Getting Help for Mental Health Emergencies

Overview of Mental Health Emergency Services

In Massachusetts, there is a continuum of services available for residents experiencing a mental health emergency. Services are available 24 hours a day, 7 days a week, 365 days a year to provide crisis assessment, intervention and stabilization services for both mental health and addiction-related emergencies. Individuals can call or text the Behavioral Health Helpline (BHHL) at 833-773-2445 who can provide phone triage, including a referral to be seen at the caller's local Community Behavioral Health Centers (CBHC's) or a response by Mobile Crisis Intervention (MCI) if it would be better for someone to be seen in the community. The goal of mental health emergency services is, whenever possible, to help individuals avoid a lengthy hospital emergency room visit by offering community-based alternatives, in which individuals and/or families can be seen in more comfortable and less stressful environments. CBHC's will work with the client in crisis to develop a strategy that promotes long term stability in the least restrictive environment possible. Crisis evaluations can be provided at CBHC office locations by calling for an appointment or by walking in during their hours, or by MCI teams at schools, homes, residential facilities, and other community settings. When a client is a risk to themselves or others and it is deemed unsafe for a client to be seen outside of a hospital, mental health professionals will also evaluate clients in their local hospital emergency rooms. Anyone may call for assistance regarding a mental health crisis or urgent need for substance use intervention. This includes the individual experiencing the crisis, family members, mental health workers, first responders, physicians or other medical providers, schools, employers, and community members.

Who qualifies for mental health emergency services?

Services are available to everyone, and no insurance coverage is required. However, the services are covered by most insurance plans, including all MassHealth (Medicaid) and Medicare plans.
Mobile Crisis Intervention (MCI) is available to anyone of any age.
The state of Massachusetts is divided into 30 catchment areas which cover every town throughout the state. One Community Behavioral Health Center is assigned for each catchment area. To find out what catchment area and team covers your town, you can consult an online list for the whole state, visit their website to find the location nearest you, (and this guide tells you how to use their tool) or call the statewide Behavioral Health Helpline toll-free number, 833-773-2445 and they can connect you to the team that covers your area, including making a request for Mobile Crisis Intervention if that is needed.

What to expect when calling Mobile Crisis Intervention (MCI) for an adult, or child or adolescent?

When you call to speak to someone at your local Mobile Crisis Intervention team, you will speak with a member of their team who has expertise in crisis intervention. They will ask you a series of questions to determine the nature of the emergency you or your family member are experiencing, and the team will be assessing early on the best place for you or your family member to be evaluated. Should the clinician believe you are in imminent danger of hurting yourself or others, they may direct you to the nearest emergency room, and/or may prompt you to contact the police. If you are not in imminent risk of safety but are in active crisis, the clinician will discuss scheduling an appointment with a clinician at the local Community Behavioral Health Center, or determine where a team should respond to meet with you or your family member.

The individual being served should have the opportunity to receive an assessment and the appropriate services in his or her primary language. Assessment findings should be considered in the context of their ethnicity and culture, and cultural and linguistic factors are considered when making level-of-care decisions, and are accommodated whenever possible. Many CBHC's use translation lines in order for you to be able to communicate with them in your primary language.

Below is some information that may be asked during an evaluation. Keep in mind that you have a choice in deciding which questions you feel comfortable answering.

Demographic information such as your name, address, date of birth, your relationship to the caller if you are not the person seeking assistance, and the individual’s school or job.
What is happening right now that is leading you to call, how long it has been going on, and anything that is happening that is making the problem more significant right now?
What are some of the symptoms or behaviors that either you or the person you are calling about are experiencing that are related to your concerns? For example, changes in eating, sleeping, relationships with family or friends, or other behaviors that are concerning. This could also include questions about your or your family member’s ability to do things for everyday living such as basic hygiene or being able to go to work or school.
Current and past suicidal/homicidal ideation and may include questions about a plan, intention or access to means.
History of substance use, including current and past use, any current withdrawal symptoms if appropriate, previous treatment, and any history of relapse.
Previous and current mental health treatment, and if appropriate, recurrence of previously managed symptoms. You may be asked about treatment progress if you or your family member are already receiving mental health services. You may also be asked about any history of psychiatric hospitalizations.
Medical history, including recent surgeries, allergies, history of head injuries, medicine related medical problems, as well as any medical problems that are related to psychiatric symptoms or behaviors. The evaluator will also ask about who you see if primary care and the last time you were seen by them.
Current medications, who is prescribing them, and your compliance with taking them as prescribed.
The involvement of family or other supportive individuals or resources that could be important to assisting in a treatment intervention.
Any history of experiencing trauma.
Obstacles to treatment, in the past or currently.

Could I participate in the intervention as a parent, guardian, or caregiver?

It is crucial that the individual, their family or other primary caretakers/guardians, and natural support systems participate in the crisis intervention process whenever possible. The provider will determine what level of care is appropriate for you and/or your child and will consult with you regarding recommendations for treatment before making arrangements for the appropriate level of care (e.g. inpatient, CBAT, detox).

Crisis clinicians will work with the client and their family to discuss the most appropriate treatment recommendations, and they will never remove a client from their home as all of the referral options that crisis clinicians make are solely recommendations that the client and their family can choose to pursue or not. However, in some circumstances, when a client is at high risk to harm themselves or others or is too unsafe to remain the community and the client is unwilling to go an emergency room on their own, a crisis clinician will consult with an on-call psychiatrist to determine if a client needs to be brought into an emergency room on a section 12 (involuntary commitment).

How do I know if I or my child needs a crisis evaluation?

For a clinician at at CBHC or MCI, at least one of the following would be a reason for an evaluation:

The individual or child has thoughts about hurting or killing themselves or someone else.
The individual or child's symptoms are disruptive and/or harmful towards themselves or others to the extent that an immediate intervention is required.

Crisis clinicians also identify services and alternatives that will minimize distress and help to stabilize a crisis. Clinicians as part of a Mobile Crisis Intervention or being seen at a Community Behavioral Health Center will make referrals and coordinate services to link individuals and their families with other services. This could include same day or next day urgent behavioral health appointments with a clinician, medication evaluations, group therapy or connection with peer support.

Do MCI's provide medication evaluations?

Unfortunately MCI's are unable to provide medication evaluations. However, clients that are seen at Community Behavioral Health Center's can be referred for more urgent psychopharmacology appointments to medication evlauation and addicition treatment. However, MCI's can refer clients to various levels of care that can assist with medication management, such as outpatient psychiatry, partial hospital programs (for children and adults), and Community Crisis Stabilization Units (3-5 day overnight placement that provides therapy, case management, therapeutic groups, and medication management for individuals 18+).

What are the various levels of care that MCI's can refer to?

FOR ADULTS: MCI's can refer adults to: outpatient therapy/psychiatry, Detox/substance abuse programs or Intensive Outpatient Programs (IOP's), Partial Hospital Programs, Enhanced-Acute Treatment Services for Substance Abuse (E-ATS), Community Crisis Stabilization Units (CCS), and inpatient hospitalization.

FOR CHILDREN/YOUNG ADULTS: MCI's can refer children/young adults to:

Outpatient therapy/psychiatry
Children's Behavioral Health Initiative (CBHI) services for clients with MassHealth or Behavioral Health for Children and Adolescents (BHCA) for clients with commercial insurance, which includes services like in-home family therapy, intensive care coordination, in-home behavioral therapy, and therapeutic mentoring
Partial hospital programs which can last 1-2 weeks and consist of individual/group therapy, case management, and medication evaluation during the day while the client stays at their home overnight.
Community Based Acute Treatment (CBAT) is a 1-2 week staff secure overnight program which consists of individual/family/group therapy and medication management services
Inpatient hospitalization