On a Saturday afternoon last year, two parents in Northern Utah were worried about their teenage son. He had a history of depression, and had been spending more time in his room than normal. He also hadn’t been washing his hair or eating well.
The parents called a mental health crisis line, and Bear River Mental Health social worker Adam Boman showed up at their house with a mobile response team. Things were worse than the parents realized.
“I could tell he'd been holding onto it for a while and was pretty scared,” Boman said.
The Stabilization and Mobile Response Team for children goes directly to patients. When Boman and the others arrived at the family’s house less than an hour after the parents called, he sat in the hallway outside the teenager’s room and tried talking to him.
“The youth was on their bed and initially didn't want to really talk,” he said. “Gradually, I was able to get the person to discuss the concerns and was able to build rapport to where the youth mentioned more than the parents were aware of.”
He told Boman he wanted to kill himself.
“At which time it became pretty obvious this person had access to lethal means,” he said. “The youth had knives in possession.”
Boman convinced him to hand over the knives and likely saved his life.
There are adult versions of the program, called Mobile Crisis Outreach Teams or MCOTs, throughout Utah already, but Bear River doesn’t have them.
The state Legislature approved $2.6 million to fund new MCOTs in rural counties during the 2020 General Session. But that funding was on the chopping block this spring when lawmakers were forced to cut $850 million dollars from the state budget to make up for lost tax revenue due to the coronavirus pandemic. Legislators cut almost all new funding, but they spared the MCOT program.
Boman has seen the upside to having mobile mental health teams firsthand. He said setting up a traditional outpatient therapy appointment would have meant the teen he assisted last year could have ended up waiting days or even weeks for help, and “it would have been hard to get that much information in a traditional 50 minute therapy session where you're just meeting for the first time.”
The difference, Boman said, is that these mobile visits are longer and take place in a familiar environment. And, 90% of their calls are resolved without transporting the patient to an inpatient facility, he added.
But in this case, the teenager still wanted to harm himself, so he was admitted to the hospital for more help.
Right now, Bear River Mental Health only has mobile outreach teams for people under the age of 21. And during the first year of the program, from 2018 to 2019, hospitalizations of people with mental health issues went down 21%, according to Bear River Mental Health CEO Beth Smith.
That’s why Smith was so excited when funding for MCOTs was approved in March and when the funding was spared during June’s budget cuts.
“We saw how wonderfully successful the children’s [program] has been,” she said. “When I saw that, I just could not get — and I cannot get — the adult version of that fast enough.”
Smith said not only are mobile teams effective at stabilizing children in crisis, they also save money.
“If an individual lands in the emergency room, the chances of the cost of that averaging about $9,000 is very high,” she said. “We can deal with crises with an MCOT team at a cost of under $400.”
Bear River Mental Health has now received $500,000 from the state, Smith said, to start a mobile outreach team for adults in Northern Utah. Those teams are staffed with a peer support specialist, a social worker, and a licensed therapist with a master’s degree.
Rep. Steve Eliason, R-Sandy, sponsored the bill with that funding. He said he made the case to his fellow lawmakers that this would actually save the state money in the long term, by cutting down Medicaid and policing costs.
“We believe that actually long term savings, both in human lives and in dollars and cents,” Eliason said, “were some of the compelling reasons why we're able to maintain this funding during a period of budget cuts.”
Eliason said recent anti-police brutality protests and calls to divert police funding to social services also contributed to lawmakers preserving the MCOT funding.
“The bill funded additional mobile crisis outreach teams that can often replace a police officer in a nonviolent situation involving somebody with a mental health issue,” he said.
An estimated half a million people with a serious mental illness are incarcerated. And while this move doesn’t take any money away from law enforcement, Black Lives Matter Utah founder Lex Scott said this is a step in the right direction.
“We need to take that money that is spent on mass incarcerating mentally ill people and put it back into treating mentally ill people,” Scott said. “Because it's not illegal to be mentally ill.”
But, she said she’d like to see the mobile outreach team service integrated into 911 dispatch.
Boman, the social worker from Bear River Mental Health, said his team has acted as a replacement for police before. About 10 months ago, they helped a family that usually called police when their son became belligerent and confrontational to take him to a youth shelter.
“I was able to help calm the youth down and then come together literally at their kitchen table and ... help each see the other’s side of it,” he said.
They came up with a plan to avoid situations like that in the future, and Boman said the child hasn’t been taken by police to a youth shelter since.
It can be hard for providers in rural areas to find licensed therapists who are willing to work nights, Beth Smith said, since the outreach teams are available 24-7. So, she teamed up with two other rural providers to share resources. Teams will still have two in-person members, but therapists will visit virtually.
“Bear River already has a pretty hardy system of master's level crisis workers who can be available via telehealth,” she said. “We will be sharing them at night, after hours or even during the day.”
Bear River’s MCOT is expected to come online by early August.
If you or someone you know needs help, contact the Utah Crisis Line at 801-587-3000 or the Bear River outreach team for children at (833) 723-3326.
Correction: 6:41 p.m. MDT, 7/21/20. A previous version of this story misspelled Adam Boman's name.