Multidisciplinary teams consist of multiple areas of practice across professions. For instance, law enforcement working closely with mental health or substance use treatment providers. These teams can be extremely helpful with assisting the community and filling the gaps of unmet services. Multidisciplinary teams are utilized in several counties across the state of Oregon. Teams include assertive community treatment teams and  intensive case management teams,discussed in more detail below.

Community collaboration involves professionals working across different disciplines towards a common goal. Multidisciplinary teams are often seen within law enforcement and social service agencies. These teams can also be utilized with various professionals in different fields of practice within the same agency. For example, a licensed nurse practitioner, mental health clinician, substance use clinician, and peer mentor may all work together on the same team. In this section, we’ll introduce three models of multidisciplinary teams that work collaboratively to solve a community need across different professional disciplines.

5.3.1 Assertive Community Treatment (ACT)

The assertive community treatment model (ACT) is commonly used for people with serious and persistent mental disorders. This model of care is community-based, meaning these clinical-based teams meet people in a person’s home or in a community location. ACT teams focus largely on keeping people with mental disorders in the community and trying to decrease hospital admittance. Forensic Assertive Community Treatment (FACT) is a model that is specifically used to treat people with severe and persistent mental disorders (SPMI) who are also involved in the criminal justice system (SAMHSA, n.d.). The forensic, or criminal court-related, piece of this model is mainly focused on keeping people with mental disorders from reoffending – and entering or returning to jail or prison. If you are interested in learning more about this model, please consider viewing this website: Forensic Assertive Community Treatment (FACT) [Website]

FACT team members focus on the client’s mental and physical health needs, including addressing any substance use disorder(s). In addition, The FACT team works to decrease the risk of recidivism, and increase public safety. Recidivism is defined as the likelihood of re-offending. A FACT team generally consists of a mental health professional, peer specialist, substance use disorder clinician, and a licensed nurse practitioner. This team is community-based and commits to meeting a client multiple times a week in the community to address their needs. These teams are familiar with the criminogenic risks and needs of the individual and work to incorporate these risks and needs into the individualized treatment plan. A FACT team might have a person engaged with a certified recovery mentor to receive support from refraining from drug use, as well as meeting with a supported employment specialist on the team to reduce their chances of reoffending (SAMHSA, n.d.).

5.3.2 Mobile Crisis Team: Project Respond

Project Respond is a local multidisciplinary program run by Cascadia Health in Portland, Oregon (Cascadia Health, n.d.). Project Respond is just one local example of what is known as a mobile crisis team. Mobile crisis teams generally respond to events in the community that rise to the level of someone expressing a threat of harm to themselves or others,  where a significant contributing factor appears to be a mental health issue. The Federal Bureau of Justice Assistance encourages local development of mobile crisis teams because they are successful in reducing problematic outcomes – including enforced hospitalizations and arrests that lead to criminalization of mental disorders. One Illinois police department that created a guide on how to successfully implement a mobile crisis team (Justice Center The Council of State Governments, 2021). If you are interested in reading this implementation guide, visit Mobile Crisis team  [Website] for more information. This Illinois police department (composed of mental health and law enforcement members) to respond to mental health calls in the fall of 2020 saw immediate positive results. The team was present for about half of mental health calls in the following three months – and resolved most of them at the scene. Strikingly, only 13 percent of the calls resulted in hospital visits for people with mental disorders – compared to 70-75 percent  who were taken to the hospital in previous quarters.

Portland’s Project Respond, similarly, partners with the Portland Police Behavioral Health Unit to respond to mental health crises in a coordinated effort. Project Respond receives calls from PPB directly and responds accordingly. The Project Respond team will meet the person with the mental health need at their residence or in the community to address the needs of the individual. The Project Respond team are qualified mental health professionals and can use a variety of techniques to support someone in a crisis. If a situation becomes unsafe at any time, police are available on scene to support and intervene.

5.3.3 Police Alternatives: Portland Street Response (PSR)

Portland Street Response is a new program within Portland Fire & Rescue (figure 5.4). This team is potentially game-changing in that it is a true alternative to police response – rather than a co-response team operating alongside police. PSR can be employed when community members call 911 for help, but where law enforcement is not needed. This opportunity for response and assistance without the use of police  removes many of the risks associated with police interactions, especially for people experiencing the impact of mental disorders. PSR took some inspiration from the very successful police-alternative program CAHOOTS, which has been operating as a non-profit (rather than a city agency) in Eugene, Oregon for more than thirty years. See Spotlight on CAHOOTS in this chapter for more details.

Figure 5.4 shows an image of the Portland Street Response team members responding to an area of the city were houseless people are living.

Examples of calls that will prompt PSR to be dispatched include: someone experiencing a mental health crisis; someone who is intoxicated; or a person needing a referral for services, but who does not have access to a phone. Of course, sometimes law enforcement may be needed: PSR will not respond to calls where a weapon is in plain view, when a person is presenting violently, when a person is suicidal, or when a person is inside a private residence.

PSR services initially piloted in a single neighborhood in Portland, OR. In April, 2021, the volume of calls led to an expansion of the PSR. In November, 2021, the PSR geographical coverage expanded once again to cover Portland Police Bureau’s East Precinct. For the years 2022-23, the budget for PSR has been increased to over 11 million dollars, intended to fund more than fifty positions and allow PSR to offer services during all hours, city-wide (City of Portland, 2022).

Stabilization Centers

Stabilization centers work with crisis management through a multidisciplinary team. These teams often include peer support specialists, mental health clinicians, medication prescribers, etc. These centers are intended to fill the gap for people who do not need jail and do not need emergency medical services (i.e. emergency department inside a hospital), however still need access to services to help with their imminent behavioral health crisis. These centers have continued to open up across the state of Oregon. They are 23-hour care programs. Specifically not 24 hour facilities as they are not residential programs. They clearly state that they focus on the immediate crisis and refer out to longer-term care. Law enforcement  and medical providers see an on-going need that someone is experiencing  acute mental health symptoms however jail nor the emergency department is an appropriate fit. Take for example a person is causing a public disturbance, the person is not behaving in a way that would cause a police officer to take them to jail, however being symptomatic alone is not a sufficient reason to take someone to an emergency department. There is a gap to fill between jail and the emergency department. People can access these stabilization centers that are opening in several counties to focus on stabilization of the immediate mental health crisis.

If you would like to learn more about the stabilization center model that multiple counties are considering in Oregon, check out this optional article (22 minute audio) for more information: The Bend stabilization center’s future is unknown – OPB  [Website]

5.3.4 Emergency Call: 988

The newly established Suicide and Crisis Lifeline  offers national 24/7 access to crisis counselors to assist people experiencing a mental health related crisis. The Lifeline went live in July of 2022, and implementation efforts continue across the United States (SAMHSA, 2023). If you would like to visit the website to learn more, please click here: 988  [Website].

People in distress can call or text 988 and receive crisis support. The 988 Lifeline was created to provide crisis support for the growing numbers of people in the United States experiencing suicidal ideation and increased symptoms related to their mental disorders – and to eliminate, where possible, the need to call the traditional 911 emergency line, often involving law enforcement. The 988 Lifeline instead offers the opportunity for people to access crisis services by a trained crisis counselor. The goal of the 988 program is to continue to enhance crisis response services and develop toolkits for crisis counselors. Ideally, the Lifeline will be able to offer support and share information with callers to help decrease future crises due to a mental disorder (SAMHSA, 2023).

5.3.6 Multidisciplinary Teams Licenses and Attributions

“SPOTLIGHT: Crisis Assistance Helping Out On The Streets (CAHOOTS)” by Kendra Harding is licensed under CC BY 4.0.

Figure 5.4. Photo of Portland Street Reponse (c) Portland.gov is all rights reserved and included with permission.

Figure 5.5. “CAHOOTS Interview on CNN – Alternatives to Police Response” by Ebony Caprice Morgan is licensed under the Standard YouTube License.

” 988 Suicide & Crisis Lifeline” by SAMHSA is in the Public Domain

“Forensic Assertive Community Treatment (FACT)” by SAMHSA is in the Public Domain

Summarized from:

Portland Street Response | Portland.gov

https://csgjusticecenter.org/wp-content/uploads/2021/04/Field-Notes_Mobile-Crisis-Team_508FINAL34.pdf