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What Is the Mobile Crisis Outreach Team (MCOT)?

Interviewer: Mental health crises don't always happen in a therapist's office. They can happen at home, at work, or on the street. And when they do, knowing who to call and what will happen next can sometimes feel overwhelming. And for citizens in Salt Lake County and the state of Utah, the Mobile Crisis Outreach Team, or MCOT, can be a good resource.

Today we're joined by Claudine Miller. She is a licensed clinical social worker with Huntsman Mental Health Institute's Community Crisis Intervention and Support Services team. Now, Claudine, why don't you tell me a little bit about MCOT, the Mobile Crisis Outreach Team, and what exactly it does?

Claudine: Oh, I would be so happy to. MCOT is definitely a passion of mine. I have worked in all different levels of care, and I find MCOT to be very unique. So what MCOT is, is a mobile team of two people. It's a licensed clinician, so an LCSW, a CMHC, and a peer support specialist, and a peer support specialist has lived experience. And we find that team of two to be just the sweet spot for our community.

So what would happen is somebody determines they're having a crisis, and our big motto here at Huntsman Mental Health Institute is that the caller determines the crisis. It's not for us to determine. Somebody can call and say, "Gosh, I'm really struggling." A team of two people will go out to wherever they are. We have met people in a park. We have met them in a parking lot. We have met people at home. We have met people at work. We will come to wherever you are to assess and determine what's the next best step.

And for the majority of people, having somebody here and having somebody just to listen and hear what is happening is the game changer. Our goal for all of MCOT across the whole county or the state really is diversion. Can we keep people out of ERs? Can we reduce the impact of law enforcement on mental health calls? So our hope is that MCOT can go out and provide that mental health piece in-person in real time.

The piece that I absolutely love is the ability to be in someone's space gives us a look into their life. In the beginning, you had mentioned crisis doesn't always happen in a therapy office. But often, what happens in a therapy office is somebody will bring in a concern to the therapist that they want the therapist to know, but they don't have the big picture. As we go out into your home, as we go out into your workplace, we're able to see a big picture. We're able to see that, "Dang, you guys might be struggling with some food insecurity," or "Hey, I noticed that you also have grandma living with you. Are you guys doing okay? Do you have the support that you need?" So, as we're able to see someone in their environment, we're able to provide a different layer of support. And it's the piece that I love the most about MCOT.

Who Can Call MCOT?

Interviewer: That sounds like an amazing service that could be really helpful for people in our community. But I did want to ask, is this service, say, just for adults? Is it just for people who are having a crisis, or people who see it? What types of people can call into the MCOT?

Claudine: Anybody, any age, any situation. So, if I can break it down, the way things would work is someone calls 988. A certified crisis worker is going to talk to them and determine, "Hey, maybe MCOT might be a great option for you." If that's the case, they will reach out to whatever county where that person is living in and the MCOT teams in that county will be deployed.

Here in Salt Lake City, we're able to have a dispatcher in the office. So if someone calls 988, they're living in Salt Lake County, the crisis worker that they talk to on 988 will notify the dispatcher. Our dispatcher will then look at our MCOT teams locally here and say, "Oh, I know there's a team really close by. I'm just going to send them." Our response time within Salt Lake County is about 30 minutes on average.

Here in Salt Lake County, our teams are available 24 hours a day, 7 days a week, and anybody can call. We have been in schools, elementary schools. We have been in retirement facilities. We have been in our shelter system. We have been in beautiful homes throughout the valley. So it can be anybody of any age, we will go out and see you.

What to Expect When the Team Arrives

Interviewer: When the MCOT team arrives, what can a loved one or a person in crisis expect when the team actually gets there?

Claudine: That's a great question. The team will arrive, and typically when I go out, because I love going out as well, when I go out, I'll say, "Hey, I'm Claudine from the Mobile Crisis Team. I've heard you've had a bad day. Do you have a place that you would like to talk?" And really, it's going to be the two of us, the clinician and the peer, sitting down with somebody and talking and figuring out what's going on.

What we're really trying to do is determine what the crisis is and how we can best support that. We give a lot of resources. "Hey, have you heard about this resource? Have you heard about this therapy office? Did you know about this food bank?" We will try to create a crisis response plan, which is shorter than a safety plan. If people are familiar with the safety plan, a crisis response plan is a lot shorter, and it's in the moment, and it's very interactive.

Typically, it could fit on a three-by-five card, but it's a plan that somebody could, in a moment's notice, pull out and say, "Oh, I've identified that my neighbor Johnny down the street is a really great resource for me to talk to or reach out to. I also know that I can call the crisis line again." The 988 is also a text line. I could text in if I don't like talking to somebody.

Peer Support as a Bridge to Trust

We will create a really great safety plan, but I think the most important piece is that we're there to listen. We're there to give you that space and that ability to voice whatever is happening without judgment, and it's having a peer can be the game changer. I have been out on outreaches where somebody said, "I've been in the military. I'm really scared to take medications." And my peer can turn around and say, "You know what? I was also in the military, and I take medications. Can I tell you what it's been like for me?" Or a peer to share some of their lived experience. "Yeah, I'm also 20 years in recovery. Can I tell you what that's been like for me?"

So having a clinician who can do that really great assessment mental health-wise and the peer that can share the lived experience and be able to step into those shoes for a minute and say, "Yeah, that was a struggle for me too," that's the sweet spot that we come to on MCOT.

Why MCOT Is a Better First Step Than 911 or the ER

Interviewer: Now, what makes the MCOT different than, say, going to the ER or calling 911, or calling law enforcement?

Claudine: Oh, there are so many differences. First, MCOT is no charge. You will not be charged to have an MCOT team come out to your home, your work, or wherever it is. We'll just show up. So that's a huge game changer.

We know wait times in the ER are wicked long. So, to sit in an ER to try to get a mental health assessment could be a very long wait. And if we can prevent somebody from having to do that, we will come out, we will do an assessment.

Sometimes when we're out there, maybe somebody does still need to go to the hospital, and in that case, we are calling the hospital and giving them a heads-up, "Hey, we just met with Johnny. He's expressing some suicidal thoughts," whatever the case may be. We're going to give them a heads-up, and they're going to know that MCOT has already done an assessment.

We also know that our local law enforcement does great work, and they're trained to do what they do really well. Our clinicians and the MCOT team are also trained to do what we do really well. So if we can allow our officers to work in their scope and continue to protect and do the things that they do in our community, we can also do that. So, if we can prevent and lighten their load when mental health calls come in, that is what we prefer.

We do have a working relationship with all of our amazing law enforcement here in the county, and they know that if somebody has called 911, they've responded, it's more of a mental health call, they actually call MCOT and will say, "Hey, will you guys come out? This seems more mental health-related." And we'll go out, and they'll give us a brief introduction and say, "Are you guys okay if we leave?" We say, "Absolutely." And they'll be able to leave and go do other things that are really, really important to our community, and we'll be able to stay and support the mental health side of things.

So it's a great first step, in my opinion. I think it's a wonderful service. But it's a great way to maybe not have to involve law enforcement. It's a great way to maybe not have to involve an ER. And it's a great way to get a quick assessment, like, "Gosh, am I kind of losing my mind? Am I on the normal spectrum? Is this okay?" type of questions, is something that we can answer. And we'll come to you and do it without any charge to you. All those pieces contribute to making MCOT a really great resource for our community.

Meeting People Where They Are—Literally and Emotionally

Interviewer: Now, for people who live in Utah, who live in Salt Lake County, what are some of the barriers that will prevent someone from calling in or receiving the service, and, you know, what would you say to them and address those concerns?

Claudine: Sometimes people are embarrassed to have someone else see their home. Maybe they don't like the state of the room that they live in or whatever. And that can be a barrier to them. "I don't want somebody to come to my home. I don't want somebody to come to my workplace. I don't want them to see this because maybe I'm a little bit embarrassed." So in that case, we can also do a tele-MCOT. It's kind of like telehealth, but it's MCOT that we can do virtually. And if somebody doesn't have the ability to have a tele-MCOT, maybe we just meet down the street at 7-Eleven. Maybe we can just meet at the park. There are options if that is really something that somebody is looking to do. We are super flexible, and we can be with you at any time of the day or night.

Hospitalization Isn't the Default

Interviewer: So when someone calls in, one of the concerns that they might have is that they might be forced to be hospitalized, and that might be something that is really kind of nerve-racking for a lot of different reasons. How does the MCOT deal with those types of crises, and kind of making sure that the person is voluntarily participating in all of this?

Claudine: So our goal is to keep someone in the least restrictive environment needed. If somebody does need to go to the hospital, we're going to work really hard to determine if there is a way to voluntarily go. Through our conversations, we can help explain about maybe what a hospital stay might look like. We can help with concerns, fears that go into that. But you're right. There are some times when we need someone to go to a higher level of care, which could be an ER. It could be the receiving center, which is a really great resource.

But we're also looking at, what is the least restrictive environment this person needs? Our goal is to keep someone in the least restrictive. And 85% of the people that we see remain in place. So it is not the norm that somebody would need to go to the hospital. We are really trying to keep someone in place as much as possible.

Part of a Bigger Picture: Utah’s Crisis Response System

Interviewer: What is the kind of approach that MCOT is part of to, you know, help people get the mental resources they need?

Claudine: We are governed by SAMHSA, which is a nationwide mental health governing body. And SAMHSA's best practice is a three-pronged approach. Someone to talk to. That is 988. It can be the chat line. It could be the voice line. It's also the warm line. We have here in Utah something called a warm line, which is, "I'm not in crisis, but I'd really like someone to talk to." So, best practice, someone to talk to, someone to help you. That can be MCOT. It can be SMR, which is our mobile response team that helps stabilize kids, that can do a more long-term aspect of mental health care. And then somewhere safe to go.

988 is the someone to talk to piece. Someone to help you is the MCOT piece. Somewhere safe to go, we here in Salt Lake County are opening a new crisis care center where someone can go for up to 23 hours. Maybe they just need a break. Maybe they need to decompress for a little bit. It's not an ER. It's somewhere to go that's safe and supported.

So that three-pronged approach is really what we're looking at in the crisis services division. And I might be biased, but I think here in Utah, we do a really amazing job with this approach.

Thinking About Calling 988? That’s Reason Enough

Interviewer: What's your message to someone who's maybe scared to make that first call to 988 and to kind of find out what is even available to them and get the help they need?

Claudine: The big question is, "How do I know if I need to call?" And our response is, "If you are considering, then you probably need to call." It doesn't have to be a phone call. I know so many people don't like talking on the phone. It can be a text. You can text 988, and it will connect you with a crisis worker. There's been some really great work on making sure people are routed to the appropriate state because 988 is a big nationwide number, and here in Utah, we've done some great work. So if you are considering it, just do it. You never know what might happen, and maybe you'll learn of a new resource that you didn't know about before.