Mobile response team aims to provide alternative to calling 911 in mental health crisis

You may not think you know — or know of — anyone with mental illness, but odds are you do.

Nationwide, 20% of adults experience some form of mental illness — serious in more than 25% of the cases — while 17% of youths 6 to 17 years old experience a mental health disorder, according to statistics reported by the National Alliance on Mental Illness, or NAMI.

Here in New Hampshire, more than one third of adults reported symptoms of anxiety or depression in 2021, and 57,000 of them suffered serious mental illness. Meanwhile, youths aged 6 to 17 experience a mental health disorder every year, with 15,000 Granite Staters between the ages of 12 and 17 suffering from depression.

The issue of mental illness is far from the thoughts of most of us, most of the time. But tragedy has a way of yanking our attention to face realities we would otherwise prefer not to think about.

Such a tragedy occurred on New Year’s Day this year when a Gilford teenager with a history of mental illness was fatally shot by a police officer. Just minutes after two officers arrived at Mischa Fay’s residence, the 17-year-old, who was holding a knife, was tased and then shot.

News stories about the tragic event pointed to the fact that Fay had been suffering from some form of mental illness for two years, and at times his emotional state would deteriorate to the point where he would lose control and fly into a rage — behavior so frightening that others in the house feared for their own safety and called the police.

Fay is an example of someone in severe mental health crisis — an extraordinary, though certainly not rare, situation. Helping someone in a mental health crisis might be compared to firefighters requesting additional companies combatting a fire.

“You want to provide people with help before they are in crisis,” said Maggie Pritchard, executive director of Lakes Region Mental Health Center, one of 10 regional mental health agencies in the state providing community-based services.

Being able to provide services to people when they are in the early stages of an emotional struggle is a challenge that has become increasingly daunting, Pritchard said.

The struggles facing the mental health system have existed for years, say Pritchard and others in the field, and they are not unique to the Granite State. The problems are a shortage of psychiatrists, psychologists and other front-line clinicians, as well as a shortage of beds for those whose mental health has reached the crisis stage. People in crisis — whether adults or youths — require, at least for a time, treatment in a controlled hospital setting.

LRMHC provided counseling services to 3,512 between July 1, 2021, and June 30 of last year. Of that total, 2,527 were adults, with youths aged 17 years and younger comprising the remaining 949 clients, or 27% of the total. The agency provides behavioral health services to 24 communities in Belknap and southern Grafton counties.

The agency struggles to provide services in a timely manner, and the demand is outpacing the agency’s ability to deliver. Currently, there are 60 adults on the waiting list for an appointment to receive counseling. How long those people will have to wait will vary, depending on the severity of their symptoms and other factors, Pritchard explained.

Like other agencies in the state, the biggest problem LRMHC faces is a shortage of trained clinicians: psychiatrists, psychologists, psychiatric social workers and other professionals. Currently the agency is looking to fill 20 clinician positions. Clinicians make up about 65% of the agency’s 200 full-time staff positions.

Each care provider typically has a caseload of 50 to 60 clients at any one time, Pritchard said.

“It’s a hard sell as a career,” Pritchard said. “We need a comprehensive plan to attract people to the profession and to pay them.”

With insurance reimbursements for mental health services lower than for physical health services, behavioral health professionals earn less than their counterparts working in physical medicine, noted Ken Norton, immediate past executive director of NAMI-NH.

“For example, a cardiologist gets reimbursed 30% more for a 15-minute appointment than a mental health clinician,” Norton said.

Pritchard, who also serves as president of the board of the New Hampshire Community Behavioral Health Care Association, said she has lobbied state legislators for a $30 million increase in Medicaid reimbursement for mental health services statewide.

Medicaid accounts for 70.3% LRMHC’s revenue in 2022, according to its annual report.

Despite the challenges posed by workforce shortages, and the growing demand for services, Pritchard said the agency has undertaken initiatives to increase access to care, especially to those who are most at risk.

Vital to this effort is the rapid response/mobile crisis team which provides mental health crisis services in the communities served by LRMHC.

Launched at the beginning of last year, and funded by a $54.2 million state contract, these teams are now up and running in each of the 10 community mental health centers across the state.

The mobile units are designed to work much like an ambulance does for urgent medical aid, but for mental health needs.

The team consists of a master’s level clinician, as well as a specially trained peer support specialist who uses their lived experience to support the person in mental health crisis, or a bachelor’s-level therapeutic support specialist, explained Kimberly Goldberg, director of the Acute Services Team at LHMHC which includes the rapid response team.

The team is on call 24/7.

A person in crisis or anyone who cares about someone who is having trouble coping emotionally can call 833-710-6477. They will be immediately connected with a trained clinician. According to Goldberg, the clinician may be able to help resolve the caller’s issue over the phone. But if the clinician concludes the caller’s situation is particularly severe or problematic, the mobile response team will be notified. A member of the team will then call the patient or whoever made the call. In the overwhelming number of cases, a face-to-face assessment of the patient is warranted.

“About 90% of our assessments are in-person,” Goldberg said.

Typically, the team deals with people contemplating suicide, or who are severely depressed or struggling with overwhelming symptoms, a child acting out, or someone in the throes of substance abuse, she said.

Once on the scene, and after determining the patient is not a threat, the team will then evaluate the patient to see if they are safe, determine what kind of support they need, and whether they need to be taken to a hospital. Fewer than 10% need hospitalization, Goldberg said.

In its first year of operation, the mobile response team had more than 1,000 dispatches and served 311 adults and 60 youths.

Goldberg and Pritchard both say that educating the public about calling the rapid response hotline and accessing the mobile crisis teams is essential if those initiatives are to have their maximum impact.

“It takes the public time to get accustomed to something new,” Goldberg said.

“When you use it it works,” Pritchard said of the mobile crisis team. “But not enough people are using it.”

The mobile crisis response teams will not eliminate law enforcement’s involvement in mental health calls. But their role will change.

“We don’t want law enforcement to be the de facto responders for people in mental health crisis,” said Susan Sterns, the executive director of NAMI-NH.

She and many others, both in law enforcement and the behavioral health fields, say better training is key.

“They need to be trained on what needs to be done,” Stearns said. “Law enforcement are critical partners. Law enforcement wants to be part of an effective response.”

Laconia Police Chief Matt Canfield says his department is heavily invested in training its officers in learning how to better deal with people with mental health issues.

“Mental health calls [to the department] or some kind of substance abuse are an everyday occurrence,” said Canfield.

In light of that, Canfield said, since 2020 all officers have completed a total of 2,600 hours of de-escalation, implicit bias, and ethics training. Moreover, several officers have been through the 40-hour Crisis Intervention Team program, which provides specialized training to police officers so they can interact with people with mental illness in a more understanding way. Canfield said the goal is for all sergeants and first line officers — 14 all told — to complete the training.

According to NAMI, 60% of police shootings in New Hampshire involve someone who has a known mental health condition.

NAMI officials said that to date, 471 New Hampshire police officers have completed the intensive training, but there are more than 2,900 sworn officers in the state.

Last year the state passed a law providing $1.3 million to cover direct and related costs for at least one officer from every law enforcement agency in the state to take the 40-hour CIT course. The law is the result of a bill introduced by then-state Sen. Bob Giuda, who represented several communities in both Belknap and Grafton counties.

Since 2019, NAMI-NH has been presenting the CIT program to law enforcement officers and other first responders. Canfield said the Laconia officers who have taken the course have found it extremely valuable and informative.

“The NAMI training is helping [officers] to understand more about mental health,” the chief said. “If they can understand what the person is going through, there is a better understanding how an officer can deal with that person effectively.”

Canfield welcomed the mobile crisis team and said his department has interacted with the team on some calls.

“If the person is not homicidal or suicidal, we will call the mobile crisis team,” he said. But, he added, if there is information that a person is out of control or acting irrationally, then it is imperative that police are dispatched to the scene.

“The officer usually gets very limited information from a 911 call,” he said. “It makes sense for us to get to the scene first.”