Is access to crisis teams associated with changes in behavioral health mortality?

Abstract

Behavioral health-related mortality-deaths from suicide, drug overdose, and acute alcohol injury-are leading causes of death among US adults. Crisis teams, trained behavioral health professionals who serve as first responders to assess and stabilize clients in crisis, as well as refer to treatment as necessary, have been shown to reduce psychiatric hospitalizations, but whether crisis teams reduce behavioral health mortality has not been studied. We assessed the association between changes in access to crisis team programs and changes in county-level suicide, drug overdose, and acute alcohol injury mortality from 2014 through 2019. We found that 250 (9%) of counties experienced crisis team program entry and another 237 (9%) experienced crisis team program closure. Access to crisis team programs was associated with significant changes in county-level drug overdose deaths, but not suicide or acute alcohol injury. Compared with counties with no change in access, crisis team program entry was associated with a 7% reduction in county-level drug overdose death rates, and crisis team program closure was associated with a 13% increase in drug overdose death rates. These findings may support the use of crisis teams as 1 intervention to address substance use disorder treatment gaps in the United States.

Keywords: acute alcohol injury; behavioral health treatment; crisis intervention; drug overdose; suicide.

Figure 1.

County-level variation in crisis team program entry and closure, 2014–2019. Sources: County-level crisis team program entry and closure was determined using responses to the National Mental Health Services Survey (N-MHSS) included in the National Directory of Mental Health Treatment Facilities. For each year included in the study period, the N-MHSS asked facilities to report whether they “offer a crisis intervention team that handles acute mental health issues at this facility and/or off-site” (yes or no). We defined each county as either experiencing no change in crisis team access (either never had access or always had access respectively), entry of a crisis team program (no program in 2014 and gained access to at least 1 program by 2019), or closure of a crisis team program (at least 1 program in 2014, and lost program access by 2019). In addition to Alaskan and Hawaiian counties excluded from the study sample, we excluded the 11% of continental US counties (n = 355) that gained and lost crisis team programs at more than 1 time point.