Assessing the impact of community-based mobile crisis services on preventing hospitalization

Objective: This study evaluated the impact of a community-based mobile cris is intervention program on the rate and timing of hospitalization. It also explored major consumer characteristics related to the likelihood of hospit alization. Methods: A quasi-experimental design with an ex post matched con trol group was used. A community-based mobile crisis intervention cohort (N = 1,696) was matched with a hospital-based intervention cohort (N = 4,106) on seven variables: gender, race, age at the time of crisis service, prima ry diagnosis, recency of prior use of services, indication of substance abu se, and severe mental disability certification status. The matching process resulted in a treatment group and a comparison group, each consisting of 1 ,100 subjects. Differences in hospitalization rate and timing between the t wo groups were assessed with a Cox proportional hazards model. Results: The community-based crisis intervention reduced the hospitalization rate by 8 percentage points. A consumer using a hospital-based intervention was 51 pe rcent more likely than one using community-based mobile crisis services to be hospitalized within the 30 day's after the crisis (p < .001). Treating a greater proportion of clients in the community rather than hospitalizing t hem did not increase the risk of subsequent hospitalization. Those most lik ely to be hospitalized were young, homeless, and experiencing acute problem s; they were referred by psychiatric hospitals, the legal system, or other treatment facilities; they showed signs of substance abuse, had no income, and were severely mentally disabled. Conclusions: Results indicate that com munity-based mobile crisis services resulted in a lower rate of hospitaliza tion than hospital-based interventions. Consumer characteristics were also associated with the risk of hospitalization.