Mental Health Commission Seeks to Mend System Troubled by ‘Limitation of Services’   

At the long-awaited first meeting of the statewide Behavioral Health Systems for Future Generations Commission in Helena last week, lawmakers, state agency officials and representatives from Montana public health organizations began charting a course towards what is hoped to be an overhaul of the state’s behavioral health system that providers and advocates have long described as lacking and dysfunctional.

“A lot of us in this room have been waiting a long time for this moment to come about. We went through a similar process 20 something years ago. Senator [John] Esp and I have been waiting a long time for this moment. I’m very excited about it,” Rep. Bob Keenan, R-Bigfork, the chair of the commission, said during opening remarks on July 20.

Keenan, who began his first term in the Legislature in 1999, sponsored House Bill 872 during the most recent session, the law that allocated $300 million for the work of the Behavioral Health Systems for Future Generations Commission. In addition to Keenan, Rep. Michele Binkley, R-Hamilton; Rep. Mike Yakawich, R-Billings; Rep. Dave Fern, D-Whitefish; Sen. John Esp, R-Big Timber; Sen. Ellie Boldman, D-Missoula; DPHHS Director Charlie Brereton; and two Montana experts on behavioral health and developmental disabilities sit on the commission.

The commission is tasked with providing a report to the governor’s office in July 2024 that will outline recommendations for modifications to the state’s mental health infrastructure.

Throughout the daylong meeting, committee members and advocates described a patchwork system of mental and behavioral health services that often leave Montana’s most vulnerable residents without critical care. Discussions focused on the lack of preventative and community resources embedded throughout the state — a shortage that often forces those seeking care to travel to the Montana State Hospital in Warm Springs, or to go without resources altogether, making them more vulnerable to homelessness, addiction and interactions with the criminal justice system. 

“There’s a lot of savings to be had by treating people before they fall off the cliff,” Mary Windecker, executive director of Behavioral Health Alliance of Montana, said. “$300 million sounds like a lot of money, but it will go very quickly if we establish crisis facilities in many state hospitals across the state and don’t really shore up some of the prevention and community-based programs that keep people out of those facilities.”

Amy Eddy, judge for Montana’s 11th District Court in Kalispell, touched on the confluence between the criminal justice and behavioral health systems, a relationship Eddy said has been strained due to the state’s lack of mental health resources. The judicial branch interacts with the work of the commission in family law proceedings, involuntary commitment proceedings, and mental health evaluations conducted during criminal trials. Specifically, Eddy said, the judicial branch relies on state behavioral health services during competency restoration, a procedure that occurs when a defendant is found incompetent to stand trial, and the state provides services to “restore” the individual to competency ahead of criminal proceedings.

“That is a key piece, I believe, of where we could interact with the commission,” Eddy said. “Those restoration proceedings can only be done at a DPHHS facility. It requires people to be sent to the state hospital, which obviously has a well-publicized and documented limitation of services.”    

For Eddy, as well as the meeting’s attendees, offering services closer to home emerged as a central goal for reshaping behavioral healthcare in the state. 

In recent years, 125 beds in group homes and 31 beds in crisis stabilization facilities have closed across the state due to workforce shortages, major budget cuts and a stagnant Medicaid reimbursement rate amid rising costs of care. Gianforte last month signed into law a major increase in Medicaid reimbursement rates, a success for behavioral health advocates, however the shuttering of numerous care facilities across the state can still be felt by patients and providers.

The Western Montana Mental Health Center (WMMHC) shuttered its Kalispell crisis stabilization facility in 2021. Two years later, Sunburst Mental Health in south Kalispell closed its doors after years of underfunding, leaving patients in the Flathead Valley with limited in-patient resources.

Brereton said that the committee would seek to expand community-based care, rather than fortifying the facilities offered at the state hospital.

“The intent is also not to expand the number of institutionalized beds on the state side,” the DPHHS director said. “It’s to ensure, as I said earlier, that patients are being served in the most clinically appropriate setting and, equally as important, that they’re being served closer to home and not being shipped off to Warm Springs and to the state hospital when we could be serving them in a regional manner closer to their family and their loved ones.”

The committee is set to consider a number of priorities, including creating a comprehensive statewide crisis system; reducing dependence on state-run healthcare systems while bolstering community initiatives; increasing the capacity of developmental disability services and children’s mental health care; addressing issues for individuals with co-occurring behavioral health and developmental disability challenges; and supporting families and caretakers.

“This is a long term commitment to improve the lives of our constituents that are afflicted with these problems and for their families,” Esp said. “I’m proud to be a part of the effort, and I’m proud that we’re thinking long term. It’s usually not the way we do things around here. We think of things two years at a time, and I’m glad we’re thinking long term, because this is a long term problem.”

The commission is set to meet again in September.

More information about the Behavioral Health Systems for Future Generations Commission can be found at futuregenerations.mt.gov. Patients, family members, advocates and service providers are encouraged to submit feedback to the commission here until August 11.