community case studies

Expansion of Access to Mobile Crisis Teams in New York State

State Mobile Crisis Teams were first started in New York State (NYS) in combination with Comprehensive Psychiatric Emergency Programs (CPEP) in 1989 (See CPEP textbox), but have recently been expanded considerably.

Criteria for an in-home/community response by a Mobile Crisis Team:

• A person is eligible for a Mobile Crisis Team (MCT) if the person currently meets the NYC/NYS definition for a behavioral health crisis, and the person is unwilling or unable to seek or adhere to behavioral health care on their own or with the aid of a family member, caregiver or friend – or if the person requires short-term supports until behavioral health services are available.
• MCTs can provide mental health engagement, intervention, and follow-up support to help engagement in treatment. Depending on what a person is willing to accept, the teams may offer a range of services, including:
• Assessment.
• Crisis intervention.
• Supportive counseling.
• Information and referrals, including to community-based mental health services.

A new Crisis Intervention benefit became effective in Medicaid Managed Care in NYC (2015), and for the remainder of NYS (2016). A MCT is part of this larger Crisis Intervention benefit. NYS-approved Mobile Crisis providers bill Medicaid Managed Care Organizations for mobile and telephonic follow-up services.

A MCT consists of:

• A multidisciplinary team that is accessible 24/7, 365 days a year.
• No prior authorization allowed for billing. • Respond within three hours of the initial contact.
• Initial evaluation and triage.
• Follow-up services may be delivered face-to -face or through telephonic contact and are eligible for reimbursement if provided within 14 days of the qualifying crisis episode. Contacts with collaterals are also billable services.

Billable activities may include:

• Therapeutic communication and interactions.
• Maintaining stabilization following a crisis episode.
• Preventing escalation of behavioral health symptoms.
• Facilitation of engagement in outpatient behavioral health services, care coordination, medical health and/or basic needs related to the original crisis service with the individual receiving services.
• Follow-up with the individual and the individual’s family/support network to confirm that enrollment in care coordination, outpatient treatment and/or other community services has occurred or is scheduled.

If a mobile crisis team determines that a person in crisis needs further psychiatric or medical assessment, they can transport that person to a hospital psychiatric emergency room.

Mobile crisis teams may direct police/EMS to take a person to an emergency room against their will only if they have a mental illness (or the appearance of mental illness) and are a danger to themselves or others. This is in accordance with New York State Mental Hygiene Law.

MCT calls are handled centrally, in NYC, through a single point of access program coordinated by NYC Well. There is an online application that can be filled out and submitted by treatment providers or a single phone number, 1-888-NYCWELL that families, friends, or concerned individuals can call to initiate a MCT consult.

As of February 2021, NYC, through a collaboration between the NYC Fire Department (FDNY) and Health and Hospitals, a team of behavioral health clinicians (MCT) will co-respond with FDNY Emergency Medical Services/Emergency Medical Technicians for 911 calls for people in a behavioral health crisis. Police will only respond if the co-response team believes there is an imminent risk for violence. This pilot is modeled after the CAHOOTS (Crisis Assistance Helping Out On The Streets) program in Oregon.

References:

New York State Office of Mental Health 2012 Annual Report to the Governor and Legislature of NYS on Comprehensive Psychiatrist Emergency Programs. https://omh.ny.gov/omhweb/statistics/cpep_annual_ report/2012.pdf

Crisis Intervention Benefit: Mobile Crisis Component Benefit and Billing Guidance. June 18, 2019. https://omh. ny.gov/omhweb/bho/docs/mobile_crisis_intervention_guidance.pdf

NYC Well: Mobile Crisis Referrals. https://nycwell.cityofnewyork.us/en/providers/mct-referral/

Journal of Emergency Medical Services. https://www.jems.com/2020/11/10/new-mental-health-teams-to-respondto-mental-health-crises-in-ny/