The impact and mechanisms of mobile response services for individuals experiencing behavioral health crisis

About This Grant

Abstract Behavioral health crises are periods of extreme suicide risk, yet rigorous causal evidence on the effectiveness and mechanisms of mobile crisis response for suicide prevention remains a critical gap. Existing research largely lacks the study designs needed to definitively establish the added value of in-person mobile response services over telephone-only support. Our proposed project will rigorously evaluate the real-world effectiveness and implementation of mobile crisis services, studying the A3 Crisis Response program in Contra Costa County, CA. This large-scale program includes a crisis call center and 30+ mobile crisis teams, providing 24/7 service to all county residents. With a population of 1.2 million across 19 cities and 700 square miles, the county encompasses a range of communities and socioeconomic variation, positioning this research to be relevant to all Americans. Using a convergent mixed-methods design, we will concurrently and iteratively pursue two integrated aims. Aim 1 will use a quasi-experimental Instrumental Variables (IV) study design to determine the causal impact of mobile crisis response (vs. telephone support only) on suicide, self-harm, and service use and identify mechanisms of effect. Service use outcomes include: involuntary psychiatric holds, psychiatric emergency services and general Emergency Department visits, inpatient hospitalizations, jail intake, outpatient mental health visits, substance use disorder (SUD) treatment visits, and primary care visits. We will then use IV-based mediation analyses to test whether increased engagement with community-based follow-up care (outpatient mental health, SUD treatment, primary care) mediates reductions in suicide, self-harm, and use of acute services/ jail intake. Aim 2 will qualitatively identify effective mechanisms and implementation strategies of mobile crisis response using implementation science-guided ethnography. We will use an ethnographic approach combining multi-sited observations (call center, dispatch, field response, linkages to care, follow-up) and in-depth interviews with crisis response staff, cross-sector partners, and clients to generate qualitative evidence on implementation determinants and mechanisms. Analyses will be guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative findings will be integrated iteratively with Aim 1 to contextualize and explain findings, refine mediators, and guide subsequent analyses. This application directly addresses RFA-MH-25-135 by rigorously evaluating effectiveness and implementation of crisis response for suicide prevention in a real-world system. Building on a 6-year research-practice partnership, this study was co-designed with Contra Costa Health and a community Advisory Board, ensuring strong stakeholder alignment. The integrated mixed-methods design will provide actionable evidence to help policymakers, payers, health system leaders, service users, and families make informed decisions about investing in, implementing, and accessing crisis response services.