For the past three years, Jessica Culver’s boyfriend has regularly been admitted to Logan Health’s emergency room during episodes of psychosis. In between his chronic encounters with law enforcement in the Flathead Valley, he’s also sought treatment at numerous local mental health facilities.
Diagnosed with schizophrenia and bipolar disorder, he also struggles with methamphetamine addiction, which aggravates the cycle. Culver has tried to find him help through various mental health services, including Western Montana Mental Health Center (WMMHC) and Recovery Centers of Montana (RCM), but he always returns to meth.
“It’s been a vicious cycle,” Culver said. “He’ll go for two months, and he’ll be clean and then he’ll stop doing the program and he’ll go and get high. Then the cops get called — the police will put him in jail just for his sake.”
Because Culver and her boyfriend also have three children together, she’s been forced to set hard boundaries when he’s using meth, an addiction with which she’s also struggled. Sometimes, he’ll disappear during a psychotic episode and Culver will receive calls from sheriff’s deputies who let her know that the father of her children is safe.
“It’s pretty sad when they know him by name,” Culver said. “They know me by name. It’s really devastating to sit there and watch somebody not in touch with reality and there’s no help for him.”
Some days, Culver will make 30 or 40 phone calls to various mental health providers, who tell her they are booked out. She’s also tried obtaining court orders to have her boyfriend admitted to the hospital involuntarily.
“For the past three years, I’ve had to rely on the sheriffs to help me more than the mental health facilities in this town,” Culver said.
In the Flathead Valley, there are few low-barrier mental health providers that fit the specific needs of much of the population. Most local facilities provide outpatient services, but only a few provide inpatient services, including RCM in Columbia Falls and Logan Health Behavioral Health (formerly Pathways), which has strict criteria for admitting patients.
The dearth of available resources to treat mental health crises and addiction isn’t unique to the Flathead Valley. Across rural America, the services remain out of reach for segments of the population that need them the most.
According to National Alliance on Mental Illness data, just 48% of adults with a mental illness in non-metropolitan areas received treatment in 2020, while rural Americans must drive twice as far to the nearest hospital.
Locally, the valley’s chronic resource shortage has been exacerbated by the closure of some facilities.
The Glacier House Crisis Facility in Kalispell, which is affiliated with WMMHC, recently shut its doors and no longer offers services. Local providers say the closure was due to staffing shortages, but officials with the agency could not be reached for this story. Other facilities have stopped accepting new clients because of the surging demand.
At Oxytocin Clinic in Kalispell, owner and director Pam Liccardi provides outpatient addiction and mental health services, most of which are geared toward substance abuse; however, she also provides for a wide range of clients, including “hard serve” clients who require more attention.
“We are getting the harder serves here, which is a little bit difficult because they are not always appropriate for our care, but we ethically have to serve them,” Liccardi said.
After seeing a gap in mental health services, Liccardi opened the for-profit Oxytocin clinic in January 2019. She heard a lot of discouraging stories about services that didn’t have a systematic approach to treatment, leaving clients without long-term solutions.
“We were just hearing people say they go to treatment, there’s nothing planned and there’s no curriculum to follow,” Liccardi said.
While there are some mental health services in the Flathead, including a new program called Greater Valley Health Center, which formerly operated within the Flathead City-County Health Department but is now independent, Liccardi says the demand is too high to help the number of people in need. Moreover, many people in need are often connected to services that are inadequate or inappropriate given their condition.
“The biggest challenge that I see is there’s not a lot of case managers out there to help people with their mental health issues,” said Sara Lombardi-Thorman, a licensed addiction counselor and social worker at Oxytocin. “There is no program that sends them to the resources they need or makes sure they keep getting those resources.”
Lombardi-Thorman has a client who formerly sought services from WMMHC, but she was not assigned a case manager to help with her substance abuse and to make sure she takes her medications.
“We were using our peer support to supply her with all of her medical appointments and making sure she goes to them,” Lombardi-Thorman said. “She just fell through the cracks because we can’t do all of that for her constantly … They won’t give her those case management services.”
At Logan Health Behavioral Health, which houses one of few inpatient services in the Flathead Valley, emergency room doctors adhere to rigid criteria before admitting clients. Individuals who are in a crisis often go to the emergency room, where they are either admitted into the behavioral health unit or are referred elsewhere.
Logan Health Crisis Intervention Specialist Colby Wood sees about five to seven clients per week, who are typically having some type of psychiatric issue like anxiety or suicide. After an evaluation, Wood determines how acute or severe the emergency is and whether the patient is a harm to themselves or others. Depending on the situation, they are admitted to the behavioral health unit, the pediatric unit if they are underage, or they are discharged from the hospital.
Some of the clients Wood sees would be better suited for a crisis facility or drop-in service, but since Glacier House Crisis Facility closed, many of those patients are diverted to the emergency room, even if they’d gain more benefit from a lower level of service.
“It causes a lot of problems for us because we really worked hand-in-hand with Glacier House,” Logan Health Behavioral Health Director Leslie Nyman said. “People who weren’t as acute could go to a crisis house … We really miss that we could divert people there.”
For Culver, she wishes there was another option for her boyfriend when he’s experiencing a crisis, but she says the default is often the emergency room. Sometimes, she says she feels like he’s better off in jail.
Culver is often relieved when her boyfriend breaks the law and he’s booked into Flathead County Detention Center, because she knows where he is, and she knows he’s safe.
“I feel helpless because I’m just sitting there wondering where he is and what’s going on,” Culver said. “Then he breaks the law, and he goes to jail, and I actually feel relieved.”
“At that point, there’s just nowhere else for him to go besides jail,” she added.
According to Kalispell Police Chief Doug Overman, in his 23 years in law enforcement he’s seen a steady increase in mental health-related calls come through dispatch. Even though the police department has learned to navigate the landscape of mental health crises and has tried to adapt their responses accordingly, Overman says law enforcement remains limited.
“The options are to release them on-scene, take them to the jail, or take them to the hospital,” Overman said. “Those are our resources.”
In 2020, WMMHC hired the Flathead’s first Community Crisis Co-Responder, Sarah Winfrey, who helps law enforcement with mental health-related calls, working with the Flathead County Sheriff’s Office and the Kalispell, Whitefish and Columbia Falls police departments.
Winfrey is dispatched to respond to calls along with a law enforcement officer. Once the scene is safe, she helps deescalate individuals experiencing a mental-health related emergency and connect them with appropriate resources.
In 2021, Winfrey responded to 385 calls with law enforcement and 309 calls without law enforcement — most of which were phone calls. On average, she goes on 30 calls per month, saving law enforcement officials around 20 hours per month. Out of these calls last year, there were 58 arrests that fell under either the Mental Health Act or jailable offenses.
“This opens up a whole new level of resources,” Overman said. “The goal is to connect people with services — then all of sudden, they are no longer calls for us … I’m really proud of this in the community and it’s a tool for law enforcement.”
There is funding for two co-responder positions within WMMHC, but officials can’t find another person to fill the second position. Winfrey works 40 hours per week, Tuesday through Friday, but law enforcement is on their own to deal with mental health-related calls the remainder of the week.
In Winfrey’s experience, many of the calls involve addiction and individuals with chemical dependency that co-occur with mental illness, and she sees many of the same people over and over. But she says her observations are not representative of mental health beyond crisis situations that she responds to.
“There’s a good degree of repeats,” Winfrey said. “There’s some from last year who are now housed and on medication and are more stable, but we always have new people popping up.”
Following an evaluation, Winfrey often refers clients to resources in the valley and like other providers, she previously utilized Glacier House. Now, she often must redirect people to the hospital instead.
“It’s a lot more pressure on the hospital,” Winfrey said. “They have a pretty strict criteria of who they take but they’re doing the best they can. I used to be able to do direct admits to Glacier House and I could bypass the hospital and law enforcement.”
Liccardi, the director of Oxytocin, believes there needs to be a more diverse network of services that works together in order to accommodate clients’ individual needs. From case management to addiction treatment to housing — the Flathead population needs many resources to gain stability.
Austin Goddard recently started treatment at Oxytocin after struggling to overcome meth addiction. On his path to recovery, he’s run into challenges like housing insecurity and a dearth of providers.
“It’s really hard to get on your feet,” Goddard said. “You go and seek out mental health counselors and medication when it’s not there. It’s really impossible because you don’t feel like you have a safe place to go to. You wind up getting progressively worse and they just put you in jail. You might dry out in there, but the problems are still there.”
Goddard spent this past winter couch surfing before he sought treatment. He recently moved in with his wife, Kat — who is also in recovery — their young son and her parents, but he’s trying to find a sober living facility like Ray of Hope, a shelter in Kalispell.
“With this valley growing, it’s hard to get into those beds,” Goddard said. “Trying to find housing on your own is pretty hard.”
If Goddard didn’t have the option of staying with his wife’s parents, he says he would likely be on the street — cast out into an environment that might lead him to use drugs again.
While Liccardi says the community is trying to tackle issues like affordable housing and mental health facilities, there needs to be support systems set up for a wide variety of services. With the current price of real estate, it’s difficult to launch new facilities and Liccardi stresses the need for community support.
“There’s a 100% need for community outreach,” Goddard said. “There’s a huge gap in education on both sides. The community needs to come together instead of pushing this issue away.”
Providers at Logan Health would like to see facilities similar in capacity to an urgent care come online for people experiencing a mental health crisis, and Winfrey would like to see a juvenile mental crisis home and more walk-in crisis facilities.
Thara Rasnic, a recovery sponsor at Oxytocin, says she lived in an apartment complex in Arizona that was dedicated to people who were in recovery and getting back on their feet.
“I went to prison out there and when I was released, I went to this facility that they put together that they got through state funding and they turned an apartment complex into a sober living complex,” Rasnic said. “It was amazing, and it housed 70 women.”
Liccardi has been working with local officials for funding resources at Oxytocin, and they were recently awarded $500,000 in state funding. That award comes as members of the Flathead County Commission grasp the severity of the mental health and addiction crisis touching all corners of the valley.
“The Flathead needs to deal with behavioral health and these services have shrunk tremendously,” said Flathead County Commissioner Randy Brodehl, who helped direct the funding for Oxytocin.
Liccardi plans to use part of the funding for a prevention program at Oxytocin that will provide education for not only those in need of services, but also for community members who misunderstand the problem and the population it impacts.
“There’s a stigma attached to addiction and mental illness,” Oxytocin intern Burch Bowen said. “People think they are bad people trying to be good, but the reality is they’re sick people trying to get well.”
Correction: A previous version of this story stated Greater Valley Health Center operated within the Flathead City-County Health Department, but it became independent from the county on June 1.
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