The mobile crisis team in Bozeman is heading out on a call on a snowy afternoon.
Mobile Crisis Responder Evan Thiessen is on the phone, getting information from a family member of a local man in crisis.
“You’re doing the right thing and we’re going to make sure he gets help today, ok?”
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 his home. Licensed therapist Luke Forney jots down some notes from the man’s police record, which shows past instances of violence.
“Especially if he’s confused and upset, we want to keep an eye on that,” Forney said.
Ultimately the crisis team found that the man was physically safe where he was. He didn’t pose a threat to himself or others. So they will check in with him in the following days.
Gallatin Mobile Crisis Director 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, 7 days a week.
“I think that everyone is on the same page of seeing the value that these programs bring,” Mattson says.
He says finding a way to keep paying for them is the hard part.
“I’m confident we’ll be here through next fiscal year. That’s about as confident as I am at this point.”
Bozeman’s mobile crisis program costs about $1 million every year.
These programs are facing several financial hurdles. They are more expensive to run than initially anticipated. Most private insurance companies don’t reimburse for mobile crisis, and Medicaid payments are below state health officials’ projections. Time spent documenting crisis calls or waiting for the next one isn’t paid for by insurance.
“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”
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.
“Broadly, it is kind of this patchwork and there’s a big question as to whether these services are sustainable across states.”
Unlike Montana, some states have mandated that private insurers cover mobile crisis care. Others have implemented fees on cell phone bills to help pay for the service.
Some local communities have chipped in local tax dollars.
In Great Falls, the mobile crisis unit closed in part because of low Medicaid payments. It’s one of two units in the state that have already shuttered.
Casey Schreiner is an executive at Alluvion Health, the clinic that used to run the program in Great Falls.
“We need a completely revamped system to pay for these services,” he says.
Montana health officials acknowledge mobile teams are financially struggling despite some state financial support. They say they are considering increasing Medicaid payments.
But the state says local programs will have to find a way to fill funding shortfalls.
Again, Schreiner.
"Is it a priority for our state, or is it not?”
He says the state will need to provide more funding if it wants these programs to survive.
