Rural communities felt the effects of Western Montana Mental Health Center’s budget cuts five years ago. However, the decline of one the state’s most important mental health providers has continued and it’s created a vacuum in behavioral healthcare care.
It began in Livingston, a small town of 8300 people. In 2018, Western shut down an outpatient clinic. More than 100 patients were referred to me To stabilize mental health care, you will need to travel 30 miles up a mountain pass from Bozeman. Western also closed the clinic in Bozeman this spring, making it a crisis center in one Montana’s fastest-growing towns.
Initial closures of the private nonprofit were attributable to state Medicaid cuts Made in 2017. Western’s financial problems have worsened since then. Since 2019, it has cut jobs and retrenched services each year. Western shut down three mental health crisis centers in February. This left only two other centers to serve the rural state of 147,000 square miles.
The slow growth of Western’s money problems is due to low reimbursement rates from Medicaid and staffing strains. Employees and former members of the Western board claim that poor management also played a part. According to the company, it is losing money through subsidizing state crisis services.
Western’s CEO Levi Anderson stated, “We have become the face for the system’s failure because we are the only one providing these services.”
This decline is indicative of a U.S. healthcare system that fails to adequately pay for mental care. Nationally, clinics have shut down programs and left empty beds that they don’t have staff.
Chuck Ingoglia CEO of National Council for Mental Wellbeing said, “These are the stories I hear every week.” “More people experience depression and anxiety, and they are in need of treatment. We also have a corresponding decrease in our capacity. It’s a perfect storm.”
Montana’s system has been cracked elsewhere. Staff can’t be found in community clinics. Private practice therapists face long wait lists. After staffing shortages and poor management, the Montana State Hospital was forced to lose federal funding. Patient deaths and assaults.
Policymakers They have pledged to increase funding Budget measures and bills are available to support behavioral health care in the state. Although hopeful, health professionals aren’t optimistic that an influx in cash will be enough to bring about lasting change.
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When someone’s mental health spirals into suicidal thoughts and disconnection from reality, community crisis centers can provide a safety net. They offer services to stabilize patients and prevent them from recurring crises.
Western opened these centers in Butte and Bozeman, Helena Kalispell, Kalispell, Polson and Missoula in 2010, starting in 2010.
Tom Peluso, a former director of Western’s board of directors and a mental health advocate, stated that “of all the crisis houses in the State, every one was started and operated primarily by Western.” “Nobody else was willing make the investment.”
According to a survey, Montana had almost all of the crisis stabilization services that were not available in Montana. State-funded report Released last year. The state hospital and emergency rooms have been replaced by less-equipped options.
Western’s most patients depend on Medicaid, which is a federal-state program that provides health coverage for those with low incomes and disabilities. Long-time health professionals claim that Medicaid’s state-set payment do not cover the cost for care. State-commissioned study confirmed.
Anderson stated that crisis services are not profitable. Western had to rely on other programs until recently to make up the difference. For example, case management links patients to ongoing healthcare.
The state nearly halved Medicaid reimbursements for case management in 2017. In 2019, Western spent $3.4 million It earned more than it got.
The covid-19 pandemic struck, disrupting school-based mental healthcare services. This was another source of Western revenue. Learning became difficult. The competition for health workers soared simultaneously, causing Western to have to raise their pay or reduce the number of employees.
The company reduced its school-based programs in 2020. Dozens of people were laid off number of mental health workers and closed at least two sites. It also listed two large, affordable housing units on the market for sale in Hamilton, where it closed a Hamilton group home. Western closed its doors last year. Kalispell Crisis Centre It was unable to fill the remaining crisis centers with staff.
Western lost trust as services fell apart. This included Peluso who, after nearly two decades of service, resigned from the company’s board in last year. Peluso stated in his resignation letter that “selling assets is not a business plan.”
Kathy Dunks was a Western employee who worked in Butte for 29 years. She felt a shift when Anderson and other leaders arrived shortly after the retirement of the long-serving CEO.
Dunks stated, “It was the first moment it felt like, ‘If you don’t like it leave.’”
In 2019, she was fired by Western after the replacement of regional leaders with managers who would oversee company-wide program oversight. Dunks refused a new position with Western because she didn’t trust the company.
Anderson stated that Anderson was trying to save money and standardize treatment across sites. Anderson stated that Anderson also received raises for some of the highest-paid employees at the company. Anderson believes this was to keep top-trained staff members.
Anderson stated that the company is trying to balance services clients require with being viable. He also said that employees are encouraged to give feedback. Anderson said that although there was some turnover due to restructuring management, the pandemic and low funds have only exacerbated the long-standing pressures.
Western was paid by 17 counties to provide services in their localities at its peak. The number of participating counties fell to one in the wake of Western’s financial troubles.
Anaconda Deer Lodge County terminated its contract with Western in 2020. Western helped it provide crisis intervention and psychiatric evaluations.
“We began running into problems with them saying that they didn’t have anyone who could come out right now, but we’ll send somebody in the morning,” said Ben Krakowka, County Attorney. “That doesn’t work when someone’s in crisis right now.
In late 2019, Lewis and Clark County Announced It would terminate its contract with Western for services at its detention center. Officials from the county said that they would hire their own staff to provide better control and access to data. In addition, the county announced that it will be seeking applicants for its crisis response team. This is a Western service.
Western severed all ties with the county, closing the only crisis center in the region. Anderson stated that the company was clear in its demands: Western must provide a continuum care for its employees to be successful.
Although Lewis and Clark County has filled in some gaps, the county’s crisis room remains closed. One company applied for the job and determined that reimbursement rates would only cover half of the cost.
Gallatin County is one example of a jurisdiction that does not allow for this. It ended its contract Western will open crisis centers with other providers in 2022. Anderson stated that Montana’s problems can’t be solved by new vendors.
Anderson stated that “our current state isn’t a result Western not knowing how to provide good care.” Anderson stated that the current state is due to poor funding of good care.
The lawmakers Consider a bill It would spend $300 million in several years. Fixing the state’s problems behavioral health care system. They are also looking at a constitutional amendment To establish a trust fund for mental health. This would be in addition a Republican Governor fund. Greg Gianforte was created to fill the gaps in mental healthcare care. However, some details are still unclear and there will be a lot of competition for those funds.
Representatives from the states also suggested raising Medicaid reimbursement rates But we haven’t reached an agreement How much. According to mental health workers, adjusted Medicaid rates are a temporary fix and emergency services cannot rely solely on them.
Officials from Montana Are you exploring? A statewide program that funds specially-designated clinics offering local mental health or substance abuse services. Instead of paying for each service individually, it pays for the entire value of the care.
Mary Windecker, executive Director of the Behavioral Health Alliance in Montana, stated that “we have to change it.”
To begin planning for the adoption of that system, the Montana Department of Public Health and Human Services was awarded a federal grant. However, it could take years before that system is adopted.
Mental health clinics are trying to preserve existing programs.
Anderson stated that Western is committed to providing services for clients. Western began accepting new residents in March and is now using ex-crisis beds as a way to expand its group home programs.
The company does not plan to return to the level of its crisis services in the near future.
He stated that “the need is there.” “We can’t continue to subvention the program.”
Western’s remaining two crisis centers can be found in Missoula or Ravalli counties, which are located 47 miles apart in the vast state.