Building a behavioral health crisis response program: a qualitative implementation case study

Introduction Mobile crisis response programs (MCPs) are increasingly recognized as effective alternatives to law enforcement-led interventions for addressing behavioral health crises. However, there is limited evidence on how specific strategies and contextual factors shape the design and implementation of these programs. This study aimed to characterize key factors influencing the early development and implementation of a county-led MCP in Northern California in 2023. Methods Between 2022 and 2023, we conducted 58 interviews with stakeholders involved in program design and implementation, as well as frontline staff. Results The data revealed four major themes. First, sociopolitical momentum played a critical role in aligning political will and securing longitudinal funding. Second, a collaborative design process involving cross-sector stakeholders enabled broad buy-in and tailoring to community needs. Third, workforce shortages posed challenges to scaling, which this program managed through flexible hiring and staffing measures. Finally, MCP coordination with existing services, such as law enforcement and emergency medical services, benefits from strong foundational relationships and can be improved through clear role definition and protocols. Conclusion In total, this study identifies actionable policies, including protocolizing collaboration, cross-sector engagement, and implementation flexibility, which may inform the establishment of MCPs elsewhere.