Who is responsible for mental health emergencies in Gallatin Co?

Gallatin County officials, community advocates and medical providers have arrived at another crossroads in their efforts to overhaul local mental health services: figuring out where to go first for people experiencing a mental health or substance use emergency .

This latest debate is part of Gallatin County’s long-standing struggle to create a reliable system for those with acute mental health and addiction needs. For years, local activists have pressured the local hospital and elected officials to fill a broad spectrum of psychiatric and therapeutic services. Unlike other major metropolitan areas in Montana, the southwest Montana county, to which Bozeman belongs, currently has no psychiatric beds and no designated crisis center where law enforcement officers can deal with people at risk of harming themselves or others.

“It is absolutely true that our community lacks critical services to meet the behavioral health needs of our children, our families, our friends and our neighbors and ourselves,” Ellie Martin, a behavioral health consultant representing Gallatin United Way, told a provincial commission. meeting July 12. “The system needs to be repaired and stabilized across the continuum.”

The issue of emergency crisis beds, a temporary environment for people involuntarily detained by the police, was central to the July meeting.

For years, Gallatin County had a contract of nearly $30,000 per month with the nonprofit Western Montana Mental Health Center for a variety of mental health services, including two emergency emergency beds at the Hope House facility. The province terminated that contract in February, citing the organization’s struggles to provide reliable services due to staff shortages and rising costs.

“It is absolutely true that our community lacks critical services to meet the behavioral health needs of our children, our families, our friends and our neighbors and ourselves.”

Ellie Martin, a behavioral health consultant representing Gallatin United Way

Since that contract was terminated, Bozeman Health Deaconess Hospital’s emergency department has handled most acute mental health emergencies, including the temporary incarceration of patients before discharge, transfer to a psychiatric ward in another city. or committed by a judge to state psychiatry. hospital in Warm Springs.

Earlier this year, Gallatin County Commissioners and County Attorney Marty Lambert made it clear that they wanted the Bozeman Health agreement to continue. In a letter to hospital management in May, provincial officials stressed the importance of stabilizing those services as soon as possible.

“In consultation with the Commission, the county’s clear desire is to contract directly with BH as an established community entity and partner to ensure an appropriate provision of mental health services in this community,” the letter reads.

The appeal of the province did not convince the hospital. Although Bozeman Health representatives have said the hospital plans to expand its emergency behavioral health services and eventually open a 12-bed adult psychiatric ward, the hospital’s leadership has maintained that the hospital is not currently the right provider for stabilizing emergency psychiatric patients or providing involuntary detention for patients at risk.

“A specialist crisis response provider is now needed, in addition to what Bozeman Health does, in an appropriate facility,” Bozeman Health’s chief nurse Diane Patterson said at the July meeting. “And it should be available to address the shortcomings we’ve had in our community over the years.”

Hospitals in other cities in Montana — including Providence St. Patrick Hospital in Missoula, St. Peter’s Health in Helena, and Billings Clinic in Billings — have incorporated specialized behavioral health emergency care into their emergency rooms. Patients arriving at those hospitals are assessed by behavioral health teams in a separate area of ​​the emergency department before being discharged, admitted to the local clinical department, or transferred to Warm Springs.

Bozeman Health has said it plans to open a new psychiatric unit within its emergency department by the end of the year and that the clinical unit will be operational by 2024, a later timetable than originally promised when it opened the department last October. announced.

On Tuesday, the hospital announced other financial challenges in a sweeping round of layoffs. CEO John Hill said in an internal email that 28 full-time leadership jobs have been terminated and an additional 25 open positions have been closed due to economic pressures in the health care system. He told staff that the hospital had lost nearly $15 million in the first half of 2022.

In an interview on Wednesday, Hill attributed some of the hospital’s financial problems to staff shortages and increased reliance on contract workers. He said the hospital’s plans for more behavioral health emergency services and a 12-bed clinical ward have a tough road ahead but are still on track.

“Those two projects, as we have them now, are still in the works. And I think the caution we have in opening those two units is the availability of healthcare behavioral professionals,” Hill said. “We’re clearly in a staffing crisis for medical professionals… It’s a tough place right now. to bring those people to Bozeman with the cost of living, and frankly just the challenges we have here in our community.”

The lack of immediate and robust hospital services has created a void for other mental health and crisis services providers. In a strategy supported by Bozeman Health at its July public meeting, Gallatin County commissioners voted to bid for an assortment of emergency services previously contracted with Western Montana Mental Health Center, a mobile crisis response unit and crisis center that shelter of voluntary patients and temporary involuntary beds. According to a copy of the county’s request for proposals reviewed by Montana Free Press, a supplier can receive up to $568,000 in public funds annually for all services — an amount that includes budget allocations from the county, the city of Bozeman, and a federal grant. . The proposal stipulates that the crisis shelter should be operational by March 2023.

One provider expected to submit a proposal before the deadline later this month is Connections Health Solutions, an Arizona-based for-profit crisis services company recommended to the county by Bozeman Health.

In an interview with MTFP, Connections employees emphasized the company’s ability to provide services not currently offered in Gallatin County, including temporary detention beds. dr. Chris Carson, the company’s co-founder and chief medical officer, said that while Connections believes in a full spectrum of outpatient and rehabilitative mental health services, the county’s lack of inpatient psychiatric beds is a “stark deficit.”

“There are obviously gaps and we’re willing to go into any gap that it makes sense for us to go into,” Carson said. “We don’t come in with, ‘Here’s our model in a box, and we can put that box in Gallatin County.'”

“What I see is that there is a big poker game going on right now between Bozeman Health and Gallatin County.”

Gary Popeil, long-time community advocate for mental health

Local activists who have long pressured Bozeman Health to provide psychiatric services strongly opposed the county’s plan in July to contract with another provider for behavioral health emergencies. Those medical treatments, they argued, are a perfect fit for the community’s nonprofit hospital and should not be subsidized with public dollars.

“What I see is that there is a big poker game being played between Bozeman Health and Gallatin County right now,” Gary Popeil, a long-standing mental health advocate, said at the public meeting in July. Referring to Connections, he said Bozeman Health is “inviting someone from out of state” to provide emergency and acute psychiatric care at taxpayer expense.

“It’s a game,” he said. “The whole point of it is that they don’t have to do it… Bozeman Health needs to get up and they’re avoiding it.”

In an interview following the July meeting, Gallatin County Commissioner Zach Brown said the County Commission does not view the situation with Bozeman Health as a game. More important, he said, is figuring out how to build a system with the resources that are immediately available, rather than waiting for Bozeman Health to speed up or change its approach.

“The ‘chicken game’ outcome where we choose to do nothing has dangerous outcomes for vulnerable people,” Brown said. “Should we invest in other services and take Bozeman Health at their word that they are still focused on intramural [services]? That seems the most likely course of action for the province.”

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