One of the new services for families in Massachusetts is the mobile crisis initiative or MCI. Mobile crisis — sounds like something that will come to you when you have a crisis and stay there till the worst has passed, doesn’t it? Except it doesn’t always work like that.
This service has incredible potential. And in some parts of the state, it helps families whose children have a behavioral health crisis enormously. The intake worker “gets it” and sends out the team, the team goes where the child or youth is and figures out what to do, and the family has follow-up for 72 hours if that’s what they need. The team includes a family partner whose role is to ensure that a family’s perspective and choices are heard loudly and clearly and included in the solution. Until these new services began, the only “mobility” anyone ever saw was the crisis team going from their office to the hospital emergency department and then traveling back to their office.
The tricky thing about mental health care is that how well it works relies heavily on relationships, even very short term ones. Clinical skills count as does experience and expertise. But the expectation that each person has a job to do and is doing it as best they can is what builds the bond that can make things work.
Most crises, as any parent can tell you, happen at home and after business hours. Sure, there are times when a child or youth becomes suicidal or out of control at school or somewhere else. But a huge percentage of mental health crises occur at home. The parent sees what sets things off, usually knows what isn’t going to work ahead of time and can judge what’s outside of their own ability to handle things. So, they call in reinforcements.
Sometimes problems start with the phone call. The intake worker decides that the parent should be able to “manage” things at home. Or advises the parent that the MCI team can’t come out and they should try the emergency department instead. Sometimes new problems come with the team themselves. In one instance, the mobile crisis worker remarked, “This child is running the house. What are you going to do about that, Mom?” In these cases, the service may have changed but the attitude hasn’t.
Massachusetts Behavioral Health Partnership, who oversees the new mobile crisis services, has been working hard to improve them by offering training, consulting and other assistance. For some provider agencies with MCI teams, this is just what they need. Others, however, don’t seem to have the committment to adopt this new model and, instead, continue to do business as usual.
One father wrote in an email recently of his experience with the MCI team in his area. He called and outlined the escalation in his son’s delusions and behaviors and asked for the team to come out. Instead he was told to go the emergency department. After several hours, poor service and little help, a supervisor apologized for making his son and he go through it all. “I told them that the ER visit wasn’t needed, and now all we got was an apology for having to go through it, he wrote. “Parents need to be listened to from the beginning, not apologized to at the end. “