Bridging gaps in mental health crisis care: a RE-AIM evaluation of the Superior North Specialized Treatment and Alternative Response (STAR) team in Northwestern Ontario

Abstract

BACKGROUND: Northwestern Ontario (NWO) faces a mental health crisis underscored by underfunding, limited services, overreliance on emergency departments (ED), and provider burnout. Superior North Specialized Treatment and Alternative Response (STAR) is a mobile mental health crisis response team (CRT) being piloted in Thunder Bay, Ontario that includes paramedics, Crisis Response workers and Indigenous health associates to ensure culturally appropriate and timely care. STAR co-responds to EMS activations for mental crisis calls and provides an alternate, culturally appropriate pathway to care towards reducing ED burden. As STAR is in its pilot phase, metrics associated with impact have been identified towards determining potential upscale. OBJECTIVE: To determine the utility and impact of STAR on reduced burden on ED admissions and other pre-determined key performance metrics using the RE-AIM theoretical framework. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), is a robust tool for evaluating effectiveness of community-based initiatives such as STAR. METHOD: Field data from (April 2025-August 2026) on, call details, disposition (patient outcome at scene), and connection choices (post-response referral options), were analysed using descriptive statistics guided by the RE-AIM framework to access Reach (proportion of EMS calls resulting in STAR activation) and Effectiveness (ED/Hospital diversion rate). Adoption and Implementation were assessed qualitatively through thematic analysis of STAR team meeting minutes from (July 2024-August 2026), guided by RE-AIMs Adoption construct and Implementation’s fidelity and adaptation sub-constructs. RESULTS: Over 17-months, STAR responded to 135 Mental Health and/or Addictions (MHA) calls, with the proportion of SNEMS calls resulting in a STAR activation peaking at 0.60% before declining to 0.08% by the final quarter. Under half (46%) of calls resulted in ED/Hospital transport. Thematic analysis showed meaningful Adoption at the community and setting level, with engagement and activations increasing over time. Implementation maintained fidelity despite adaptations, though staffing constraints limited program availability over the evaluation period. IMPLICATIONS: First responders are reacting to a critical mental health burden in Thunder Bay, Ontario. From the results of the evaluation using the RE-AIM framework, STAR demonstrated strong utility and impact in reducing burden on the ED through supporting individuals who are in mental health crisis in accessing appropriate community-based care.