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Montgomery County Emergency Service – A Model Provider-Based Diversion Strategy

Contributor: Tony Salvatore

Montgomery County Emergency Services (MCES) was created in 1974 by a community coalition that saw jail diversion as a mental health system role.  We exemplify the provider-based approach. MCES’ facility is a 73-bed nonprofit psychiatric hospital in Norristown, PA.  In addition to assisting law enforcement, we offer a hotline, walk-in and mobile crisis services, inpatient care, a crisis residential program, and a psychiatric ambulance service. 

MCES was established in part as a 24/7 resource to police in situations involving psychiatric emergencies.  Since 1975, we have offered crisis intervention training to police as the foundation of a comprehensive diversion strategy.  Our program is designed for a setting with multiple jurisdictions.  We serve a county with over 50 law enforcement agencies.

We see crisis intervention and the recognition of possible mental illness as basic law enforcement competencies. Our Crisis Intervention Specialist (CIS) Program educates police, correctional officers, probation/parole staff, and others to recognize and manage a mental health crisis.   In 2007, 829 criminal justice personnel in PA and NJ took our 3-day course.  

Our law enforcement training program has both classroom and field segments.  Since 2003, NAMI’s “In Our Own Voice” program has been part of the training.  Officers also spend time on our inpatient unit or join our Mobile Crisis Team in the community.  We also offer “roll call trainings” and advanced training on special topics. 

MCES is primarily a pre-booking program, but we are also known for “co-terminous diversion” because we try to have any charges dropped for individuals brought in by police, when appropriate.  We intervene at multiple points in the criminal justice continuum, particularly at the county prison, as indicated by this extended “sequential intercept model:”

1. Police Contact –Through CIS-trained officers, a “cop card” (wallet-sized services summary), and on-site assistance to police, we direct at-risk individuals to MCES for psychiatric evaluations 24/7.

2. Initial Detention/Hearing –Criminal Justice Liaisons go to municipal lock-ups and district courts to arrange evaluations for individuals in custody.

3. Pre-trial/Trial –Liaisons seek dispositions involving treatment.  We provide a mental health manual and education to judges, public defenders, and prosecutors.

4. Incarceration in Jail/Prison- The Forensic Transition Case Manager does case-finding at the county prison and advocates at court hearings for inmates with mental illness.

5. Re-entry from Prison – The Forensic Transition Case Manager does short-term follow-up after release from the county prison to facilitate community reintegration.

6. Community Supports – Outreach Specialists do interim case management and develop supports to strengthen prospects for recovery.

In 2007, MCES had over 1100 admissions after police referrals.  There were 368 evaluations following police contact.  Our mobile crisis team, which includes a psychiatric nurse, responded to 320 mental health calls at police request. The county mental health office funds our diversion staff.  The Pew Charitable Trusts, the van Amerigen Foundation, the American Psychiatric Foundation, and the Patricia Kind Foundation have also supported the CIS Program. 

Tony Salvatore ( does development, program planning, and suicide prevention, at MCES. MCES is on-line at