One patient drove three hours to get treatment for his suicidal ideation at a Great Falls hospital. A woman described being treated “like a criminal” by police officers when she suffered a manic bipolar episode. A patient on methamphetamine and experiencing postpartum depression asked police to take her to jail instead of a hospital during her crisis with the hope that incarcerated women “would have shown me compassion” and treated her “like a person.”
Instead, she was placed in the jail’s isolation unit.
The stories are part of a recently released study, commissioned by the state Department of Public Health and Human Services, detailing first-person experiences with Montana’s behavioral health crisis system.
The report by JG Research and Evaluation includes information drawn from interviews with 26 people, including former patients identified by pseudonyms and anonymous family members, health care providers, administrators and law enforcement personnel. The study’s participants are residents of Custer, Gallatin, Glacier, Hill, Lewis and Clark, Missoula, Silver Bow, Valley, and Yellowstone counties.
The peer-reviewed study is notable for its qualitative, first-person approach, a rare strategy in Montana’s behavioral health research landscape that the authors said “greatly expands our existing understanding” about the state’s crisis response systems. One of the authors, Brandn Green, told Montana Free Press the respondents’ interviews were analyzed to identify key points.
“Thematic coding looks for patterns among all interviewees to identify general insights in qualitative research,” Green said. “Quotes that are included in the report are intended to be reflective of themes that were identified by multiple interviewees.”
The report’s takeaways are organized into four sets of recommendations for state health officials and community service providers: breaking down silos of care by adding case managers and improving coordination between different service provider groups; developing a network of drop-in, crisis, and transitional housing facilities; improving mobile crisis units and emergency response; and bridging the current patchwork systems with state-level databases, infrastructure and financial investments.
The report comes as the Children, Families, Health and Human Services Legislative Interim Committee is developing draft bills to improve Montana’s child and adult mental health systems. Lawmakers on that committee are also anticipating the release of a separate study about how much health care providers are reimbursed for treating Medicaid patients, research that behavioral health advocates have said could help stabilize Montana’s struggling health care workforce.
State health department spokesperson Jon Ebelt declined to comment on the JG Research and Evaluation study, saying department staffers are still reviewing the final version.
Without substantial changes to Montana’s crisis-response system, the report indicates, “significant gaps” and “barriers to services” will persist.
Among other difficult experiences, interviewees described being handcuffed in the back of law enforcement vehicles for transport to and from various health care facilities, including local hospital emergency departments and the state psychiatric hospital in Warm Springs. Some reported spending time in jails during their crisis or seeking help from suicide prevention and poison control hotlines.
Many described feeling isolated and misunderstood during their health crises.
“Taking someone who is suicidal into a backroom and leaving them alone is probably not the best idea,” said one participant, who told researchers he was placed in an isolated room at a hospital emergency department in one of Montana’s urban areas. “It just compounded, I guess, the feeling that I felt of hopelessness and aloneness, and that even when I was making an attempt to get help, I didn’t matter. I was an inconvenience.”
Some law enforcement officers and health care providers recounted a lack of crisis services for patients, leaving those frontline workers scrambling for solutions. In one instance, a law enforcement officer from an unidentified Montana town described a young person in crisis being turned away from services after he damaged hospital equipment.
“They [the hospital] said, ‘No, we’re not taking him. We refuse to take him. We will not take him. You guys need to deal with him,’” the officer told researchers. “So, that puts us in a horrible spot because we can only take people to detention facilities if they’ve committed certain crimes … So, we drove this kid to [another city] and released him to his grandma because the grandma was the only person in the state we could get a hold of that would take this kid.”
A shortage of immediate crisis resources, including drop-in centers and long-term care facilities, was one of several hurdles identified by participants.
“Almost every provider, family member, or individual who had been through crisis mentioned a lack of housing as a barrier to care and eventual recovery,” the report says. “From homeless mothers who could not take their children or pets into treatment centers to time limits, to the lack of affordable or transitional sober housing, the dearth of transitional and/or supportive housing options in Montana remains a significant barrier to sustaining recovery.”
The report highlights additional shortfalls of the state’s health care system: inadequate communication between medical and social service providers, isolation of patients during and after a crisis, inefficient transportation, and an overall lack of services.
Several respondents, the authors said, stressed the importance of diverting patients from crisis through better community services and case management.
“Largely, participants were in agreement that more time could be spent on working to prevent behavioral health crisis through a better network of community mental health centers, case workers that helped to manage continued recovery, or other facilitators, rather than through prioritizing resources for response rather than recovery,” the report said.
Montana wants to expand institutional mental health and addiction treatment. What’s the downside?
In July, the federal government authorized Montana to use Medicaid coverage at large inpatient addiction treatment facilities. But health authorities also delivered a significant set-back for the state’s overall plan: they would not allow Medicaid to cover treatments at large hospitals that handle serious mental illnesses, including the problem-plagued Montana State Hospital in Warm Springs.
The study received initial affirmation from the Behavioral Health Alliance of Montana, which represents service providers. Executive Director Mary Windecker said Wednesday the report has been long-needed.
“Everything in it has been what providers have long been saying that the system needs, but to hear it from the clients makes it impossible to ignore and heart-breaking,” she said. “We need compassionate case managers and community-based services to treat people in their communities, near families and loved ones, instead of taking them hours away during a crisis. We need short-term crisis and long-term residential care available in more communities than just at the state hospital so people can get treatment for as long as they need it and as often as they need it.”
A researcher for JG Research and Evaluation told MTFP there are no further discussions planned with DPHHS to review the report’s findings, but that the research group will continue working with the state agency on other overlapping behavioral health projects.
If you or someone you know is in crisis, call 988 to be connected to the National Suicide Prevention Lifeline.
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