In yet another casualty of state budget cuts to social services, a therapeutic group home for girls in Kalispell called the Sinopah House closed its doors on March 30, shuttering the only facility of its kind in Northwest Montana.
Since opening in 1994, the Sinopah House, under the umbrella of Western Montana Mental Health Center (WMMHC), served adolescent girls suffering from abuse, neglect and mental health and behavioral issues. The group home offered eight beds, a safe and comfortable environment and a staff of trained professionals to provide therapeutic treatment for an especially vulnerable population.
The facility will now become the Fox Creek Group Home, a therapeutic facility for adults, who cost less than children because of different staff requirements and reimbursement rates, although tight margins will still be a persistent dilemma.
Sheila Smith, WMMHC’s Flathead County executive director, says the loss of Sinopah leaves behind a large hole in the community, and she worries about the girls it served, who already have numerous other odds stacked against them and frequently fall through the cracks.
Now the girls, like other kids around the state displaced by budget cuts, will end up wherever there is availability, perhaps in out-of-state “facilities we know nothing about — safety or anything,” Smith said. They will also likely move around more frequently, as opposed to the stability offered by the Sinopah House.
“Then the problems start over again, and we just recycle these kids and never give them the opportunity to complete their treatment,” Smith said.
The Sinopah House joins a growing list of collateral damage in social services resulting from tens of millions of dollars in budget cuts to the state health department, including reductions in Medicaid reimbursement rates, rule changes and deep slashes to case management, all stemming from decisions at last year’s regular legislative session and special session to address a $227 million state budget shortfall.
The cuts to the state health department have been amplified by the loss of federal matching funds, combining to unleash sweeping layoffs, as well as facility closures and other impacts, and forcing towns and counties to scramble for solutions to address a myriad of concerns associated with losing those services.
Western Montana Mental Health Center, the state’s largest community mental health center, has shut down campuses in some towns and laid off employees statewide. Although the nonprofit closed the Sinopah House and has laid off workers in the Flathead, it continues providing services at its Kalispell campus, including outpatient child-family therapy at Stillwater Therapeutic and adult services at Lamplighter and now two group homes.
As cuts began taking shape last year, officials from a diverse array of professions warned that the erosion of community-based mental health services would have ripple effects, impacting local governments, housing, hospitals, schools, homeless shelters, jails, employers, families, and more, and threatening to roll back years of efforts to coordinate diverse entities to better treat people with mental health issues in their communities and keep them out of institutions.
Gallatin County Sheriff Brian Gootkin, who spoke at a statewide Mental Health Policy Summit in Bozeman on March 16, said in an interview last week that budget cuts are pushing the state back to an era that many Montanans have been working hard to leave behind.
“We were making strides forward in the mental health community in the last decade with community-based solutions,” Gootkin said. “Now we’re going back in time decades ago when we just used to flat out take people to the state hospital.”
“Anyone who has been around for any period of time knows that doesn’t work,” he added. “It’s the most expensive on the taxpayer system, too.”
Although it’s still too early to have extensive hard data, law officials and mental health providers say there’s evidence of their concerns already coming to fruition, and they anticipate that data will later spell out the impacts in harsh numbers: rising crime, increased involuntary commitments, more suicides and untreated mental illnesses, upticks in homelessness and foster care, overburdened officers and institutions, and more.
“All of the things we said would happen are happening,” said Dan Aune, board president of Mental Health America of Montana, the organization that held the March 16 summit in Bozeman. Aune added that one county in Montana has hired help to figure out how to handle the loss of services.
Sheriff Gootkin says any weakening of the community-based mental health model puts a greater onus on law enforcement because people who would otherwise be treated by case managers and mental health professionals will now more frequently end up as the authorities’ responsibility. Flathead County Sheriff Chuck Curry has also voiced serious concerns over the “unintended consequences” of cuts to social services and impacts on the county’s already overpopulated jail.
In law enforcement, it’s not uncommon for an officer to respond to a situation with a potential mental health issue involved. Officers in counties with the appropriate resources, such as Flathead and Gallatin, can call on mental health professionals at any time of day to help assess the people and decide whether detainment is necessary to prevent them from harming themselves or others.
Montana Public Radio recently reported that the number of people in Missoula County held in institutions due to mental disorders has spiked 30 percent in the wake of budget cuts. Echoing Gootkin, Deputy Missoula County Attorney Jordan Kilby attributed the rise in involuntary commitments to the loss of community-based mental health services, especially case managers.
Requests for involuntary commitment in Flathead County have thus far remained consistent with past years, according to figures from the county attorney’s office, although Smith of WMMHC, which provides mental health professionals to assist law enforcement, said her on-call team has been slammed. A person may be detained for an acute mental health emergency for 72 hours pending a court hearing that would decide whether an involuntary commitment is necessary.
The cuts have particularly targeted case managers, who make sure people with mental illnesses have access to medication and take their medication, among many other responsibilities. As Smith explains, it’s expecting a lot for a person with schizophrenia to maintain their medication regimen without a case manager, let alone fill out paperwork for disability insurance, housing and other needs.
Those people, without case managers and other services, are also more likely to get the police called on them, not necessarily by doing anything illegal but by loitering in odd areas, talking to themselves and exhibiting other behavior that attracts attention.
“It’s just this cascade, and I don’t understand how that couldn’t be seen,” Smith said. “The result is more homeless people, more people without medication getting in trouble or not doing anything wrong but getting law enforcement called.”
Smith notes, however, that Flathead County is fortunate to have a law enforcement community that strives to understand mental health issues, as well as Pathways Treatment Center to treat acute mental health emergencies and WMMHC’s voluntary crisis-stabilization Glacier House. Smith’s agency has helped coordinate two crisis-intervention training seminars statewide with first responders, including law enforcement, and is offering another one this spring.
“I devote a lot of staff to that for our community,” Smith said.
Gootkin said many of Montana’s larger communities, like Flathead and Gallatin counties, are fortunate to have crisis-stabilization centers to accommodate emergency detainments, although he fears for their future in light of the budget cuts’ cascading effects. There’s also the worry of centers not being able to handle a sustained influx.
But smaller communities that have lost services and have no crisis facilities will struggle more, Gootkin said, pointing out that cuts have forced WMMHC to close campuses in less populated towns. Also, AWARE Inc., a major provider of mental health and developmental disability services, shut down all of its services east of Billings, which covered Miles City, Glendive and elsewhere.
Officers in such communities, Gootkin said, will now more frequently be forced, in acute mental health emergencies, to handcuff people and drive them to Warm Springs. In areas with small police forces, it’s particularly problematic for a deputy to leave the county for an extended length of time to travel across the state. Moreover, the experience is traumatizing for a person with a mental illness.
“It’s the worst thing you can imagine,” Gootkin said.
Aune, of Mental Health America of Montana, believes a unified front and message among providers and other stakeholders will be key during discussions with the state and at the 2019 Legislature, with the ultimate goal of crafting a comprehensive strategic plan for mental health in Montana. The formation of a legislative mental health caucus also gained traction from both sides of the aisle at the March 16 summit, Aune said.
Developmental disability services have also been impacted. In December, the Department of Health and Human Services notified four major developmental disability service providers that their case management contracts with the state wouldn’t be renewed. The state then changed course, but efforts to renegotiate the contracts stalled. Ultimately, the state agreed to open up a bidding process to offer one statewide contract, while extending existing contracts in the meantime, according to Pat Noonan, public policy officer with AWARE, one of the contract hopefuls.
AWARE has laid off 75 employees across Montana and closed facilities while consolidating others. Last fall, the organization shut down its Kalispell campus, including two group homes, which eliminated 20 jobs and displaced at-risk children. As AWARE waits on the results of the bidding process, the organization is in a “holding pattern,” Noonan said, which puts stress on current employees and deters job applicants.
“We can’t expect all of our staff to hang around while everything is still unknown,” Noonan said. “There has been so much uncertainty in every level of the human services we provide, staff is nervous. Every single week there’s something new.”
Cami Imperato of Kalispell’s Sunburst Mental Health says the confusion extends to clients and the public. She has heard from people who thought Sunburst had closed down and is spreading the word that it’s still open. She’s also trying to encourage members of the public to reach out to legislators to air their concerns, adding that “schools are really getting hit hard.”
“We’re telling people that we don’t have to lay down and not come back,” Imperato said. “We can fight this and change it.”
Seven Democratic senators and representatives sent a letter on March 13 to the state Legislative Finance Committee, Gov. Steve Bullock and legislative leadership requesting emergency funding to help solve what they call a “public health crisis,” saying the well-being and lives of the state’s most vulnerable residents are at stake.
“It is truly an emergency, and to do nothing is not who we are as Montanans,” the legislators wrote.
Gov. Bullock’s office has indicated the funding isn’t possible, although last month it announced it was requesting $23 million in supplemental funding to address the budget cuts in other ways, including $9 million for child-protective services, $6 million to cover Medicaid shortfalls and $2 million for nurses and psychiatrists at the state hospital in Warm Springs.
But Rep. Mary Ann Dunwell, D-Helena, one of the legislators who signed the letter, says the funding doesn’t address the most pressing and core community-based mental health and disability needs. In an interview, she made both a moral and economic argument for emergency funding, saying it’s more expensive in the long run to dismantle the community-based model and then try to rebuild it again.
Furthermore, Dunwell said it’s impossible to fully measure the “human misery and extreme social implications” resulting from the cuts, and she wouldn’t be surprised to see lawsuits.
“I just can’t believe in 2018, in the great state of Montana where Montanans care about one another, that we can’t do anything,” Dunwell said. “I refuse to throw in the towel and say we can’t do something. This is a public health crisis, clearly. I shudder to think that we’re returning to the dark ages of institutionalization.”
“Let’s find the money to save lives,” she added. “Let’s get it done.”
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