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Item 1.

City Council Work Session
Date:	11/18/2024
Title:	Crisis Response Unit Models of Service
Presented by:	Jason Banfield, Assistant Fire Chief
Department:	Fire
Presentation:	Yes
Legal Review:	No
Project Number:	N/A

RECOMMENDATION

Staff recommends the Behavioral Health Community Paramedicine model as the optimal approach to address the specific needs and capacity of our community. Staff will summarize 5 different crisis response models. By aligning with Billings’ unique requirements, the chosen model will ideally enhance community safety and resource efficiency.

BACKGROUND (Consistency with Adopted Plans and Policies, if applicable)

The SAMHSA National Guidelines emphasize that an effective crisis system includes mobile crisis response as one of its three essential components. The goal is to resolve crises quickly in the individual’s environment, reducing unnecessary engagement of law enforcement, Fire Department resources, and EMS. Proper implementation of crisis response models can also minimize hospitalizations and incarcerations, leading to improved outcomes for individuals in crisis and better resource allocation for the city.

STAKEHOLDERS

The entire community benefits from an improved crisis response system, which can enhance public safety, support mental health needs, and reduce strain on emergency services.

ALTERNATIVES

City Council may provide direction on:
1. implementation of a select model or;
2. other guidance.

FISCAL EFFECTS

All projected costs will be included in the presentation as we receive them from programs across the region.

SUMMARY

The Department of Public Health and Human Services (DPHHS) supports five models of crisis response services. Below is a detailed description of each model:

Mobile Crisis Unit:
The Mobile Crisis Unit consists of mental health professionals and/or paraprofessionals, such as peer support specialists and behavioral health aides, who respond to crisis situations in the community. The MCU aims to stabilize individuals in crisis on-site, addressing the immediate situation and facilitating connections to follow-up care. This model reduces the need for emergency room visits, hospitalization, or law enforcement involvement by providing immediate de-escalation and assessment. SAMHSA identifies this model as a core component of effective crisis response, emphasizing the value of a specialized response tailored to individuals' behavioral health needs.

(The Billings Fire Department and Rimrock Foundation implemented this model over the last year. In this model the Billings Fire Department provides the EMT, response vehicle, continuing education, medical supplies, patient care reporting software, and the Medical Direction for the EMT. The other private or public provider would provide a Montana Licensed Clinical Social Worker (LCSW) or a Montana Licensed Clinical Professional Counselor (LCPC), medical oversight, Medicare/Medicaid compatible patient documentation software, and billing services. The mission of this unit is to provide on-scene de-escalation and a crisis assessment for patients in an acute event. Additionally, this unit can provide a medical patient assessment at the basic level and determine if a medical problem is causing the patient to have an acute crisis. This unit can transport patients to different facilities for additional treatment and allow law enforcement, fire, and EMS resources to remain in service. This unit allows for continued medical and mental health assessment and care on-scene for an extended period without impacting fire, EMS, and law enforcement resources. Additionally, this unit provides the ability to complete a safety plan with the patient and leave them at their residence.)

Co-responder Model:
This model embeds a behavioral health specialist within a law enforcement team, allowing for a collaborative response to behavioral health crises. In the co-responder approach, mental health professionals assist police officers during crisis situations, providing real-time assessment, de-escalation, and guidance. This integrated response reduces the potential for forceful intervention, promotes community trust, and helps prevent unnecessary arrests by addressing mental health issues directly. The co-responder model aligns with SAMHSA’s focus on community-oriented crisis response, fostering a supportive and understanding approach in situations traditionally handled by law enforcement alone.

(This model provides a Montana Licensed Clinical Social Worker (LCSW) or a Montana Licensed Clinical Professional Counselor (LCPC) to work with a police officer and provide on-scene de-escalation and a mental health assessment. In this model, the intent is to greatly reduce officer interactions with patients in acute crisis and provide a softer touch. In this model, no medical assessment is done to determine if the patient is experiencing any medical problems, and the law enforcement officer will have to remain on-scene for the duration of the call and transport if necessary. A private/public partner will need to provide the LCSW/LCPC, medical oversight, Medicare/Medicaid compatible patient documentation software, and billing services.)

Behavioral Health Community Paramedicine (BHCP):
Behavioral Health Community Paramedicine pairs a mental health professional with EMS to respond to crises involving medical and behavioral health needs. This model allows for comprehensive care that includes mental health assessments, crisis intervention, and immediate medical support when necessary. SAMHSA supports the BHCP model for its ability to address both psychological and physical health components, offering a full-spectrum response. This model is particularly useful in cases involving complex medical needs or in rural areas with limited access to mental health resources, as it ensures individuals receive appropriate care without the need for emergency department visits.

(This model is very similar to Mobile Crisis Unit in bullet point number 1 but raises the level of medical intervention and assessment to the Paramedic level verses the EMT level. In this model the Billings Fire Department or another EMS agency provides the Paramedic, response vehicle, medical supplies, continuing education, patient care reporting software, and the Medical Direction for the Paramedic. The other private or public provider would provide a Montana Licensed Clinical Social Worker (LCSW) or a Montana Licensed Clinical Professional Counselor (LCPC), medical oversight, Medicare/Medicaid compatible patient documentation software, and billing services. The mission of this unit is to provide on-scene de-escalation and a crisis assessment for patients in an acute event. Additionally, this unit can assess the patient for on-going medical issues such as diabetes, heart failure, and sepsis at the advanced Paramedic level. This unit allows for continued advanced medical and mental health assessment and care on-scene for an extended period without impacting fire, EMS, and law enforcement resources. Additionally, this unit provides the ability to complete a safety pan with the patient and leave them at their residence. This unit can transport patients to different facilities for additional treatment and allows law enforcement, fire, and EMS resources to remain in service.)

Consultant Model:
In the Consultant Model, mental health professionals provide virtual support to law enforcement, available on-call to offer guidance during crises. This model is ideal when in-person intervention is not feasible, as it ensures access to behavioral health expertise via phone or video. SAMHSA recommends this model for situations requiring immediate behavioral health support that doesn’t necessitate on-site personnel. By providing law enforcement with expert advice, this model allows for effective triage and resource conservation while still addressing the mental health needs of individuals in crisis.

(This model would contract with a private Mental Health Clinician service to provide virtual assessments and de-escalation. Tablets, software, and usage training would need to be provided for those offices who would use this resource. No medical assessment would be provided, and officers would need to transport the patient if additional services are needed. City impacts would include the ability to provide some mental health services without adding additional costs of FTE.)

Crisis Intervention Team (CIT):
The Crisis Intervention Team model involves specially trained law enforcement officers who respond to mental health crises independently, without direct healthcare involvement. CIT officers receive extensive training in recognizing mental health issues, de-escalating crises, and diverting individuals to appropriate services. This model aligns with SAMHSA’s emphasis on proactive community partnerships, as it fosters collaboration between law enforcement, mental health providers, and community organizations. The CIT model has been shown to reduce harm, build community trust, and decrease recidivism by connecting individuals in crisis with long-term resources and support networks.

(This model and the CIT training has been implemented and is being used by law enforcement in Billings for Mental Health Crisis de-escalation.)

Each of these models offers a unique approach to crisis response, emphasizing different types of expertise and intervention strategies that align with SAMHSA’s National Guidelines. The selection of a model should consider our community's specific needs, resource availability, and desired outcomes in crisis intervention and mental health support.

SAMSHA National Guidelines for Behavioral Health Crisis Care
https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf
(Page 18 provides the best practices for Mobile Crisis Teams)

SAMHSA National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit Executive Summary
https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-services-executive-summary-02242020.pdf

Attachments

CRU Powerpoint 2024