Crisis Response and Mobile Crisis Teams for Substance Use Disorders

A crisis response system is a structured network designed for efficient and effective intervention during behavioral health crises, including those related to substance use disorders (SUD). These systems aim to stabilize individuals in crisis within their communities, reducing the need for law enforcement and emergency department involvement.

The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines three essential elements of a crisis response system:

• Someone to contact: Resources like the 988 Suicide & Crisis Hotline and substance use helplines
• Someone to respond: Mobile crisis teams and outreach services
• A safe place for help: Access to emergency and crisis stabilization services

It can be difficult for rural communities to implement crisis response systems due to limited behavioral health and SUD resources, including workforce shortages. As a result, law enforcement is often the default responder, which can lead to unnecessary criminal justice involvement. Many rural communities have adopted SAMHSA's Sequential Intercept Model, which identifies critical points where individuals with SUD and mental health disorders can be diverted to appropriate care instead of incarceration. For more information about crisis response systems for mental health, see the Mental Health in Rural Communities Toolkit.

Mobile Crisis Teams for Addressing SUD

Mobile crisis teams are a key part of crisis response systems. They can help de-escalate crises, administer immediate care, and connect individuals to SUD treatment. Ideal teams typically include licensed clinicians such as social workers and psychiatrists. Flexible models have also been successful. One example of an alternative model is the co-responder team, which pairs behavioral health professionals with law enforcement officers. Another example is the non-clinical team, which uses trained peer support specialists or community health workers supervised by licensed behavioral health providers.

Examples of Crisis Response and Mobile Crisis Team Programs

• The Crisis Intervention Team (CIT) Academy in southwest Montana is a 40-hour training program for emergency responders and detention staff, focusing on crisis intervention strategies related to substance use and mental health crises.
• Mobile Integrated Health (MIH) Program in Richmond, Indiana collaborates with first responders to provide post-crises follow-ups and connect individuals to SUD resources.
• The Alabama Crisis System of Care expands mobile crises teams to improve crisis care access in rural areas, providing de-escalation, medical coordination, and peer support.

Considerations for Implementation

Effective crisis response systems in rural areas can use resource-sharing and innovation to address unique local challenges. Key implementation strategies for rural communities include:

• Shared resources. Community partnerships enable rural regions to share vital resources such as telehealth equipment, vehicles, and training materials, making services more sustainable and accessible.
• Telehealth. Utilizing telehealth can enhance crisis care by connecting individuals with behavioral health professionals via internet-enabled devices.
• Training. Workforce shortages can be mitigated by training paraprofessionals, such as peer support specialists, clergy, and community health workers, to provide crisis intervention and support.
• Regional partnerships. A regional approach to pooling resources across counties strengthens these systems, reducing financial strain, and increasing the reach of these services for timely SUD-related crisis care.

Crisis response systems should address a broad spectrum of behavioral health needs, including co-occurring SUD and mental health conditions. Providing integrated responses is essential. Rural providers should have clear policies and protocols for intoxication or withdrawal, incorporating screening, brief interventions, and referrals when necessary. Staff training is also important to effectively recognize, assess, and manage substance use and co-occurring conditions.

Focusing on safety and overdose prevention is important in rural crisis response systems. Programs should work on collaborative safety planning, including suicide and violence risk assessments, as well as crisis and suicide safety plans, to promote immediate safety and long-term stability. Programs should also establish overdose prevention protocols tailored to local substance use trends and cultural factors. These systems should include strategies for recognizing and responding to overdoses while addressing the specific patterns of substance use in rural communities.

Resources to Learn More

2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care
Document
Provides guidance on developing and enhancing crisis services.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 1/2025

988 Partner Toolkit
Website
Shares resources to promote the 988 Lifeline including FAQs and marketing materials.
Organization(s): Substance Abuse and Mental Health Services Administration

Crisis Systems Response Training and Technical Assistance Center
Website
Supports states, territories, tribal organizations, and other community partners in the development of an integrated, equitable, and sustainable crisis care system.
Organization(s): Substance Abuse and Mental Health Services Administration

How to Successfully Implement a Mobile Crisis Team
Document
Provides an overview of a mobile crisis team and offers tips and examples for various jurisdictions intending to implement a mobile crisis team.
Organization(s): The Council of State Governments Justice Center
Date: 4/2021

The Rural Behavioral Health Crisis Continuum: Considerations and Emerging State Strategies
Document
Describes state-developed interventions and programs to strengthen rural behavioral health crisis care.
Author(s): Pearsall, M. & Wilkniss, S.
Organization(s): National Academy for State Health Policy
Date: 4/2023