Austin, TX: Mobile Crisis Outreach Team (MCOT)

Location

• City: Austin TX (Expanded Mobile Crisis Outreach Team- EMCOT, MCOT-Mobile Crisis)
• Population Size: 978,908
• Jurisdiction Size: 297.9 sq miles

Intercept

• Intercept 0-MCOT
• Intercept 1- EMCOT

Model Components

Staffing Structure

• Austin’s embedded counselors (called C3 or TCD Counselor)
• There is one clinician dedicated to the EMS call-takers
• There is also an “overwatch” on site at 911, a supervisor belonging to Austin PD, whose job it is to make sure unnecessary calls don’t go to patrol

Staff Training/Qualifications

• Austin’s embedded counselors (called C3 or TCD Counselors; all master’s level
• At 911, all clinicians are level 4 CGIS compliant, but they can’t run anyone or conduct record checks

Dispatch Structure

• EMCOT Can be accessed through 911
• MCOT can be accessed through crisis line and can receive referrals from jail
• Austin’s embedded counselors get forwarded calls straight from the 911 call-takers as a warm handoff (they’re certified to be on the 911 system), and in addition to resolving calls over the phone, they have the capability to dispatch mobile teams as well. Austin’s 911 (operated by Austin Police Dept) is the primary entity that does initial triage to determine if someone is having a MH crisis and can transfer the call to the onsite counselor (employed by Austin’s behavioral health authority) who takes over the call and provides de-escalation, emotional support, crisis resources, connections to ongoing treatment team, or if an immediate response is needed, they can dispatch their own mobile crisis team. They can also patch 911 back in if police is deemed necessary.
• 911 call-takers use a decision tree to determine whether or not the call is eligible for transfer (started with narrow focus on call types – suicidal ideation, parent-child conflicts, individuals with symptoms of psychosis, paranoia, delusion – and then added more – welfare checks primarily called in by passer-by or family or friend living elsewhere where safety can be determined). 911 call-takers create a call in CAD called “TCD Counselor” and send the call to the counselor. In July 2020, they allowed counselors access to CAD and 911 answering system (CGIS compliance — level 4 CGIS compliant). 911 call-takers also create a queue for the counselors so if they’re busy and it’s a nonemergency, call-taker says we’ll have the counselor call you back ASAP. There is also an “overwatch” on site, a supervisor belonging to Austin PD, whose job it is to make sure unnecessary calls don’t go to patrol.
• EMS call-takers also have the same MH transfer procedure as 911 call-takers, except they cannot cancel the EMS response (e.g., heart attack? No, actually anxiety, but they can’t divert an ambulance response, which was a medical leadership decision). There is one clinician dedicated to the EMS call-takers. The counselor can give info gathered on the call to EMS. Police referrals are much higher than EMS

Operating Structure

Operations

• 911 call-takers use a decision tree to determine whether or not the call is eligible for transfer (started with narrow focus on call types – suicidal ideation, parent-child conflicts, individuals with symptoms of psychosis, paranoia, delusion – and then added more – welfare checks primarily called in by passer-by or family or friend living elsewhere where safety can be determined). 911 call-takers create a call in CAD called “TCD Counselor” and send the call to the counselor. In July 2020, they allowed counselors access to CAD and 911 answering system (CGIS compliance — level 4 CGIS compliant). 911 call-takers also create a queue for the counselors so if they’re busy and it’s a nonemergency, call-taker says we’ll have the counselor call you back ASAP. There is also an “overwatch” on site, a supervisor belonging to Austin PD, whose job it is to make sure unnecessary calls don’t go to patrol.
• Counselors also provide higher-risk virtual help: For individuals with imminent risk of harm/safety (e.g., suicidal ideation and have a gun in front of them), 911 call-takers conference the embedded counselor into the calls while waiting for a police response and provide emotional support and add notes to the CAD system directly so the responding officers arrive on the scene and already have the info

Funding Mechanisms

• Integral Care is a Certified Community Behavioral Health Clinic (CCBHC)- a specially-designated clinic that provides a comprehensive range of mental health and substance use services. The CCBHC model alleviates decades-old challenges that have led to a crisis in providing enhanced access to mental health and substance use care, and partnership with law enforcement and emergency services. Texas developed an 1115 waiver for managed care directed payment to fund CCBHCs that had previously been certified under a state-driven effort creating a sustainable Medicaid funding mechanism for these services.

Management Structure

• Staffed through Integral Care Crisis Services (Austin’s local MH Authority)- Staff crisis counselors and mobile responders

Data Systems / Collection

Data Systems

• Counselors have access to electronic health records

Data Collection

• Worked with their City Law Dept to produce a list of approved statements that the counselor can note directly in the CAD system (if imminent danger is not present). Counselors can share more information with EMS than PD, per HIPAA.
• Worked with Integral Care’s legal counselor

Highlighted Statistics/Outcomes Based on data pulled from 12/16/2019-9/30/2020

• Austin 911 claims that about 10-15% of all 911 calls are tagged as mental health-related calls. They receive about 1 million calls each year.
• 944 calls were transferred to the embedded counselor (looks to be around 100/month), and out of those transfers, about 84% were able to be handled without involving police. (For the 16% that resulted in a police response, most were due to imminent safety issues or the individual still requested a police response). The counselor deployed a mobile crisis team 15% of the time, and the rest of the calls were able to be handled over the phone.
• Average time spent on a call for counselors is 15 minutes.
• Since they started saying Police/Fire/EMS/MH in February 2021, they saw an increase in MH tags and found that callers are generally good at self-categorizing. From February 1, 2021 to April 29, 2021, 1,870 callers selected the MH option out of 90,485 total calls for service (about 2% of all calls). People who originally selected police and also had some MH component was 9,269 (about 10%). 432 were transferred to the embedded clinician
• Call center is now 24/7 as of June 2021

Key Takeaways

• Being embedded in the police department helps with trust and relationships