It was a snowy afternoon in Bozeman, a city of nearly 60,000 nestled between mountain ranges in southern Montana. Temperatures were hovering in the mid-30s.
The city's mobile crisis team had just gotten a call about a man walking around outside without shoes. The man's family told the team he was having a mental health crisis and wouldn't come inside.
As they drove down the highway toward the outskirts of the city, team member Evan Thiessen spoke with the relative who had reached out.
"You're doing the right thing and we're going to make sure he gets help today, OK?" he said.
They pulled up the man's police record on a laptop and saw that he did have a record of some previous encounters with police, including some that had turned violent.
Luke Forney, a licensed therapist, had that in mind as they pulled into a neighborhood of single-family homes. He stepped out of the Ford Bronco and headed toward the front door.
After a national surge in mobile crisis, a funding problem
Many communities around the country send out teams like this one to help people in psychiatric crisis, rather than dispatching regular police.
A 2024 survey found there are at least 1,800 mobile teams nationwide. But financial support for them is often inadequate and inconsistent, so many communities are struggling to find ways to keep the teams operating.
Two programs, one in Great Falls in central Montana and one in Billings in eastern Montana, recently shut down. There are now six units left in Montana.
The strategy began in the late 1980s in Eugene, Ore., but really gained momentum on a national level in the last 10 years.
Recent national news stories about police killing people who are experiencing a psychiatric crisis have sparked conversations about how to safely and effectively respond.
Most police officers are not trained to deal with people experiencing delusions or hallucinations, or to de-escalate when they are displaying threatening behaviors to themselves or others.
One analysis of fatal police shootings across 27 states found that a third of the victims showed signs of being in crisis. Another study found that people with a severe mental illness are 11 times more likely to experience use of force by police.
By contrast, crisis response teams have been trained to de-escalate such situations and provide appropriate therapeutic care.
When the team arrived at the house in Bozeman, the man had already gone back inside. The team then talked with the man's family for about half an hour and helped them devise a plan to keep him at home, and safe. Before they left, team members determined the man wasn't a threat to himself or others.
They also planned to follow up with him in a few days to connect him with ongoing mental health care. After an encounter with the team, some of the clients might need follow-up therapy, assistance with psychiatric medications, or help finding treatment for substance abuse.
In Bozeman, the team is available 12 hours a day, seven days a week. It costs roughly $1 million a year to run.
Reliable police funding usually doesn't extend to crisis care
Police departments are generally funded by local taxpayers. Mobile crisis teams don't have a single reliable source of funding.
Some, despite successful operations and local support, are shrinking operations or have closed entirely. One that shuttered was the pioneering program in Eugene, Ore.
The vast majority of crisis calls end with people staying where they are, avoiding a trip to the ER or going to jail, according to Connections Montana, which runs the mobile crisis program in Bozeman.
Police, firefighters and even members of the public can call the team directly.
"I've been out on calls where individuals have barricaded themselves in residences or in their vehicles with a firearm. So, helping to assist not only law enforcement, the negotiators, but consulting on the behavioral health side of that," said Ryan Mattson, who leads the Bozeman crisis team.
The program has reduced the time that Bozeman police officers must spend on mental health calls by nearly 80%, according to Mattson, and prevented unnecessary ER visits.
Local residents and political leaders see that value, he said, but finding a way to pay for the service has been difficult.
"I'm confident we'll be here through next fiscal year. That's about as confident as I am at this point," Mattson said.
Mobile crisis programs in Montana, which began operating about five years ago, have cost more than the state originally projected.
Health insurance is sometimes a revenue source for mobile crisis teams. That's because a crisis call is a kind of mental health service, provided by trained professionals like therapists or crisis intervention specialists. But many private insurance companies don't reimburse for mobile crisis services.
What Medicaid pays for — and doesn't
Medicaid, the government-funded insurance program for poor Americans, is another funding source. Two-thirds of states allow Medicaid reimbursement for such calls, but the rates vary.
In Montana, Medicaid only reimburses the team for their time spent responding to a call, out in the field.
Additional time spent on a case — documenting the encounters, or waiting for the next call — isn't reimbursed.
"You need to pay for the capacity to be at the ready, just like we do with fire or police, regardless of whether somebody is going to be called out," said Angela Kimball of Inseparable, a nonprofit that advocates for mental health policy reform.
It's not feasible for mobile crisis teams to rely solely on reimbursement from insurance companies, she said.
To deal with the shortfalls, many mobile teams rely on a patchwork of grants and other funding, according to Heather Saunders, who studies Medicaid policy at KFF, a nonpartisan health research organization.
Some state governments have stepped in to help.
Eight states, including New Jersey, California and Washington, mandate that private insurers cover the cost of mobile crisis calls for people on their plans, according to Kimball. Ten states have implemented fees on cellphone bills to help pay for the service.
Montana hasn't followed suit.
The state provides about $2 million annually in supplemental funds to help the mobile teams pay for service calls that aren't reimbursed through Medicaid, according to an emailed statement from Jon Ebelt, a state health department spokesman.
But program managers counter that the paperwork to access that funding is complicated and often isn't worth the staff time.
Will Montana step in to save the last programs?
Despite this state support, mobile teams are still struggling to stay afloat, Ebelt acknowledged. He says Montana officials are considering boosting what Medicaid reimburses for each service call.
In Missoula, the mobile crisis team turned to local taxpayers for additional help. Their annual expenditure is $1.4 million, but Medicaid reimbursements were only covering about 20% of the cost, according to program manager John LaRocque.
Even with the local tax dollars, the program is facing a $250,000 shortfall, so LaRocque is looking for grants.
Mobile crisis is still a relatively new concept, and growing pains are to be expected, said Sierra Riesberg, director of the Behavioral Health Alliance of Montana.
Still, abrupt closures do create instability and mean that some patients instead end up in the emergency room — placing financial pressures on another distressed part of the local health system.
"A much-needed service is available and then not available, available and then not available. These things need to be taken into consideration when developing programs in communities," she said.
If more mobile crisis teams shut down, that might interfere with Montana's recent efforts to overhaul an outdated and underfunded mental health system. The state's only psychiatric hospital hasn't been able to keep up with the number of patients committed to the facility.
Later in 2026, Montana hopes to join a federal pilot program to open a new type of clinic: Certified Community Behavioral Health Clinics or CCBHCs.
Those clinics will receive boosted levels of federal funding, but they are required to offer around-the-clock mobile crisis service as well as other crisis care.
That could be a tall order for rural communities, said Casey Schreiner, an executive at Alluvion Health in Great Falls.
Alluvion used to operate the mobile crisis team in Great Falls before it shuttered the service. One major reason was that the expected Medicaid payments covered less than anticipated.
Before Alluvion would consider getting involved again, the state would need to "completely revamp" the way the service is funded, Schreiner said.
"Is it a priority for our state or not?" he asked.
This story comes from NPR's health reporting partnership with Montana Public Radio and KFF Health News.
Copyright 2026 Montana Public Radio
