of services to address the whole person. Mobile response is only one way to ensure Black and brown people are safe and policymakers are financially supporting their communities. These communities also need jobs, quality education, access to more mental health supports, grocery stores, affordable housing, and so much more.
In addition to these key principles, mobile response services need additional funding support through Medicaid and the federal government. Currently, many states’ mobile response systems are funded through multiple sources, including Medicaid waivers 1915 (b) and (c) waivers, as well as 1115 demonstration waivers. These waivers have made it easier for states and localities to sustain their crisis services. But the federal government can do more by:
- Effectively implementing the National Suicide Hotline Designation Act. This law, which Congress passed in 2020, assigns 9-8-8 as the national suicide and mental health crisis hotline telephone number. Mobile response services should use 9-8-8 as dispatch to their mobile teams. This would help reduce costs for staff and additional infrastructure.
- Passing the Crisis Helping Out on the Streets Act (CAHOOTS ACT). This bill proposes an enhanced federal matching rate of 95 percent for mobile crisis services. This would incentivize states to make their mobile response services Medicaid reimbursable.
- Changing the priorities of the Substance Abuse and Mental Health Services Administration (SAMHSA). Normally, SAMHSA’s priorities are married to the agenda of the sitting president, which makes it hard under some administrations for states to seek guidance on services like mobile response. Because of the passing of 9-8-8, SAMHSA should create a permanent initiative to focus on technical assistance and best practice dissemination for crisis and mobile response services.