Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co-response Models

Context: Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC’s behavioral health practitioner–only team responds to 911 calls, and co-response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships.

Methods: Using data from the only national survey of CCBHCs, this study applies multivariable logistic regression to assess whether CCBHC staff capacity and police capacity are associated with CCBHC–emergency response system partnerships in mobile crisis, controlling for organizational characteristics of the CCBHC and demographic and socioeconomic features of its service area.

Findings: One-third (33.0%, 95% confidence interval [CI], 26.0-40.0) of CCBHCs report a 911 referral partnership, and nearly half (48.5%, 95% CI 41.1-55.9) report a co-response arrangement. While police capacity is not significantly associated with co-response, a one standard deviation increase in police capacity corresponds to an 11.0-percentage-point (95% CI −19.5 to −2.5) decrease in the predicted probability of a 911 referral partnership. CCBHC capacity is not associated with 911 referral arrangements, but CCBHCs in the top tertile of CCBHC capacity are 19.2 (95% CI 4.3-34.2) percentage points more likely to report a co-response partnership.

Conclusions: The internal capacity of CCBHCs and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis. Because a robust behavioral health crisis system likely requires multiple response models with varying police involvement, stakeholders may need different strategies depending on the type of partnership they aim to expand.