Bonus Ep. — National Survey on Mobile Mental Health Responders

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Leah Pope: You know, there’s been obviously more and more support for alternatives to police, whether that be clinicians or peer responders or a range of different responders. And I think the reality is that if we want those people to respond, and we think those people are best positioned to respond to a vast majority of calls, then they need to be available 24 over seven because crises happen at all times of day. And if they’re not available, then people are going to revert back to the police.

Stephanie Hepburn: This is crisis talk. I’m your host, Stephanie Hepburn. In this bonus episode, I’ll be speaking with researcher Leah Pope on a new national survey focused on mobile mental health responders. This isn’t part of our AI and mental health series. The next episode in the series comes out Friday, where I’ll be talking with three guests about how they use AI chatbots to work through mental health and personal challenges. Let’s dive in.

Leah Pope: Hi, I’m Leah Pope. I am an associate professor in the psychiatry department at the Columbia University Department of Psychiatry at New York State Psychiatric Institute.

Stephanie Hepburn: Leah. Can you tell me a little bit about the study? And also, if you can tell our listeners the duration of time that the survey is open?

Leah Pope: Absolutely, yes. So we are very excited to be launching a national survey of mobile crisis co-responder and alternative response programs. The survey is open from December 1st to January 31st in 2026. So next month, and I am working with a team of researchers that I’ve been collaborating with for a long time. Michael Compton at Columbia, Amy Watson at Wayne State University, doctor Matthew Goldman, who’s now out in Seattle, and Preston, Looper and Matt and Preston are both serving as consultants. And many people may know they did a survey in 2022 going into 2023. That was also a mobile crisis survey. So the survey we are conducting now is intended to be a new look at the landscape of mobile crisis across the United States. We know that so much has changed, and there’s been lots of attention in the crisis system to the sort of someone to respond element, but they’re also still really large gaps in terms of what counts as a mobile crisis program who’s on the team, what kinds of calls they respond to, who dispatches them, who has oversight, how they’re funded. And so this survey is really an attempt to help close that gap, even though we did learn quite a bit in the first survey, we are defining mobile crisis. And I think this is really key for listeners. We’re defining mobile crisis broadly and intentionally to include the widest range of programs that we can to really understand what the landscape looks like.

Stephanie Hepburn: Leo, who does that include is that two person, does that include single person models or what does that include?

Leah Pope: Yeah. So in terms of program type it includes behavioral health provider mobile crisis programs. What I think of in my state as sort of a traditional clinician responder mobile crisis program, but we’re also including law enforcement based co-responder programs, alternative and community response programs, which may include those that are run out of fire or EMS. And then we’re also including mobile response and stabilization services, which are more youth focused services that are coming online in many states. So a range of program types. And then the staffing really may vary. So our survey will ask about how the program is staffed both in terms of number of staff and type of role that staffs them. And we imagine based on what we know about the field already, that there’s going to be lots of variation in terms of who’s staffing teams, even if the team or program is called the same thing.

Stephanie Hepburn: So why are you going broader? Are you trying to get a better landscape analysis of what programs are being implemented right now? What’s the objective?

Leah Pope: Yeah. You know, the first survey was broad, but maybe not explicitly so. But they did get a range of different types of programs responded. And I think the key thing that we’re learning, and I continue to learn in talking to programs across the country, is that there’s really a lack of standardization in terms of terminology, insofar as people call different programs the same thing and the same programs different things depending on where you live. And so I think what we’re really trying to understand and tap into is what is the range of those models out there? Traditional mobile crisis programs have been around for many, many years, but there are lots of new programs coming online. And I think really to better understand how we’re serving people and communities in crisis, we really need to understand that full range of models that communities are implementing.

Stephanie Hepburn: Are you asking questions about integration with nine, eight, eight, whether it’s digital, whether it’s somebody who’s calling to transfer to mobile crisis. Will you be looking at that interconnection as well?

Leah Pope: Yeah we are. So we think about that 980 connection in terms of asking questions around dispatch and partnerships. So we have questions that get at where the calls are coming from, our calls coming from 988 to the mobile crisis program. And then we also have questions that ask about the types of partnership that these mobile crisis programs have. And so 988 would be one of those programs.

Stephanie Hepburn: And will you be asking about ours, for example? Those programs vary. Sometimes they can do evening hours. Some are 24 hours. In terms of the ability for mobile crisis to respond. Are you going to look at when they’re available?

Leah Pope: Yes, absolutely. That’s a key question. We are asking people to tell us if they’re 24 over seven, since that is a core element in the national models listed by SAMHSa. But also we expect that many programs will not be. And so if they’re not, they’ll just let us know which days of the week they operate and which hours in any of those days. So we’re asking pretty detailed information about operational hours precisely because we know it varies so much.

Stephanie Hepburn: And will you be asking questions about funding?

Leah Pope: Yes. We have a whole section on funding that asks sort of the various sources of funding for a program, whether it be federal, state, local, whether the programs are, you know, Medicaid reimbursable or covered by health insurance. So we’re hoping to really get a better sense of who’s paying for these programs.

Stephanie Hepburn: Our respondents anonymous, or are they sharing more information, not just state or local?

Leah Pope: Yeah. Great question. So unlike the first survey, which was completely anonymous, this survey is not anonymous. Insofar as programs will share their program name and their location, whether that location is a county or a specific city that they serve. So the location, they serve. The survey respondent themselves doesn’t need to put any personal information about themselves in, so they’re really only answering questions about the program. But this was a really intentional decision that we thought about a lot. And the reason we decided to go this route is because we really do want to get a better sense of where programs are across the country and sort of what access and adequacy looks like. And the only way to do that is to ask programs where they are.

Stephanie Hepburn: So you mentioned earlier standardizing mobile crisis services, the language around it as well. What are you hoping to do with this iteration of the survey to further that?

Leah Pope: Yeah. Great question. So I think a few things. One, I would say similar to the last survey, we will have a national report and be able to report back to people a whole range of information about what mobile crisis looks like, what are the terms people using, who are the staff members. And you’ll start to be able to see trends on a national scale particularly if more people respond. We’re also doing a deep dive, or what I like to call a deep dive in five partner states. These are states that we developed partnerships with prior to the launch to get a better sense of their range of their programs that exist in advance, so that we can specifically target each of those programs and try to get to close to 100% response rate in those states. I think what that’s going to allow us to do is to, at least in those states, have a very detailed portrait of what’s going on and then be able to look at other states in comparison to those five states, or to look at those five states among each other to say, you know, what’s going on in Michigan versus what’s going on in California. Those are two of our partner states.

Stephanie Hepburn: What are the other partner states?

Leah Pope: The other partner states are Illinois, New York and Ohio.

Stephanie Hepburn: Why those five states?

Leah Pope: Those five states are states that we had relationships with prior to launching the survey, and all expressed interest in doing work to better understand their own mobile crisis landscape. So we’re really willing to partner with us to get their programs on board. We wish we could do it in all 50 states, but I will say since we launched, we’ve also been doing sort of more targeted outreach to the other states in the country. And it seems already in the first week that we’re getting some good traction to have some state leadership push out the survey.

Stephanie Hepburn: And do the five states have centrally deployed 24 over seven mobile crisis or are they still working on that?

Leah Pope: They’re still working on it. Yeah.

Stephanie Hepburn: Leah, can you tell me a little bit about why it being centrally deployed 24 over seven is important for mobile crisis?

Leah Pope: Yeah. So, you know, I think that this is something when we think about a comprehensive crisis continuum and we think about alternatives to law enforcement. A key thing to consider is you know, what resources are able to respond at any given time of day. Traditionally, we know that that has been police and fire more recently, right. Those are services that are 24 over seven. Everyone knows you can call them at all hours of the day. And there’s a long history to why we now have overreliance on 911 as a first responder to mental health crises. I think as we in the country have made progress in terms of broadening that someone to respond element and really thinking about who is the best response for a person at a particular moment. There’s been obviously more and more support for alternatives to police whether that be clinicians or peer responders or a range of different responders. And I think the reality is that if we want those people to respond, and we think those people are best positioned to respond to a vast majority of calls than they need to be available 24 over seven, because crises happen at all times of day. And if they’re not available, then people are going to revert back to the police.

Stephanie Hepburn: So when I interviewed Preston, he mentioned that the more 911 trusts in civilian mobile crisis teams, the less likely they’ll dispatch law enforcement or law enforcement led co-responder teams. There have been some changes since that interview and geo routing was adopted by the FCC. I think it was October 17th last year. And then text geo routing was adopted over the summer in July. Do you think that will shift the organizations that you’re surveying?

Leah Pope: Yes, I do. I’m hopeful. I think there’s still a lot of work to be done, but I’m hopeful for a few reasons. Clearly, if a call is going to the right 988 center in terms of geo routing, and that 988 center has the best, closest resources available. They are much more likely to get the resource that person needs at a particular time versus as it was, if a 98 center was receiving a call from someone in a different state, they surely aren’t going to know all the mobile crisis resources. And so the likelihood of them defaulting back to law enforcement is just much higher if they’re worried about someone. So I think from that perspective, knowing that you’re getting calls from people who are in your community at the call center and then being able to dispatch the appropriate resources is a huge step in the right direction. I will say, I think your point is well taken, that the more 911 centers know these programs and see their capacity to respond and the results when they do respond, the more comfortable they feel making those dispatch decisions. But that obviously takes time and trust building and is not just on the 911 center, but really on community partnerships to really flesh out what are the right calls for these programs? When are they available? Can I dispatch them at any time? And in the case of both 988 and 911, really thinking about who has the authority to dispatch the team, will the team actually go out if 911 or 9 eight eight calls them?

Stephanie Hepburn: When it comes to funding from the last survey, there was a large percentage of teams. I think it was 40% that could not bill Medicaid in this update and this new iteration. What are you looking into? Are you also looking into whether they can build Medicaid? Are you hoping that there’s some changes there and what do you expect to see?

Leah Pope: So we know our team has been working on another project around state’s use of federal mechanisms for crisis services over the last period of time. And one of the things we specifically looked at is to understand what states have implemented state plan amendments to their Medicaid plans to specifically be able to bill mobile crisis services as a medicaid billable service. So we now have updated information on all of the states that have the ability to bill Medicaid for mobile crisis, and those states that don’t. Now, of course, being able to bill Medicaid doesn’t mean teams actually are. But I think what we’re hoping to see is in those states that have the capacity to do so, is anyone taking advantage of that benefit yet? We’re going to ask which codes specifically they bill for, and then we’ll have a better sense of whether that mechanism is being used. I suspect my gut instinct is that it’s we will have moved the needle a little bit, but it’s still a pretty new benefit. And that many programs may not be sure how to access it yet.

Stephanie Hepburn: And what about 988 service fees that are similar to 911 service fees that some states have passed.

Leah Pope: Yeah, that’s a good question. So we haven’t thought a ton about 988 service fees. And maybe that’s an oversight. I think our understanding as a team, and we could be wrong, was that many of the 988 service fees can be used broadly for crisis services. But that it’s a little hard to dig into how exactly they’re being used. And so that really then requires you to do a deep dive in any given state. And we haven’t been able to do that.

Stephanie Hepburn: Is that something you hope to dig into the future or right now? You’re primarily focused on larger funding concerns like Medicaid?

Leah Pope: Yeah, I think right now we’re focused on higher level. And then over time, it certainly would be interesting to know how the funds are actually being spent and how they trickle down to programs themselves.

Stephanie Hepburn: If you could expand on technology and data collection and what you’re digging into when it comes to those two topics with the respondents.

Leah Pope: Sure. Absolutely. So in terms of technology, we’re really asking about a few different things, both like what sort of tech platforms do they use to get information about the caller, or respond to calls or put their case notes in. And then also, if they are using technology to actually do crisis work. Right. So some programs do telehealth. And so we ask about that. So we really are trying to understand sort of how technology is being leveraged in their program in terms of data collection. This is actually expanded considerably since the first survey. And I think that’s because there’s been a lot of discussion. Good discussion in the field about how do we compare programs and what are outcomes and who’s collecting what data. What data should programs even collect to begin with? And there’s been some good work done in the field about thinking about common metrics. And what we do in the survey is we have a number of core metrics that are recommended by several other groups for collecting data on mobile crisis, and so we define the metric for the participant filling out the survey. We ask them if their program collects data on that metric. And then we ask them to report their data. For the first nine months of 2020 5th January through September, the first three quarters, if they’re able to do so. And so the idea is to both understand what kinds of data people collect. For example, does everyone collect how long it takes to respond? Does everyone collect client age and gender, or the time on scene, or the number of calls stabilized in the community? And then if they do, are they willing to report their numbers? And I hope that filling out that section is also a learning opportunity, particularly for newer programs who may not collect all that data. But think about it as an opportunity to add some new common metrics.

Stephanie Hepburn: Leah, will you be evaluating feedback loops? So for example. One thing I’ve thought about is the interconnection with 911988, but also what that feedback loop looks like. So if there’s any meetings where there’s an evaluation of these calls could have been transferred to mobile Crisis, that feedback loop, is that something you all are looking at?

Leah Pope: It’s not. But I think it’s such an important question. And I think perhaps in terms of our survey, we’ll be able to understand sort of the range of call types that programs are responding to, as well as the types of calls where they may or may not request law enforcement for those programs that are not, you know, co-responder models. So I’m hoping that gives us a little better sense of where are those opportunities for calls to be transferred? And where is the field in terms of certain types of calls really requiring law enforcement still?

Stephanie Hepburn: Thank you so much for spending this time with me, Leah, I appreciate it. Is there anything else that you want to add that you think listeners should know about the survey?

Leah Pope: Yeah, I would just reiterate that the survey is open now through January 31st. We have a really responsive team who can answer questions. So if you’re not sure you should respond or you want to ask who in your program should fill it out, please reach out. We’re really receptive. We’ve been in contact with lots of teams. And I just hope that people see this as an opportunity to really see their program represented in the national landscape.

Stephanie Hepburn: That was Leah Pope at Columbia University. I’ll include a link to the survey in the show notes. If you enjoyed this episode, please subscribe and leave us a review. It helps others find the show. Thanks for listening. I’m your host and producer, Stephanie Hepburn, our associate producers, Rin Koenig. Audio engineering by Chris Mann. Music is vinyl couch by blue Dot sessions.