"Acting As the Face of a Broken System": Challenges Experienced By Mobile Crisis Workers

Background and Purpose

In recent years, national interest in improving mental health crisis response services has increased. A large body of research, as well as high-profile media coverage, has demonstrated the harm that can occur when police officers respond to mental health crises, including arrest, use of force, or even death. In efforts to reduce reliance on police for addressing mental health crises, 2020 legislation established the nationwide 988 Suicide & Crisis Hotline to redirect calls to trained mental health professionals, including social workers. Among such interventions are mobile crisis teams, which respond to mental health crises in community settings. The growing recognition that mobile crisis teams are a critical component to comprehensive crisis response systems has been unaccompanied by an increase in the mobile crisis workforce. Furthermore, we know of no prior research that attempts to understand factors that may disincentivize entry into or promote staff turnover in this field. This study represents a first step toward understanding the challenges faced by mobile crisis workers so that service systems can improve working conditions and increase a sufficient and stable mobile crisis workforce.

Methods

This study used qualitative thematic analysis to analyze mobile crisis worker perspectives on job challenges. Part of a nationwide survey of mobile crisis workers (n = 369), study data were drawn from responses to open-ended questions about mobile crisis workers’ perceptions of challenges faced in their work. Codes were developed through an iterative inductive-deductive process and all data were coded by two researchers. Inter-rater reliability was assessed throughout, and conflicts were reconciled based on discussion and consensus. In accordance with methodological guidelines, we used tables and matrices to promote understanding of codes, their relationships to one another, and ultimately themes. Reflexive dialogue, research triangulation, and data triangulation were used to promote authenticity.

Results

Findings indicated that mobile crisis workers face challenges across five primary domains, including 1) the nature of mobile crisis work, 2) resource constraints, 3) the workplace environment and workforce, 4) psychological impacts on workers, and 5) structural and systemic factors. Notably, service user characteristics were infrequently referenced. Challenges related to the nature of mobile crisis work (e.g., unpredictability and uncertainty, involuntary hospitalization, and decision-making), were best understood in the context of the other four domains. For example, unpredictability and uncertainty was exacerbated by varied levels of training among colleagues (i.e., workplace and workforce challenges), which reflects the need for universal training standards (i.e., structural and systemic challenges).

Conclusions and Implications

Based on these findings, we conclude that ensuring an adequate mobile crisis workforce will require serious improvements in working conditions for mobile crisis workers, increased investment in community mental health service systems, development and implementation of a standardized mobile crisis training program, and comprehensive education on mobile crisis services for partnering agencies and the surrounding community. In lieu of focus on clinical capacity building to address challenges related directly to the service user population, policy makers should consider policy and administrative changes to foster an adequate and stable crisis intervention workforce.