Associate Professor of Pediatrics University of Vermont Larner College of Medicine Burlington, Vermont, United States
Abstract : Introduction/Aims Delivering effective mobile mental health crisis services is a crucial aspect of suicide prevention care. Historically, communities relied on informal or law enforcement responses to crisis situations, however these encounters can be traumatizing and dangerous when non-mental health trained responders are involved.1 In recent years a Mobile Crisis (MC) approach was developed in our state to respond to individuals with non-medical emergencies related to mental health and substance abuse/misuse. MC services are provided in a variety of locations including residences, public areas and healthcare settings. Key elements of MC efforts include providing a timely and compassionate response that helps clients navigate their crisis and connecting them with services in the least restrictive environment possible. Suicide prevention-related services provided by MC responders include screening, safety planning, care coordination and follow-up. Evidence supporting the general effectiveness of MC approaches has been reported, however the impacts of MC response specifically related to suicide prevention and in rural settings has not been well described in the published literature.2 People living in rural communities experience disparities in accessing mental health care, have disproportionately high rates of suicide deaths and attempts, and rural individuals experiencing a mental health crisis are frequently seen in Emergency Department or other settings where the available care and physical environment may not be aligned with clients’ needs. Our state is predominantly rural and providing services rapidly and at the location chosen by the client are especially important in communities where challenges to mental health access include fewer mental health providers, long travel times, and lack of transportation. The MC model developed in our state did not initially include people with lived experience as responders. However, integrating Peer Specialists who are trained in peer work and can support clients in ways informed by their personal experiences and knowledge about available services may increase the effectiveness of MC responders working as teams, including in addressing suicidality. At the start of 2024, our state launched an enhanced MC model in which two providers, a licensed mental health professional and a Peer Specialist with lived experience of mental health and/or substance-use related challenges, jointly respond to 988 calls in the community. We performed a formative evaluation of the integration of Peer Specialists into MC teams to better understand their impacts on crisis response and support making changes that will increase the sustainability of the peer-integrated MC model.
Methods This study uses a qualitative design in which semi-structured interviews were conducted to learn Peer Specialists’ perspectives on their integration into MC teams. Initial outreach was done to the state Department of Mental Health to obtain project buy-in and elicit feedback on the proposed methods. Community mental health agencies implementing the integrated MC approach were identified and contacted to aid in recruiting Peer Specialist participants. Two agencies serving rural communities provided information and the identified Peer Specialists were invited to participate in an interview conducted over Zoom. Interviews were recorded and transcribed, and participants received $30 for participating. Data analysis consists of the researcher team reviewing transcripts to establish initial procedures and codes, followed by them coding independently and later reconciling their codes and identifying preliminary themes 3. To date, four interviews have been completed and transcribed, and thematic content analysis is ongoing. This study was determined as exempt from review by our organization’s Institutional Review Board.
Preliminary Results Review of the initial qualitative results suggests that integration of Peer Specialists into MC teams’ responses is beneficial to the teams’ work with clients. Preliminary themes include the value of their own lived experience in providing crisis care, fostering trust between MC teams and clients, and the importance of comprehensive training for Peer Specialists. Peer specialists reported feeling empowered by the fact that they were able to utilize their lived experience to help others. Additionally, they said that having lived experience helped them connect with clients on a deeper level. Overall, Peer Specialists reported feeling valued as team members and being well prepared and supported by the MC teams in their agencies. The Peer Specialists’ presence and talking with the person in crisis helps provide hope to clients and generally make calls more productive. Peer Specialists also described serving as a “translator” between the clinician and client and explaining things in a way both parties understood and added to the comfort of the interaction for the person in crisis.
Conclusion Preliminary analysis of interviews with Peer Specialists integrated into MC teams suggests this is a promising approach for improving the delivery of crisis services in the communities where it has been implemented, including for people experiencing suicidality. The impacts of the integrated MC related to rural services has not been identified as a specific theme, yet this remains important context given the predominantly rural environments and populations served by the integrated MC teams. Recruitment of Peer Specialists into this evaluation has been challenging, however, as agencies continue hiring and supporting this role additional participants are being identified. The scope of this evaluation is limited in that we are unable to assess clients’ perspectives on having peers involved in mobile crisis response, and future research on their perspectives will be key for understanding the impacts of integrating Peer Specialists into MC teams. To fully understand the dynamics of integrating Peers Specialists we will also need to assess the perspectives of their licensed counterparts. Data collection is ongoing, and the findings will be used to identify possible quality improvement work aimed at improving the effectiveness of the teams and the comfort of the MC team members.
Learning Objectives: • Describe the role of Mobile Crisis responders in supporting the mental health of communities • Discuss the integration of Peer Specialists into Mobile Crisis Teams
