San Francisco Department of Public Health, 1380 Howard Street, San Francisco, CA, USA.
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA, USA.
BMC Public Health. 2024 Aug 12;24(1):2183. doi: 10.1186/s12889-024-19596-2.
Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.
We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent's self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.
Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team's person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.
In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT's effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.
移动危机小组 (MCT) 可为低危 911 来电提供重要替代紧急医疗服务或执法部门的选择。MCT 通过缓和与心理健康或物质使用障碍以及伴随的社会需求相关的非暴力情况来解决危机，这些情况在无家可归者 (PEH) 中很常见。我们试图探讨一个城市的 MCT 如何满足最近接受过 MCT 服务的 PEH 的需求并支持他们的长期和短期目标。
我们对 Street Crisis Response Team 的服务接受者进行了 20 次半结构化访谈，该团队是 2020 年 11 月在旧金山实施的新的 911 调度 MCT。在他们相遇后的几周内，我们采访了受访者，了解他们对整体 MCT 体验的看法，并与类似服务进行了比较，包括受访者认为对实现自我定义的生活目标的促进因素和障碍。我们使用主题分析对访谈记录进行分析，以捕获文本中出现的突出主题，并按照社会生态模型进行组织。
几乎所有受访者都更喜欢 MCT 模式而不是传统的急救人员，突出了团队的以人为本的方法。受访者将 MCT 模式描述为有效地满足他们最紧迫的需求（例如，食物）、暂时缓解无家可归的需求、急性心理健康或物质使用症状以及即时情感支持。然而，系统资源的限制限制了团队有效解决导致危机的长期因素的能力，例如解决当前住房和医疗保健系统以及社会服务导航质量和能力不足的解决方案。
在这项研究中，受访者认为这种 MCT 模式是对执法部门和其他急救人员的理想替代方案，同时满足了他们的基本生存需求。为了提高 MCT 对 PEH 的效果，这些团队可以与能够将客户与资源和服务联系起来的后续服务提供者合作，以满足他们的长期需求。然而，如果不对导致无家可归的上游驱动因素和护理系统碎片化进行结构性改变，这些团队可能无法对 PEH 危机产生有意义的影响。
