Why This Landed on My Radar
We’ve all had that patient - the one spiraling into psychosis, the family desperate for help, and you’re left holding a phone trying to figure out who to call besides 911. Mobile crisis teams have been our lifeline for these situations, but they’re shutting down across the country despite actually working. If you’ve been counting on these teams to keep your most vulnerable patients out of jail and ERs, we need to talk about what’s happening to their funding.
Here’s What’s Going On
A new survey found at least 1,800 mobile crisis response teams operating nationwide in 2023 - specialized units trained to respond when someone’s experiencing delusions, hallucinations, or acute psychiatric emergencies. These aren’t cops with tasers; they’re therapists and trained responders who show up in unmarked vehicles and de-escalate without handcuffs. In Bozeman, Montana, one such team has cut police time spent on mental health calls by nearly 80%.
But here’s the problem: unlike police departments funded by local tax dollars, mobile crisis teams operate on a patchwork of grants, temporary funding, and payer reimbursements that never quite cover the real cost. The result? Successful programs are closing. Montana just lost two programs - Great Falls and Billings - despite strong community support and proven track records. Six units remain, but they’re operating on financial quicksand.
These teams started appearing in the late 1980s as an alternative to criminalizing mental illness. They work. Families use them. We refer to them. But nobody’s figured out how to pay for them sustainably.
What This Means for Your Practice
This funding crisis hits Texas practices from multiple angles, and it’s about to get worse. We already operate in a state with the nation’s highest uninsured rate and no Medicaid expansion. That means a huge chunk of our patients with serious mental illness have zero coverage for anything, let alone specialized crisis response.
When mobile crisis teams disappear, the entire burden shifts back to us, our staff, and the ER. You know the drill: frantic family calls at 4:45 PM on Friday. Your medical assistant is on the phone for 45 minutes trying to find someone to help. The patient ends up in police custody or your local ER where they’ll wait 18 hours for a psych bed that doesn’t exist. Then they’re back in your office next month, traumatized, with a police record, and even less likely to engage with treatment.
The economics are brutal too. We’re not getting paid for those crisis management calls. We’re certainly not billing for the time our staff spends trying to coordinate care that should exist but doesn’t. And when these patients end up cycling through ERs and jails instead of getting appropriate crisis intervention, their chronic conditions (diabetes, hypertension, the stuff we are managing) deteriorate rapidly.
In Texas metros like Houston and Dallas, competition for commercially insured patients is fierce, but the patients who need mobile crisis teams most often have Medicaid or nothing. Without Medicaid expansion, there’s no revenue model for crisis services targeting this population. BCBS Texas and United aren’t exactly lining up to reimburse for mobile crisis response at sustainable rates.
Rural Texas practices face an even starker reality. If a crisis team shuts down in Lubbock or Amarillo, the nearest alternative might be 150 miles away. Your patient in crisis either gets police response or nothing. The liability exposure for our practices increases when we’re forced to make impossible referrals to services that don’t exist.
Key Takeaways
- Mobile crisis teams are proven to work but operate on unstable funding - grants and patchwork reimbursements that don’t cover actual costs
- When these teams shut down, the burden shifts entirely to primary care offices, ERs, and police, with no compensation for our time
- Texas’s lack of Medicaid expansion means many patients needing crisis services have zero coverage, making sustainable funding nearly impossible
- Document every instance where you need crisis services that don’t exist - this data matters for TMA advocacy and future funding discussions
- Build relationships now with whatever behavioral health crisis resources still exist in your region before you’re scrambling during an actual emergency
What Smart Practices Are Doing
Forward-thinking practices are documenting every gap - tracking how much staff time goes into managing behavioral health crises, how many patients end up in jail or ERs because alternatives don’t exist, and building the case for why sustainable crisis funding isn’t charity, it’s essential infrastructure. They’re also connecting with local TMA chapters to push for state-level funding mechanisms that don’t depend on grants running dry.
Source
“Despite Their Successes, Some Mobile Crisis Response Teams Are in Crisis,” KFF Health News
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