Local Providers Decry ‘No Services for Individuals in the Community’ at Behavioral Health Commission Meeting

Stakeholders from across the Flathead Valley flocked to the fourth meeting of a statewide commission designed to mend Montana’s broken behavioral health system last week, laying bare the structural failures that have left providers, families and people experiencing behavioral health challenges in the Kalispell area with nowhere to turn.

The Behavioral Health Systems for Future Generations Commission met Nov. 30 and Dec. 1 at Flathead Valley Community College, where commission members recommended two policy initiatives to the governor’s office and heard from community members and providers over the course of expert panels and public comment sessions. The commission is chaired by Bigfork Republican Rep. Bob Keenan and includes five state lawmakers, as well Montana Department of Public Health and Human Services (DPHHS) Director Charlie Brereton, Flathead Industries CEO Patrick Maddison and Janet Lindow, executive director and co-founder of the Rural Behavioral Health Institute.

“The Flathead is really hurting,” Tonya Horn, executive director of the Flathead Warming Center, told the commission during public comment. “In our community, we do not have the places for people to go to be well.”

Horn was among dozens of community advocates, law enforcement officials, healthcare providers and Flathead Valley residents who offered testimony on the area’s lack of support for those with developmental disabilities and behavioral health conditions — a lack of support that has forced individuals out of shelters and onto the streets or into the county jail, and that has pushed homelessness and its associated problems into the public eye.

“Mental health crisis is being played out in public spaces. Our community sees homelessness on the streets of Kalispell; however, many do not see the mental illness that is with that,” Horn added. “It doesn’t have to play out this way. We can catch it upstream.”

Laurie Heckman, a Flathead resident who is the conservator for her 33-year old disabled son, decried a lack of services in the Flathead Valley that have made it impossible to care for her child. Heckman’s son is a veteran who suffered a traumatic brain injury and subsequent mental illness. He is currently receiving treatment at the state hospital in Warm Springs, a three-and-a-half-hour drive from Kalispell. Heckman said she has been unable to find a local center that will treat her son given his brain injury and mental health conditions.

“As a mother, I need services, support, help. I need that. And I have been turned down, doors shut in my face,” Heckman said. “I have made 1,000 calls.”

Logan Health Behavioral Health Director Leslie Nyman said that the Flathead Valley used to be home to a plethora of services for people with developmental disabilities and behavioral health conditions, most of which have closed their doors due to insufficient Medicaid reimbursement rates and budget cuts.

A 2022 study commissioned by the state of Montana found that Montana’s reimbursement rates for providers that care for patients on Medicaid failed to cover the average cost of care. As of earlier this year, the reimbursement rate for adult behavioral health services only covered 85% of costs.

While the Legislature raised Medicaid reimbursement rates during the 2023 session, meeting 100% of the identified gap by 2025, shuttered facilities and discouraged families in the Flathead Valley stand as reminders of years of insufficient provider compensation.

“It doesn’t feel good when you’ve worked here for 25 years and we still have the highest suicide rates, highest alcoholism rates,” Nyman said. “It doesn’t make you feel good as a provider.”

Nyman also highlighted the workforce challenges faced by developmental disability and behavioral health providers. In the post-COVID landscape, many workers prefer remote jobs that offer flexibility and higher pay, making it challenging to recruit people to do the difficult work of behavioral health management.

Providers and residents struggling with behavioral health conditions emphasized the need for a detox facility in Kalispell. In many cases, behavioral health facilities will not admit patients until they are detoxed from substance abuse, yet substance abuse facilities will not admit them until they are treated for behavioral health conditions. More often than not, no interventions occur until someone is arrested by law enforcement for drug use or other crimes.

It’s a Catch-22 that Jennifer Ball, a social worker with the Kalispell public defender’s office, said has left many individuals to deteriorate in jail without treatment.

“A lot of the times, there are no services for individuals in the community,” Ball said. “Someone who really should have been seen as a having mental health crisis is charged criminally.”

According to the American Psychological Association, 64% of jail inmates, 54% of state prisoners and 45% of federal prisoners report mental health concerns. Mental and behavioral health problems are often exacerbated by time in jail, where treatment resources are limited.

Ball said that the average incarcerated individual waits nine months in the Flathead County Detention Center before they are taken to the state hospital in Warm Springs for a mental health evaluation ahead of trial.

“We have people who are decompensating in the jail,” Ball said.

The commission also heard from representatives from the Bozeman and Kalispell school districts, DPHHS, Shodair Children’s Hospital, mental health and developmental disability provider AWARE, New Now Village, The Arc Western Montana, and Community Action Partnership of Northwest Montana.

In addition to hearing testimony from community members and behavioral health experts, the commission approved recommendation of two near-term initiatives that will be sent to the governor’s office for approval.

The first initiative provides grants to support mobile crisis response and crisis receiving and stabilization services across Montana. The Behavioral Health Systems for Future Generations Commission has followed the Crisis Now model, a national best practice model for behavioral health crisis stabilization. In the model, crisis systems should include three services: “someone to call,” “someone to respond” and “somewhere to go.”

According to a report provided by DPHHS, Montanans have access to the first service — “someone to call” — through the statewide suicide prevention hotline, or 988.

However, the second two critical services — “someone to respond” and “somewhere to go” — are lacking as the state struggles to maintain behavioral health infrastructure.

Only 51% of the state is currently covered by mobile crisis response programs. There are only four functioning crisis receiving and stabilization centers in Montana, located in Missoula, Ravalli and Yellowstone counties. Flathead County was formerly home to a crisis receiving and stabilization center, which has since closed.

Through the program, the state will provide one-time grants to existing mobile crisis response and new crisis receiving and stabilization providers to increase services across Montana.

Some commission members expressed concerns about the sustainability of opening new facilities and suggested that the grants for crisis receiving and stabilization centers go instead towards reopening shuttered programs. DPHHS officials, however, pushed back on that suggestion, saying that the four existing programs would not have enough capacity to cover the vast state.

“With a state that covers the geography that Montana does, that’s certainly not a realistic option for the majority of Montanans who are experiencing crises. And, I think, adding to existing facilities, I’m not sure what those facilities would be,” Rebecca de Camara, administrator of DPHHS’ Behavioral Health and Developmental Disabilities Division, said.

The second initiative that will head to the governor’s office for consideration would establish a standardized curriculum and certification course for crisis response workers.

According to a DPHHS report, each of Montana’s 15 crisis response providers have varying training standards and requirements, which leads to “inconsistent training curricula across the crisis system continuum” and an inability for DPHHS to “track training efficacy across service types and regions.”

The initiative proposes that DPHHS contract with a vendor to develop a standard Crisis Worker Certification Course to be provided across Montana. The outlined program budget is $1.5 million for curriculum development and platform maintenance.

Commission members expressed hesitation about requiring specific training given the already difficult landscape of hiring workers in Montana.

“I still have some concerns that we’re potentially asking people who want to be part of a workforce out of a burning passion they have inside of them to take a 40-hour course to do the work that they maybe could be qualified for with a lot less than 40 hours,” Sen. John Esp, R-Big Timber, said.

Esp also said that the commission could “tackle this problem for less than $1 million” and should focus spending the commission’s funding on supporting programs rather than developing curriculum.

Brereton said the department would seek out the best curriculum provider who can offer services at the lowest cost to the state.

Theresa Williams, program manager for the Missoula County Crisis Intervention Team, said the Crisis Intervention Training (CIT) program has allowed her team to train crisis response providers across Western Montana through a the regional “hub and spoke” model. The CIT program combines online modules with a 40-hour academy in Missoula.

“They are learning alongside first responders and they are doing practical classes and lots of other scenario-based training so they know what to expect. Training someone in de-escalation is one aspect, but understanding how to be safe is another,” Williams said, suggesting the commission build off of the existing CIT model.

Despite concerns from members about the best path forward to effective training, the commission voted to move forward with the initiative, which will go through multiple rounds of review and editing before implementation.

The next commission meeting will take place in January in Billings. More information can be found at www.futuregenerations.mt.gov.