Mobile Crisis Program: Effectiveness, Efficiency and Consumer

¶ … Mobile Crisis Program:

Effectiveness, Efficiency and Consumer Satisfaction, Questions

What are the goals of the Mobile Crisis Program?

The mobile crisis program of DeKalb County, Georgia is a component of the DeKalb Community Service Board, a comprehensive mental health service agency aimed at treating and reducing the threat of lash-outs from mentally ill persons throughout the county. The goals of the program are to provide community-based psychiatric services to stabilize persons experiencing psychiatric emergencies in the least restrictive environment, to decrease arrests of mentally ill people in crisis, and to reduce police officers' time handling psychiatric emergency situations throughout the county, thus freeing them to return to their regular duty serving and protecting their respective communities.

In allowing for this type of program within its communities, DeKalb county's overarching goal of achieving stability within its borders has the ability to come to fruition. Additionally, as the mobile crisis program's goal of intervening in possibly violent and distracting acts amongst its mentally ill citizens, the county will cut costs in terms of police and hospital involvement, as a rotating team of four police officers and two nurses are always on hand to intercede in such events, forwarding the success goal of the mobile crisis program.

2. What is the study sample?

The study's design employed the concept of a natural experiment in order to eliminate selection bias. As such, the study sample consisted of 73 psychiatric emergency cases handled by the mobile crisis team and 58 such cases handled by regular police procedures throughout a three-month period from October 1, 1995 to December 31, 1995. In order to keep the sample as random as possible, information was obtained from records of the public safety department and the mobile crisis program on subjects' demographic characteristics such as age, race and gender, the homelessness status, whether the subject had a state psychiatric hospital admission in the previous six months, whether the crisis situation involved violence, the duration of police involvement, and the disposition for the crisis situation. For the purposes of this experiment, "homelessness" was defined as having no permanent residence and currently living on the street or in a homeless shelter.

3. The program measurements focused on effectiveness, efficiency and consumer and police satisfaction. How was effectiveness measured? Efficiency? Consumer and police satisfaction?

Program effectiveness was evaluated by measuring the differences between the hospitalization and arrest rates of the study groups. Evaluation found that 55% of cases handled by the mobile crisis team were concluded without any psychiatric hospitalization.

Efficiency, in terms of psychiatric emergencies, has a standard end or common objective, of both mobile crisis programs and regular police services to resolve or ameliorate the situation for the immediate protection of the health and safety of the persons involved and to facilitate access to any additional treatment or follow-up services needed. To achieve this goal, efficiency was evaluated by comparing the cost per case/episode for mobile crisis services and regular police services. This cost was calculated as total program costs and any psychiatric hospitalization costs divided by the number of cases served. Program costs included: the department of public safety's contribution of one police officer per team per 7.5-hour shift plus the mental health service's expenditures associated with the program and its overhead.

Costs per case in terms of the regular police division included police services per hour at $39.33

multiplied by the elapsed time of the intervention (average 1 hour and 51 minutes) plus any psychiatric hospitalization costs, taking into account police salary, benefits, and overhead.

Additionally, the cost of psychiatric care was taken into account in order to determine efficiency, and was calculated to equal the total cost of residential treatment services used divided by the average number of cases served. The average cost per case for psychiatric hospitalization was calculated by multiplying average length of stay by the average daily rate for facilities used by the program and police personnel. At the end of the study, cost efficiency of the mobile crisis program was found to cut costs as compared to the costs of police intervention and subsequent hospital stays.

Consumer satisfaction was evaluated in conjunction with routine follow-up services to persons served by the mobile crisis team and program during the three-month study period. This 32-individual sample was asked to complete a satisfaction questionnaire rating items on a scale of 1-4, with 4 being the highest level of satisfaction. Additionally, satisfaction was also evaluated by the evaluation of open-ended questions posed to consumers about the satisfaction of the services they received. Of the 32 clients, 22 rated the mobile crisis program an average of 27.4+4.9 out of a possible 32.

Police officer satisfaction was determined by the distribution of a survey designed by the author regarding their satisfaction with the performance of the mobile crisis team on a 5-point Likert scale with 5 being the highest level of satisfaction. The survey was distributed to officers present at each of three consecutive shift roll calls for immediate completion and return, for a total of 106 completed officer surveys. 75% of the 106 officers responding to the survey indicated that they were very satisfied or mostly satisfied with the performance and working relationship of the team.