SCOTT DETROW, HOST:
Interactions between police and people having mental health crises can end badly, and that's why many cities send teams of mental health professionals to respond to those calls instead of police. But the funding for teams like that can be unreliable. And as Montana Public Radio's Aaron Bolton reports, some mobile crisis services are shutting down.
AARON BOLTON, BYLINE: The mobile crisis team in Bozeman, Montana, is heading out on a call on a snowy afternoon in the mountainous Gallatin Valley. Mobile crisis responder Evan Thiessen is on the phone, getting information from a family member of a local man in crisis.
EVAN THIESSEN: Well, you're doing the right thing, and we're going to make sure he gets help today, OK?
BOLTON: The man is confused and is trying to walk outside without shoes as temperatures hover in the low 30s. The team parks in front of the man's home. Licensed therapist Luke Forney jots down some final notes from the man's police record, which shows past instances of violence.
LUKE FORNEY: Especially if he's confused and upset.
THIESSEN: Yeah.
FORNEY: We want to just keep an eye on that.
BOLTON: Ultimately, the crisis team found that the man was physically safe where he was. He didn't pose a threat to others. So they plan to check in with him in the following days. Program manager Ryan Mattson says the vast majority of calls end like this one - without police having to respond at all. Police, firefighters and community members can call the team 12 hours a day, seven days a week.
RYAN MATTSON: I think that everyone is on the same page of seeing the value that these programs bring.
BOLTON: He says finding a way to keep paying for them is the hard part.
MATTSON: I'm confident that we're going to be here through next fiscal year. That's about as confident as I am at this point.
BOLTON: Mobile crisis programs in Montana have cost more than the state originally projected. Bozeman's alone has a budget of $1 million a year. On top of that, many private insurance companies don't reimburse for mobile crisis service at all. And the public insurance program Medicaid only pays for the time spent on a call. Time that workers spend documenting those calls or waiting for the next one isn't reimbursed.
ANGELA KIMBALL: You need to pay for the capacity to be at the ready, just like we do for fire and police, regardless of whether somebody is going to be called out.
BOLTON: That's Angela Kimball, with a nonprofit called Inseparable, which advocates for mental health policy reform. Kimball says relying on that reimbursement model alone is a huge problem for mobile crisis services across the country. Heather Saunders is with KFF, a nonpartisan health research organization. She says communities are scrambling for funding.
HEATHER SAUNDERS: Broadly, it is kind of this patchwork, and there's a big question as to whether these services are sustainable across states.
BOLTON: Unlike Montana, some states have mandated that private insurers cover mobile crisis care. Others have implemented fees on cellphone bills to help pay for the service. And in Montana, some local communities have chipped in local tax dollars. But the town of Great Falls and Billings have shuttered their programs. There are now six units left in Montana. Casey Schreiner is an executive at Alluvion Health, the clinic that used to run the program in Great Falls.
CASEY SCHREINER: We need a completely revamped system to pay for these services.
BOLTON: Montana health officials acknowledge mobile teams are struggling despite the state contributing some financial support. They say they are considering increasing what Medicaid reimburses for each service call, but Schreiner says the state needs to do more.
SCHREINER: Is it a priority for our state or is it not?
BOLTON: For NPR News. I'm Aaron Bolton in Bozeman, Montana.
DETROW: That story comes from NPR's partnership with Montana Public Radio and KFF Health News.
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