Montana’s Mental Health Crisis: How 1 County’s Mobile Crisis Response Team Is Filling Gaps and Saving Lives

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Montana’s breathtaking mountains, expansive landscapes, and stunning skies create a paradise for many. Yet, beneath this beautiful exterior lies a troubling reality: the state ranks 50th out of 51 in adult mental health care.¹ With 1 of the highest rates of mental illness and the lowest access to mental health services, many residents struggle to find the support they need.

The sheer geographic distance between health care providers, coupled with a lack of infrastructure, has resulted in individuals in a behavioral health crisis being taken to county jails or emergency departments (ED)—both of which are ill equipped to handle the behavioral health and substance use issues that are presented in these heartbreaking and complex situations. Should someone need access to specialized inpatient care, they must seek care at 1 of the 2 closest behavioral health hospitals to Gallatin County—which are located nearly 240 miles apart. The lack of a true 72-hour involuntary hold process and the crumbling state hospital further compound the problem, resulting in individuals being released back into the community without appropriate treatment or follow up. To try and avoid jail or the ED, law enforcement officers are left to try and fill in as makeshift social workers and counselors for those experiencing behavioral health emergencies, rather than focusing on public safety issues.

Gallatin County, like much of Montana, reflects the broader statewide concern. Recognizing the need for change, Gallatin County completely overhauled 1 aspect of its behavioral health crisis response system. Initially launched in 2019, the Co-Responder Program provided immediate access to behavioral health care to those in the community, sending a mental health provider to work alongside first responders. However, it had limited response options and fell short of its intended purposes.

Connections Health Solutions was brought in during 2022 to lead the program’s turnaround, evolving it into what is now known as the Gallatin County mobile crisis response team. Since taking over the program, Connections has delivered impressive results, including faster response times, reduced law enforcement time at behavioral health calls, and better outcomes for individuals in crisis.

The mobile crisis response team now serves as a model for other rural communities seeking to enhance a critical component of its crisis response system. Critical to the program’s success was the team’s focus on 4 key areas:

• Proper identification of mental health calls
• Building trusted partnerships to increase effectiveness and efficiency
• Developing creative solutions that increase access to care
• Leveraging data to improve performance

Proper Identification of Mental Health Calls

Developing a method to identify mental health calls within the law enforcement system was crucial to addressing the specific needs of the community. Gallatin County dispatchers manage approximately 14,000 emergency calls each month, and accurately identifying mental health calls would be vital for the mobile team to effectively resource plan.

To start the process, law enforcement diligently worked with 911 and other community partners to run 3 reports with information from the Computer Assisted Dispatch (CAD). The data collected was then used to identify:

• Calls marked as mental health related
• The number of involuntary holds
• Calls where the mobile crisis team had been previously dispatched

They then used specific keyword searches to uncover any remaining calls that were not identified via the reports. The analysis allowed the team to create heat maps (Figure 1) that indicated where most calls originated and detailed areas with higher demand for mental health services. These insights could then be used to launch targeted, more efficient responses.

Figure 1. Adapted from JG Research

Building Trusted Partnerships to Increase Effectiveness and Efficiency

Recognizing that no single agency can address the behavioral health crisis alone, the team invested time in strengthening relationships with key stakeholders like law enforcement, emergency services, Help Center, Inc, and Montana State University to improve the program’s efficiency and effectiveness within the community.

After successfully working together to identify mental health calls, law enforcement gave the mobile crisis response team access to the CAD system, which enabled the team to proactively stage themselves near locations where 911 had been called and first responders dispatched. With this access, they can notify dispatch and law enforcement of their availability. Once law enforcement clears the scene, the mobile team can quickly step in, conduct evaluations, and perform interventions. The team’s real-time monitoring and proactive staging have established a least intrusive response in the community, which has helped to decrease the chance of protective custody and the need for higher levels of care. Now, more than 90% of the time, the team is enroute before requested and has maintained a less than 11.9-minute response time.

“Since its inception, the Gallatin Mobile Crisis Response Team has positively impacted law enforcement in our community. First, it has reduced the amount of time law enforcement spends on mental health calls. Second, it lessens the need for law enforcement to keep up with the ever-changing mental health resources in our community. The team is well-informed on all our mental health partners. They can connect people in crisis to the correct resource directly. Lastly, the GMC has been a great partner to work with. They bring a positive attitude and are a joy to work with,” saidErin Taylor, Gallatin County Sheriff’s Office.

Furthermore, an enhanced partnership with Help Center, Inc, which operates the 988 hotline, enables the mobile crisis team to be dispatched directly, allowing for a civilian-first response and removing the need for law enforcement to respond when safe and appropriate.

Developing Creative Solutions to Increase Access to Care

In the absence of a dedicated crisis response center, the mobile crisis response team has developed innovative ways to provide critical support to those in need. Recognizing that jails are ill equipped to provide psychiatric services, the team partnered with local correctional facilities to offer mental health evaluations. They also work closely with the local health system’s psychiatric emergency services (PES) unit, whose purpose is to address acute crises, meet individuals wherever they are prior to a potential admission to the PES, and work with them to facilitate a warm hand off to the appropriate level of treatment, whether that be at another treatment center or a connection to a community resource.

One of the most impactful partnerships the team has forged is with Human Resource Development Council’s Warming Shelter. By offering services within the shelter, the mobile crisis response team has been able to reach a particularly vulnerable population in a setting where they feel safe. This proactive approach eliminates the need for law enforcement involvement, which can often exacerbate the situation. By providing these services, even if they may not be counted as a “mobile response,” the team is helping to increase access to life-saving care and fill critical gaps in the county’s crisis response system.

Leveraging Data to Improve Performance

Over the past 2 years since relaunching as the mobile crisis response team, there has been an abundance of data to review and analyze. The team constantly and consistently reviews call volumes, average time to arrive on scene, average time spent on scene, community disposition rates, referrals, and other key performance indicators to determine opportunities to improve efficiency and effectiveness. Using the data, the team has been able to identify service gaps, especially in more remote regions, and allocate resources more strategically. This data-driven approach has led to the team making program improvements, resulting in a 77% average reduction in law enforcement time spent on mental health calls, allowing law enforcement to spend more time on public safety issues. It has also helped them to continue to decrease their average response time to 11.9 minutes after finding better ways to integrate into response systems and stage appropriately. Lastly, data has helped the team deliver better interventions in the field, which is demonstrated by their 86% success rate of keeping individuals in the community, diverting them away from jails or EDs.

In the spirit of partnership and transparency, the team also shares the data with key stakeholders. The team reports out monthly, sharing key data insights and discussing trends to uncover areas for continuous improvement. These regular reviews allow the team to adjust their strategies in real time, fostering stronger collaboration and ensuring their efforts align with evolving community needs.

Continuing to Move Montana Forward

There is still much work to be done. Additional funding is needed to secure the program’s long term sustainability, and the team works closely with elected officials to help make legislative change in reimbursement. The team continues to build partnerships, particularly with rural communities that are still underserved, and expand the reach of mobile crisis teams. By focusing on partnerships, creative solutions, and data driven management, the team has created a system that not only responds more effectively to crises but also prevents them from escalating. These efforts have reduced the burden on law enforcement, improved outcomes for individuals in crisis, and strengthened the overall behavioral health infrastructure in Gallatin County.

Mr Mattson is the director of social services for Connections Montana, where he has led the mobile crisis response team since December 2022. Ryan is a Licensed Clinical Professional Counselor and a Certified Mental Health Professional Person whose career has been driven by his passion for helping those experiencing a behavioral health crisis. Prior to joining Connections, Ryan worked as the Crisis Intervention Specialist (CIS) Supervisor at Bozeman Health and the Service Line Director of Crisis at Western Montana Mental Health Center.

Reference

1. Mental Health America. Mental health america adult data 2024. Accessed January 21, 2025. https://mhanational.org/issues/2024/mental-health-america-adult-data