Yellowstone County Launches Mobile Mental Health Crisis Response Team with $3 Million Grant

Megan Gibson, behavioral health systems improvement manager at Riverstone Health, stated that the coalition behind the initiative had been planning for over a year, indicating strong community support for the program. Initially, the program will operate with one two-person team available for 10 hours a day, seven days a week. Each team will consist of a licensed behavioral health clinician from the community crisis center and an EMT from the Billings Fire Department. The goal is to have the program operational within the first six months of the grant period, with a potential launch in January pending the completion of hiring and training.

The program aims to expand in phases. By the end of the second year, it intends to provide 24/7 coverage, and by the end of the third year, expand services to rural areas of Yellowstone County. The fourth year will focus on ensuring long-term sustainability beyond the grant. Additionally, care coordinators will be added to assist with follow-up needs after a crisis.

When a crisis call is placed to 911 or 988, the mobile crisis team can be dispatched alongside or in place of traditional emergency responders. They will operate in a dedicated vehicle separate from law enforcement but will maintain communication with dispatch, fire, and police throughout the response. Cameron McCamly, assistant fire chief overseeing the EMS division at the Billings Fire Department, noted that historically, law enforcement generated approximately 60 to 70% of calls for crisis intervention.

Under the new program, the crisis team will implement a staging process, remaining nearby while law enforcement assesses the situation for safety. After arriving on scene, the EMT will check for any medical needs, and the clinician will engage in de-escalation efforts. This unit includes a secure compartment for transporting patients to the emergency room, ensuring a direct handoff to ER staff, which McCamly highlighted as an area needing improvement in previous efforts.

The Billings dispatch center is finalizing training on a 41-protocol system, "first party caller in crisis," which enables dispatchers to begin de-escalation immediately during acute mental health calls. They will also have the capability to transfer calls directly to a clinician on the crisis team. McCamly described the system as a three-legged stool, including the dispatch center, crisis response unit, and a component called nurse navigation, which connects callers to nurses for extended assessments. The first-year goal is to resolve 2 to 3% of calls without deploying emergency vehicles.

This new initiative revitalizes a previous program, the Crisis Response Unit (CRU), implemented after a public safety mill levy passed in 2022. Initial success was noted, but the program faltered when anticipated Medicaid reimbursement did not come through. Since then, the Billings Fire Department has run a version of the crisis response unit for about 18 months, using EMTs to connect people to community resources.

Gibson emphasized that the community's contribution was instrumental in writing the successful grant application. Partners such as Billings Clinic and Intermountain are involved in planning and supporting the mobile crisis initiative, which will initially serve Billings and its urban fire service area. Expanding into more rural parts of Yellowstone County is expected by year three.