Billings’ Mobile Crisis Unit launched in October as an alternative to law enforcement in responding to mental health emergencies with crisis intervention. Teams like this are popping up state and nationwide. They specialize in de-escalation, and include both mental health and medical components.
Partners EMT Grace Chu and clinician Ariel Dehart weren’t at fire department headquarters in Billings long one Friday before a dispatch alerted them to a man reporting hallucinations. It was moments before the two identified the call on a station tablet and loaded into a white SUV, the Crisis Response Unit vehicle.
Teams like this one provide an alternative to law enforcement in counties including Yellowstone. The Billings crisis response unit, or CRU for short, is in its fourth month, and organizers are busy working out both daily operation and a changing funding model.
Right now in Billings, four people staff CRU in two-person shifts from 9 a.m. to 9 p.m. with a goal of transitioning to 24/7 response.
The Billings Fire Department and treatment center Rimrock Foundation manage the team with support from Substance Abuse Connect and coordination with other public services.
“We can’t think of everyone being siloed,” said Assistant Fire Chief Jason Banfield. “We have to reach across and create better pathways.”
So far, the team has gone on almost 500 calls, which include deaths calls where trauma response is appropriate, death notifications, substance abuse, welfare calls and suicide attempts or threats.
Data from the Billings Police Department in years past show officers respond annually to more than 1,500 calls coded as a mental health need, most classified as incidents related to suicide.
BPD Lt. Matt Lennick said responding to calls like that can take a long time and prevent officers from moving onto needs more directly related to public safety.
“Having somebody that is a professional there, even if they’re working with a law enforcement officer, they just have sometimes just a different tact or they have more time, or they have more patience, more ability, they have better access to the resources because they know what resources are available outside of the basic ER, crisis center, that kind of stuff,” Lennick said.
According to the Montana Department of Health and Human Services, other counties with existing mobile crisis response units are Butte-Silverbow, Flathead, Gallatin, Lewis and Clark, Lincoln and Missoula Counties.
DPHHS previously funded operations through a Crisis Diversion grant program, but with that now running out, the state is transitioning crisis response to Medicaid.
Earlier this month in Billings, Zach Terakedis with Substance Abuse Connect told city council members that Montana is late in adopting Medicaid rates and policies, which affects a lot of other services including mobile crisis response.
“[I] don’t want to call medicaid a disaster, but I think that's probably fair when you’re 4 to 6 months behind on paying your bills,” he said.
DPHHS declined to provide an interview for this story.
In an email, a spokesperson said the agency expects Medicaid service policies to officially be adopted this month and that Medicaid will be reimbursable retroactively through July 1, 2023.
The governor last month announced $3.5 million dollars in stopgap funding to help ease the transition for mobile crisis response.
“The state is trying to plug the gaps specifically for mobile crisis,” Tarekidis told council members. “Because of the results they’re seeing across the state, it’s become very important to all communities because of the quality of care, and it’s keeping people with mental health issues out of the law enforcement system because mental health doesn’t become criminal until the behavior changes because of what they’re experiencing.”
Back in their work vehicle, Clinician Ariel Dehart and EMT Grace Chu are returning to the fire station for lunch. The clinical part of the duo, Dehart grew up in Colorado and came to Montana by way of Wyoming. She says de-escalation fascinates her.
“I love the challenge of every different call,” she said. “It’s so unique - the person’s unique. They have a unique culture and spirituality and background and everything, and yeah, that's kinda why I love it so much.”
Dehart says she’s pretty confident about continued support for mobile response.
“This is such a need and the community is screaming for this sort of stuff.”
