Yellowstone County is launching a new mobile crisis response program backed by a four-year, $3 million federal grant — bringing together emergency services, behavioral health clinicians and community partners to respond to mental health and substance use crises across the region.
The grant, awarded through the Substance Abuse and Mental Health Services Administration, or SAMHSA, was announced to Riverstone Health in the first week of September. The grant period officially begins September 30.
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Megan Gibson, behavioral health systems improvement manager at Riverstone Health, said the coalition behind the program has been planning for this for well over a year.
"So our community definitely wants it and is ready for it," said Gibson.
The program will launch with one two-person team operating 10 hours a day, seven days a week.
Each team will include a licensed behavioral health clinician, staffed through the community crisis center, and an EMT provided by the Billings Fire Department.
The program must be operational within the first six months of the grant period. Gibson said a January launch has been discussed, though that timeline is still being finalized as hiring and training get underway.
"We are getting all of the position descriptions and everything finalized, so that will be coming soon."
From there, the program will expand in phases. By the end of year two, the goal is to reach 24/7 coverage.
By the end of year three, the program aims to extend services into the rural parts of Yellowstone County. Year four will focus on long-term sustainability beyond the grant.
The program will also add positions called care coordinators to assist with follow-up needs after a crisis.
And how it works?
When someone calls 911 or 988 and the call is routed to dispatch, the mobile crisis team can be dispatched alongside or instead of traditional emergency responders.
The team will travel in a dedicated vehicle separate from law enforcement but will remain in communication with dispatch, fire and police throughout a response.
Cameron McCamly, assistant fire chief overseeing the EMS division at the Billings Fire Department, said law enforcement previously generated roughly 60 to 70% of calls for the crisis response unit, with fire generating the rest.
Under the new program, the crisis team will use a process called staging — positioning nearby while law enforcement makes initial contact and confirms it is safe to approach. Once on scene, the EMT will assess for any medical needs while the clinician works on de-escalation.
"Not only can we provide, you know, again resources to get people into services but also dig into is there a mental health component is somebody struggling with something."
The unit also has a secure passenger compartment that allows the team to transport patients to the emergency room and complete what McCamly called a "warm handoff" — a direct, detailed briefing to ER staff about what happened on scene. McCamly said that handoff was a weak point in the previous program.
"What we were finding is the ER staff says, well, they're not doing this thing anymore, so we're just going to release you and then the person just, they get into the system again."
Dispatch is also a key part of the response chain. The Billings dispatch center is finishing training on a 41-protocol system called "first party caller in crisis" that allows dispatchers to begin de-escalation immediately when someone calls 911 in an acute mental health crisis. Dispatchers will also be able to transfer calls directly to a clinician on the crisis team.
McCamly described the overall system as a three-legged stool: the dispatch center, the crisis response unit, and a third component called nurse navigation — a service through Global Medical Response's parent company that connects callers with nurses who can spend extended time on the phone assessing needs.
The goal in year one is to resolve roughly 2 to 3% of calls without dispatching emergency vehicles.
The new program reinvigorates a previous effort — the Crisis Response Unit, or CRU — that launched following a public safety mill levy voters passed in 2022.
That program was a public-private partnership between the city of Billings and Rimrock Foundation. It showed early success but lost its clinical partner after anticipated Medicaid reimbursement never materialized.
The Billings Fire Department maintained a version of the crisis response unit in the roughly 18 months since, using EMTs to connect people to community resources and conducting proactive outreach to addresses that generated repeated emergency calls. But without clinicians, the behavioral health component was missing.
McCamly said the groundwork laid during that period made the SAMHSA grant application stronger.
"It's more of just a version 2.0, if you will."
Gibson said Riverstone Health is the backbone of the Yellowstone County Behavioral Health Coalition, which has been meeting monthly as a crisis work group with partners including hospitals, law enforcement, the crisis center, Rimrock Foundation and the fire department.
"It really took everyone coming together as a community to plan this and write the successful grant."
Hospital partners Billings Clinic and Intermountain are part of the coalition and mobile crisis planning. Rimrock Foundation is also involved, including work on certified community behavioral health clinic efforts that could support long-term funding sustainability through Medicaid reimbursement.
In its first phase, the program will serve the city of Billings and the Billings Urban Fire Service Area, a roughly 10-mile service zone surrounding the city. McCamly said one unit is enough to cover that area to start.
Expanding into more rural parts of Yellowstone County is planned for year three of the grant. Gibson said the need for behavioral health services is growing, and the program was designed with the entire county in mind.
"Mental health affects every individual in Yellowstone County and in the state and in the country."
At the Billings Rescue Mission, Eric Rosenlund, who's experienced homelessness and mental health struggles say consistent follow-up is what makes the difference.
"I'm a mental health patient. Way back, I just ignored it all as long as I talked to somebody, and I think, you know, I felt like it helped. But it doesn't. We need somebody to continue to poke at them to keep them following through," said Rosenlund.
Others at the mission pointed to the importance of in-person outreach for people who may not be able to navigate the system on their own.
"It would help because a lot of them seem lost," said Rosenlund. "They don't know where they're going, how they're doing it."
One person described a previous program called PATH that provided transportation to medical appointments — and the gap left when that funding was cut.
"I used to work with PATH, and they would come all the way to the floral to take me here so I could make my appointment. Just for me to visit with them for an hour, they drove basically an hour in total so I could go to my appointment. And I don't know what happened to that after," said Rosenlund.
For people dealing with addiction and mental health challenges, the promise of consistent, in-person follow-through resonates, according to Rosenlund.
"As long as they're there with that outreach and show up in person, 'hey, this is what we got to do today...' it might help."
