by Michael D. Anestis, M.S.
Some reports estimate that 7-10% of calls made to police departments involve mental illness (Deane, Steadman, Borum, Veysey, & Morrissey, 1999). Clearly, this means that police departments expend a significant amount of time and resources attempting to manage mental health crises. These situations not only represent a burden upon law enforcement, however; such situations at times result in arrests and conflict when effective psychological care is a more optimal outcome. That being said, mobile crisis units (MCUs) have become an increasingly common resource in communities worldwide. MCUs differ from region to region in terms of hours of availability, speed of services, and the make-up of the team, but they all serve the purpose of attempting to decrease the likelihood that mentally ill individuals will rely on the police and emergency rooms by offering focused psychological care capable of diffusing a crisis and motivating an individual to seek additional community care.
Unfortunately, there is shockingly little research that actually tests the degree to which MCUs offer incremental benefits above and beyond standard care. Today, I wold like to quickly review one example of research that does, in fact, support their utility.
In 2000, Roger Scott published a study in Psychiatric Services in which he reported data comparing the results of 73 911 calls handled by MCUs and 58 911 calls handled by standard police interventions. The results of his study, while by no means enough to conclusively support the notion that MCUs are an essential component of psychiatric care, were quite compelling. The primary variable in this study was the percentage of 911 calls that did not result in hospitalization. Results indicated that 55% of MCU calls did not result in hospitalization as compared to 28% of standard police calls, a highly significant finding. Of those who were hospitalized, only 36% of MCU cases were involuntary while 67% of hospitalizations in police cases were made on an involuntary basis. These results alone are quite important. First of all, it appears that MCUs are more effective at keeping mentally ill individuals out of expensive inpatient units where beds are limited. Secondly, when hospitalization occurs in MCU cases, the situation is much more likely to be amiable, with the individual making the decision him or herself to seek impatient care.
The findings from Scott (2000) extend further. The author also compared the economic impact of the two forms of intervention and found that MCU cases, on average, cost 23% less than police cases, with MCU cases resulting an an average cost of $1,520 and police cases resulting in an average cost of $1,963.
Scott (2000) considered one final outcome variable: perceptions of MCUs by both consumers and police. The data indicated that both the police and the consumers rated the MCUs highly,indicating that they are not only effective, but also well received.
So what can we take from these findings? First of all, substantially more empirical research needs to be conducted investigating the effectiveness of MCUs in their various forms. The Scott (2000) study is by no means that only such study, but there are too few given the proliferation of these units. That being said, the results here are promising, as they indicate that MCUs are less expensive than standard police interventions, less likely to result in inpatient hospitalization, and very well received both by the police and the consumers. In other words, a form of intervention that is palatable to all involved exists and it costs less than and achieves better outcomes than standard police interventions. Should these results generalize across samples, we would thus have ample justification for implementing MCUs on a wider scale, thereby freeing up the police to focus on cases more directly relevant to their own goals. In other words, everyone wins.
I would love to hear from readers who have worked on or with mobile crisis units. Did you notice any particularly important assets they bring to the table? Were there any specific problems that you think might interfere with their effectiveness? Is there an alternative approach that is better than either of the options outlined in this post?
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Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University and an incoming resident at the University of Mississippi Medical Center
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