Mental Health Emergency Response: Utilization, Outcomes and Implementation of Mobile Crisis Services in Medicaid - PROJECT ABSTRACT Adults and adolescents in mental-health crisis often face a disjointed response: most 911 calls end at an emergency department or with police, settings that lack the time, staff, and follow-up links needed for safe stabilization. Mobile Crisis Services (MCS) are teams of clinicians and peers who travel to the person, de- escalate, and connect to outpatient care. MCS programs have grown rapidly; more than 1,800 programs now cover 40 percent of U.S. counties and Medicaid spending on the model has doubled in two years. Yet no national work shows who actually receives MCS rather than ED based care, whether MCS reduces admissions or repeat crises, or which state actions help programs expand and last. This project will fill those gaps by merging 2021-2025 Medicaid claims with local workforce, socioeconomic, and policy files for nine states and the District of Columbia and pairing those data with 45 stakeholder interviews. We will pursue three aims. In Aim 1, we will measure how individual factors (age, sex), community context (rurality, provider supply), and the clarity of state Medicaid guidance predict receipt of MCS versus an emergency-department visit during a behavioral-health crisis. In Aim 2, we will estimate the effect of receiving MCS care on (a) psychiatric hospitalization during the index episode, (b) outpatient mental-health follow-up within 7 and 30 days, and (c) any repeat crisis within 90 days. A staggered, policy-based fuzzy difference-in-differences design will use four external policy shocks (ARPA mobile-crisis funds, SAMHSA planning grants, new state appropriations, and 988 dispatch statutes) to isolate variation in MCS availability. In Aim 3, we will identify workforce, finance, and coordination factors that explain the quantitative findings and shape program scale-up through semi-structured interviews with national experts, state officials, and frontline providers. By showing where MCS teams work, how large their effects are, and which policy levers matter, the study will provide actionable evidence for clinicians, patients, and policymakers to set fair payment, build staffing plans, and choose when a mobile response is the right option, directly advancing NIMH Strategic Plan Objective 4.2 and the federal goal of strengthening community crisis care.
