Mobile crisis response team reduces need for police interactions

Last weekend's police shooting death of Gilford teen Mischa Fay has highlighted New Hampshire's and the nation's struggle with access to mental health services. The incident is still under investigation by the Attorney General's Office, leaving many blanks unfilled. What is known is that Gilford police officers were dispatched for a mental health incident, that there was a report of a knife, that a taser was discharged, and then a firearm was discharged, killing Fay with a single gunshot.

Over the last few years, police have stepped up their training to better respond to people with mentally illness or those currently in crisis, but fatalities are not a rare occurrence. As reported previously by the Concord Monitor, a majority of people killed by NH police officers over the last 10 years had a mental illness.

In addition to increasing their training, some police departments have hired social workers to more safely address crisis situations, but that practice has yet to be widely implemented in the Granite State. In New Hampshire, critical incident team trainings are on the rise, and in 2021, the state implemented the New Hampshire Rapid Response System, which prioritizes a non-law enforcement oriented response to mental health crises, only calling in police when absolutely necessary.

The rapid response access point is operated by Beacon Health, a private mental health care company based in Boston.

“Beacon has contracted with [NH] DHHS to provide a 24/7 service for crisis support,” explained Eric Eason of Beacon, “taking calls, texts and chats. Folks can call in when in crisis and in need of support.”

The service is connected directly to the national 988 suicide and crisis hotline. Callers with a 603 area code will be directly connected to the rapid response access point. Those with different area codes should call 833-710-6477. The service can also communicate via text message.

“We can link [callers] to urgent appointments with local mental health centers, link to mobile crisis rapid response if necessary and we can engage 911 if we need to,” Eason added.

Since the system’s inception in 2021, the lines have been busy.

“In 2022 we were able to answer and assist 25,000 calls and engage in 600 chat conversations,” Eason said. “Seventy-five percent of the time we're able to resolve those contacts with just our staff intervening with folks. Providing support, helping them step back and assess their situation.”

As for that other 25%, that’s where mobile crisis response teams come in. These are teams of mental health care professionals who deploy in person to the caller.

According to Eason, the rapid response access point rarely has to deploy emergency responders to a scene.

“We are finding we only have to deploy 911 services 1% to 2% in total volume,” Eason said.

The system is also a “two way street,” allowing law enforcement to contact the line directly after they receive call for a mental health emergency.

“We are getting referrals from the 911 system if they feel like letting that call be managed by us,” Eason said. “If we have law enforcement service in the field, that determines the need is mental health intervention or crisis intervention, and they can reach out to us to dispatch a mobile response team. Our role is to be the access point.”

When an in-person response is needed, it’s up to one of 10 mental health coverage areas across the state to fill the need. In Belknap County, that duty falls on the shoulders of the Lakes Region Mental Health Center, which operates the area’s local mobile crisis response team.

“From just Dec. 25 to Dec. 31, we responded to 10 community-based crises,” said LRMHC’s Assistant Director of Acute Services Kristy Pearce. Of those 10 calls, Pearce says, the police did not have to be directly involved, and only one individual checked into the hospital.

“The police have been a really good support and ally during situations,” Pearce said. “Not only when we’re assisting someone, but also initiating a call.”

The mobile crisis response team falls under the acute services division of LRMHC. That team consists of Pearce, 10 full-time clinicians, the director, two full-time therapeutic support specialists and a peer support specialist.

A peer support specialist “is someone with lived experience in the mental health support system,” Pearce explained. “Someone who has struggled with issues in the past, potentially gone to a psych hospital voluntarily or involuntarily, or has had suicidal ideation, struggled with substance abuse disorder and used the resources and come out on the other side.”

These specialists can offer an extra degree of empathy and lived experience when interacting with a person in crisis.

During that period in December, the team took calls in person as far as Lebanon, and provided telehealth support to a person in Lincoln.

Organizations like LRMHC are struggling to find and pay enough professionals to manage a significant spike in the demand for mental health services.

“The number one issue in mental health is the workforce shortage and meeting the demand,” explained Beth Vachon, director of development and public relations. “Over the course of the pandemic and afterward, the need has risen at least 20%.”

Even prior to the pandemic, Vachon described the mental health profession as understaffed. Combine that with the challenges faced by rural areas, and you have a recipe for strain.

“The mental health centers in rural areas have even more difficulty recruiting, especially the further north you get,” said Susan Stearns, the executive director of NH's chapter of the National Alliance on Mental Illness, or NAMI.

“The reality is, our mental health centers in general are not able to be competitive in compensation with folks in the private sector or out of state. I know there are efforts underway to increase Medicaid rates, which would help increase their compensation.”

“More staff would ensure those holes are not occurring,” Pearce said, referencing temporary staff shortages due to COVID-19 infections. “We currently have three active, full-time clinician spots available for our team.”

Despite these national staffing difficulties, Pearce said that so far LRMHC has been rather fortunate in its ability to find enough staff for 24/7 care.

“There’s other mental health centers in the state that don’t have coverage because they're short-staffed,” Pearce said.

“Our team has doubled in the past year, which provides growing pains but is ultimately for the best, which allows us to better serve the community.”

As part of an effort to bolster mental health support, Vachon said LRMHC is planning to host free mental health first aid classes in Laconia this February.

“It's a short training for anyone who is interested to learn how to work with behavioral health issues and look for the signs that someone is in crisis,” Vachon explained. “It’s four hours long, but you walk away with a certificate and skills.”