Evaluation of a Mobile Crisis
Program: Effectiveness, Efficiency,
and Consumer Satisfaction
Roger L. Scott, L.C.S.W.
Objective: The effectiveness and efficiency of a mobile crisis program
in handling 911 calls identified as psychiatric emergencies were evaluated, and the satisfaction of consumers and police officers with the
program was rated. Methods: The study retrospectively examined differences in subjects’ demographic characteristics, hospitalization and
arrest rates, and costs for 73 psychiatric emergency situations handled
by a mobile crisis team and 58 psychiatric emergency situations handled by regular police intervention during three months in 1995. Consumers’ and police officers’ satisfaction with the mobile crisis program
was evaluated through Likert-type scales. Results: Fifty-five percent of
the emergencies handled by the mobile crisis team were managed
without psychiatric hospitalization of the person in crisis, compared
with 28 percent of the emergencies handled by regular police intervention, a statistically significant difference. The difference in arrest
rates for persons handled by the two groups was not statistically significant. The average cost per case was 23 percent less for persons
served by the mobile crisis team. Both consumers and police officers
gave positive ratings to the mobile crisis program. Conclusions: Mobile crisis programs can decrease hospitalization rates for persons in
crisis and can provide cost-effective psychiatric emergency services
that are favorably perceived by consumers and police officers. (Psychiatric Services 51:1153–1156, 2000)
sions, but Reding and Raphelson (4)
reported a significant reduction in
admissions. Bengelsdorf and associates (5) provided evidence of the
cost-effectiveness of mobile crisis intervention services based on diversion of patients from hospital admission to community-based services. In
another study, Lamb and associates
(6) concluded that mobile police–
mental health outreach teams “apparently avoid criminalization of the
mentally ill.”
This paper reports on a retrospective study of the impact of a mobile
crisis program on psychiatric hospitalization rates and arrest rates of
people in crisis. Cost-effectiveness
data and consumer and police satisfaction with the program are also reported.
The mobile crisis program
A
national survey of mobile crisis programs conducted in
1993 showed that 39 states
had such services (1). The advantages
reported for such programs included
improved access to treatment for
mentally ill persons, the capability to
avert a crisis or decrease its severity,
and reduced criminalization of mentally ill persons by diverting them
from jail to treatment. Mobile crisis
programs are also believed to be a
cost-effective service delivery strategy for reducing the costs of psychi-
atric hospitalization, family burden,
and the costs to the criminal justice
system by providing professional assessment and crisis intervention in
the community (2).
The research on mobile crisis services is mostly descriptive and lacks
significant empirical data on outcomes. Between 1990 and 1995 three
systematic evaluations of the impact
of mobile crisis services on hospitalization rates were reported. Fisher
and associates (3) found no effect of
the intervention on hospital admis-
Mr. Scott is director of care management at Georgia Mountains Community Services,
P.O. Box 907891, Gainesville, Georgia 30501. When this paper was written, he was affiliated with the DeKalb Community Service Board in Decatur, Georgia.
PSYCHIATRIC SERVICES
♦ September 2000 Vol. 51 No. 9
The mobile crisis program of DeKalb
County, Georgia, is a component of
the DeKalb Community Service
Board, which is a comprehensive
mental health service agency for the
county. DeKalb County is a metropolitan community of approximately
400,000 residents and includes part
of the city of Atlanta. The program
was implemented in 1993 as a joint
effort with the county’s public safety
department. Local advocacy groups
and family members of mentally ill
persons were actively involved in establishing the program.
The goals of the program are to
provide community-based services to
stabilize persons experiencing psychiatric emergencies in the least restrictive environment, to decrease arrests of mentally ill people in crisis,
1153
and to reduce police officers’ time
handling psychiatric emergency situations, thus freeing them to return to
regular duty. The program is staffed
by four police officers and two psychiatric nurses. They rotate work
hours to provide a team of two officers and one nurse that operates
from 3 p.m. to 10:30 p.m. seven days
a week. A psychiatrist is available for
telephone consultation to the team
during those hours.
The team provides the initial response to 911 calls identified as psychiatric emergency situations. It responds to psychiatric emergency calls
initially handled by other police units
by providing telephone or radio consultation or by going to the scene and
relieving the responding officers.
The team also responds to referrals
from the 24-hour crisis hotline of the
DeKalb County community mental
health center.
With police officer backup because
of the high prevalence of calls involving mentally ill persons who are violent, the psychiatric nurse evaluates
the person in crisis and determines
whether psychiatric hospitalization is
needed. If hospitalization is indicated, the team transports the person in
crisis and helps with the hospital admission. If hospitalization is not
needed, the psychiatric nurse provides on-site counseling and referral
assistance.
When the team is not responding
to emergency calls, it provides follow-up services by telephone or
home visit to persons who received
crisis intervention services. About 24
percent of staff time is allocated to
responses to 911 calls and the rest to
crisis hotline response and follow-up
services.
Methods
Study sample
The study’s retrospective design employed the concept of a natural experiment to address the problem of
selection bias, the primary threat to
validity in a nonexperimental study
(7,8). Because the program’s single
team can provide only partial coverage of 911 calls identified as psychiatric emergencies, a comparison
group of emergency 911 situations
handled by regular police interven1154
tion was available. The study sample
consisted of 73 psychiatric emergency cases handled by the mobile
crisis team and 58 such cases handled
by regular police procedures during
the three-month period from October 1 to December 31, 1995.
Information was obtained from
records of the public safety department and the mobile crisis program
on subjects’ demographic characteristics (age, race, and gender),
homelessness status, whether the
subject had a state psychiatric hospital admission in the previous six
The
study
suggests
that mobile crisis
programs can be justified
as an integral component
of health care systems,
including managed
care systems, on
the basis of
cost-effectiveness.
months, whether the crisis situation
involved violence, the duration of
police involvement, and the disposition for the crisis situation. Homelessness was defined as having no
permanent residence and currently
living on the street or in a homeless
shelter.
Program measurements
Effectiveness. Program effectiveness was evaluated by measuring the
differences between the hospitalization and arrest rates of the study
groups.
Efficiency. According to Mayer
(9), achieving efficiency may be understood as “trying to achieve the
most of a desired benefit in relation
to a given level of expenditure. Efficiency is a way of choosing among alternative means for achieving a standard end.” For psychiatric emergencies, the standard end, or common
objective, of both mobile crisis programs and regular police services is
to resolve or ameliorate the situation
for the immediate protection of the
health and safety of the persons involved and to facilitate access to any
additional treatment or follow-up
services needed.
Efficiency was evaluated by comparing the cost per case (cost per
episode) for mobile crisis services
and regular police services. The cost
per case for mobile crisis services was
calculated as total program costs and
any psychiatric hospitalization costs
divided by the number of cases
served. Program costs included the
department of public safety’s contribution of one police officer per team
per 7.5 hour shift plus the mental
health center’s expenditures associated with staffing and operating the
program, including administrative
and support overhead costs.
Cost per case for regular police intervention included the cost of police
services per hour ($39.33) multiplied
by the average amount of time required per intervention (1 hour and
51 minutes) plus any psychiatric hospitalization costs. For the purposes of
this study, the cost per hour of police
services included average salary and
benefit costs plus public safety department overhead. That overhead
included administrative and supervisory costs; dispatch, training, and other support function costs; and supplies, equipment, and other operating
expenses.
Cost per case of psychiatric hospitalization equaled the total cost of residential treatment services used divided by the number of cases served.
The average cost per case for psychiatric hospitalization was calculated by
multiplying the average length of stay
by the average daily rate for facilities
used by the mobile crisis team and
the police. Average daily rates and
lengths of stay were used to neutral-
PSYCHIATRIC SERVICES
♦ September 2000 Vol. 51 No. 9
ize the choice of facility in comparing
costs.
Consumer and police satisfaction. Consumer satisfaction was evaluated in conjunction with routine follow-up services to persons served by
the mobile crisis team during the
three-month study period. This convenience sample of 32 individuals or
families was asked to complete the
eight-item Client Satisfaction Questionnaire (10). Items are rated on a
Likert scale of 1 to 4, with 4 indicating very satisfied and 1 very dissatisfied; possible total ratings range from
8 to 32. Consumer satisfaction was
also evaluated by open-ended questions about whether needed services
were received and what the consumer
liked and disliked about services received.
Because the program is jointly operated by the community mental
health agency and the county public
safety department, police officers’
satisfaction with the working relationship and the team’s performance is a
critical factor for the program’s success. Police officers were asked to
rate, on a survey designed by the author, their satisfaction with the performance of the mobile crisis team;
the survey used a 5-point Likert scale,
with 5 indicating very satisfied; 3,
neutral; and 1, very dissatisfied. Also
included were open-ended items for
comments and suggestions.
The survey was distributed to officers present at each of three consecutive shift roll calls for immediate completion and return; 106 officers completed the survey.
Analysis. Chi square tests with
Yates’ correction for continuity and t
tests with Levene’s test for equality of
variances were used to determine the
statistical significance of differences
between the two study groups. The
probability level for statistical significance was set at .05.
Results
Demographic characteristics
No statistically significant differences
were found between the study
groups in age, race, gender, or homelessness status; in whether the clients
had a state psychiatric hospital admission during the previous six
months; or in whether the crisis situPSYCHIATRIC SERVICES
Table 1
Client characteristics and disposition for psychiatric emergencies handled by a
mobile crisis team and by regular police intervention
Study group
Mobile crisis
team (N=73)
Variable
N
Demographic data
Race
White
31
Black
42
Gender
Male
40
Female
33
Age (mean±SD years)
37.3±17.4
Homeless
Yes
7
No
66
Violence-related
crisis situation
Yes
32
No
41
State hospital admission in past six months
Yes
22
No
51
Disposition
Psychiatric hospitalization1
Yes
33
No
40
Type of hospitalization2
Voluntary
21
Involuntary
12
Arrested
Yes
5
No
68
1
2
%
Regular police intervention (N=58)
Total
(N=131)
N
N
%
%
42
58
15
43
26
74
46
85
35
65
55
45
38
20
36.6±12.6
66
34
78
53
37±15.5
60
40
10
90
6
52
10
90
13
118
10
90
44
56
25
33
43
57
57
74
44
56
30
70
22
36
38
62
44
87
34
66
45
55
42
16
72
28
75
56
57
43
64
36
14
28
33
67
35
40
47
53
7
93
8
50
14
86
13
118
10
90
Statistically significant difference between study groups, χ2=8.24, df=1, p
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