NH Kids Need Mobile Crisis Services

In New Hampshire, we are experiencing a multitude of crises impacting our children, including the opioid crisis, a child welfare crisis and a mental health crisis. It is our obligation to address these problems head on – to ensure we are supporting the healthy social and emotional development of New Hampshire’s future leaders.

When children are experiencing a behavioral health crisis, it is our duty to give them the specialized support they need. Mobile crisis response and stabilization services (MRSS) provide acute mental health crisis stabilization and psychiatric assessment services to children where and when they need them. They aim to provide rapid response, assess the child or youth, resolve crisis situations, and link children, youth and families with needed services.

Mobile crisis response and stabilization services do not currently exist in New Hampshire for children in any intentional way. There are long waitlists at Community Mental Health Centers and a lack of child psychiatrists, leaving children without access to services when they need them, particularly during a crisis.

Why should Mobile Crisis Response and Stabilization Services (MRSS) for children be a top priority this year?

They’re evidence-based supports to help kids. Mobile crisis response and stabilization services are widely recognized as clinically appropriate and essential for children with serious emotional disturbances. MRSS help children and youth experiencing an acute behavioral health issue receive immediate assistance and help prevent unnecessary hospitalizations.

They give families an appropriate option for kids in crisis. In New Hampshire, when a child is in crisis, families are often left with only two options – call the police or bring them to an emergency department to wait for a bed at an acute inpatient psychiatric hospital. Emergency rooms and police departments often lack the specialized expertise and training to effectively respond to a child’s unique psychiatric needs, as well as the time and infrastructure to appropriately address the needs of individuals experiencing psychiatric or substance abuse crises.

They fill a gap in New Hampshire’s System of Care. Increasing access to mobile crisis response and stabilization services for children is widely recognized as a gap in the System of Care for children. It has emerged as an important priority in 1) Implementing a System of Care of Children’s Behavioral Health in New Hampshire: Year 2 Report issued pursuant to RSA 135-F; 2) The New Hampshire Division for Children, Youth and Families Adequacy and Enhancement Assessment ; and 3) in the workgroups, public input sessions, and draft of the state’s 10-Year Mental Health Plan.

They’re community-based. MRSS can play a key role in preventing emergency room use, acute psychiatric hospitalization, residential treatment, and placement disruptions among children and youth who are experiencing a behavioral health crisis. Mobile crisis services should be differentiated from residential crisis stabilization which are often delivered within an out-of-home setting. Outcomes are better when crisis intervention is provided in community-based settings, such as a child’s home or school. However, stabilization services are a necessary component to the service array and can serve as a hospital diversion program or a step-down from in-patient hospitalization.

They save money. Mobile crisis response and stabilization services are cost effective when compared to treating children elsewhere AND can reduce the need for otherwise costly services. Several studies have shown that “significant cost savings can result from crisis services, due to reduced inpatient utilization, emergency department diversion and more appropriate use of community-based behavioral health services.” Researchers have found that mobile crisis intervention services can reduce costs associated with inpatient hospitalization by approximately 79 percent in a six-month follow-up period after the crisis episode.

They allow cost savings to help kids in other ways. Cost savings from implementation can be realized in other systems (e.g. child protection and juvenile justice). These services can also be used to divert youth with behavioral health needs from entering the juvenile justice system.

They’re part of a New Hampshire-specific solution. New Hampshire is ready to scale up these interventions. New Hampshire’s System of Care already includes a financially sustainable model for a youth and family driven wraparound approach of intensive care coordination for children and youth with complex behavioral health challenges and their families. Increasing access to mobile crisis response and stabilization services is the logical next step in building a comprehensive System of Care, as required by RSA 135-F. It can also help the State meet its legal obligations under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions of Medicaid and the integration mandate of the Americans with Disabilities Act (ADA).

What else should I know about Mobile Crisis Response and Stabilization Services?

In a May 2013 joint informational bulletin, the Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administrations (SAMHSA) described mobile crisis response and stabilization services as follows:

“Mobile crisis services are available 24/7 and can be provided in the home or any setting where a crisis may be occurring. In most cases, a two-person crisis team is on call and available to respond. The team may be comprised of professionals and paraprofessionals (including peer support providers), who are trained in crisis intervention skills and in serving as the first responders to children and families needing help on an emergency basis. In addition to assisting the child and family to resolve the crisis, the team works with them to identify potential triggers of future crises and learn strategies for effectively dealing with potential future crises that may arise.”

“Residential crisis stabilization provides intensive short term, out of home resources for the child and family, helping to avert the need for psychiatric inpatient treatment. The goal is to address acute mental health needs and coordinate a successful return to the family at the earliest possible time with ongoing services. During the time that the child is receiving residential crisis stabilization, there is regular contact between the team and the family to prepare for the child's return to the family.”