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Results of Anaconda-Deer Lodge County mental health survey show disconnect, spark change

Montana Standard - 1/13/2019

Jan. 13--Health officials in Anaconda are working to turn the results of a recent mental health study into a road map for making practical improvements to services and care in Deer Lodge County.

Montana State Hospital staff psychiatric nurse Megan Rediske and the Anaconda-Deer Lodge County Public Health Department conducted that survey in July and early August of last year, hoping to better understand local perceptions of both mental illness and mental health services available. And late last year, Rediske presented the results to county health officials.

According to Rediske's report, 54 percent of the 208 respondents said they "agree or strongly agree" that they know at least one county resident who can't access needed mental healthcare. In addition, 81 percent of respondents "disagreed or strongly disagreed" that county mental health needs are being met.

The survey findings also shed light on Anaconda's high suicide rates, which are the highest in the state according to a 2016 study put out by the Montana Department of Health and Human Services. Nearly 80 percent of survey participants said they knew someone who had committed suicide, and 52 percent considered themselves suicide survivors, meaning they lost a loved one to suicide.

But there was disconnect between some of the survey responses.

Although the majority of survey participants said access to local mental health services is lacking, nearly half also said they know where to seek help for mental health concerns and feel comfortable doing so, the report said.

After further digging, the research team discovered there are more services available to Anaconda-Deer Lodge residents than originally thought, but their availability isn't being communicated, and the services are less available than they once were.

"The communication between providers and consumers isn't good. There's a lot of confusion," said Katherine Basirico, director of the Anaconda-Deer Lodge Public Health Department. "Are there fewer services? Definitely, there are a lot fewer. But there are still some local services available."

One glaring example of the declining but persistent availability of local services can be found in the Anaconda-based service provider AWARE, which was forced to make significant cuts to their mental health services over the past year as a direct outcome of the $49 million in cuts made to the Montana Department of Public Health and Human Services on Jan. 1, 2018. In late August, the state put $30.5 million back into DPHHS to restore those cuts. But according to AWARE CEO Matt Bugni, the state's community-based mental health programs, or outpatient services, are still lacking.

"The state is grossly lacking in early mental health services, such as targeted case management and in-home support services," Bugni said. "Some of these programs were completely decimated, cut 60 percent from where they were two years ago."

And AWARE is among the programs that have been "decimated," Bugni said. As a result of the budget cuts, the non-profit organization has "mostly eliminated" targeted mental health case management or in-home support services across the state. Over the past few years of continued cuts to mental health services, he said they've gone from roughly 14 psychiatrists to one psychiatrist and a mental health nurse.

"No matter what community you talk too, it's fair to say they are significantly lacking in mental health services," Bugni said.

However, Bugni said there are some community mental health services still available through AWARE. In Anaconda-Deer Lodge and other communities across the state, the organization offers a Comprehensive School and Community Treatment program, which Bugni said offers some outpatient therapy and behavioral support for students with funding help from the schools. AWARE also offers early Head Start and Head Start child development programs, which incorporate some mental health and behavioral services.

But while these programs offer some community support, Bugni said they don't have as great of an impact as AWARE's targeted case management and in-home services did.

"We're waiting to see what the 2019 legislature might do and will try to collaborate with hospitals and community health centers to provide some in-home services," Bugni said. "But it's hard to find other viable sources of funding for these community pieces. ... We're trying to be optimistic during this time."

Bugni said he isn't familiar with Rediske and Basirico's mental health survey results but would be more than happy to work with them to better communicate what AWARE services there are. He said he also thinks a possible disconnect could stem from the media coverage around the state health department's budget cuts being restored.

"Just because some service rates are back to what they were beforehand, that doesn't mean programs forced to completely shut down are back up and running," Bugni said.

While Rediske said she didn't quite expect to see this communication-based disconnect, she also said it's not unique to Anaconda-Deer Lodge or Montana. After researching the subject, she found that a lack of mental health services is common in rural areas around the world.

Moving forward, Rediske plans to work with Basirico and county health officials to learn more about how mental healthcare providers are communicating with the public in other rural areas across the state. She and Basirico hope this information will help them better understand how to better inform Anaconda-Deer Lodge residents about what care is available to them and allow the county health department to act as the "middle man" or third-party messenger.

"We want the public health department to be a gateway or portal to these services. We want people to call or drop in to ask where they can find help and to be able to direct them to the best possible resources," Basirico said. This could take the form of a continually updated document listing all available local services that the health department can hand out to people, Basirico added.

But this middle man plan isn't the only idea sparked by the survey results. Basirico said she's looking at how Anaconda-Deer Lodge residents could benefit from telehealth services, as participants said lack of transportation limits access to mental health care. She also said she and Rediske are diving deeper into the survey results to identify the principal misconceptions of mental illnesses, which they want to "gently address" through a sort of mental health 101 course.

Basirico also said she hopes to find ways to embed mental health services in buildings with other health providers in response to negative perceptions of mental illness.

"Some people might not seek help if they think they'll be seen entering a mental health facility," Basirico said. "It's not recognized as something positive. Breaking down these barriers can be done, but it will take time."

All of these ideas are just ideas at this point, Basirico stressed. She said she hopes to use some of the survey results to apply for grants that could help fund a more structured outreach and educational campaign for the county.

Basirico also hopes to get some financial help from the county but isn't sure what that would look like. She and Rediske handed the survey results to Anaconda-Deer Lodge County commissioners in October but haven't heard back yet, they said.

"The commissioners have a lot on their plate," Basirico said. "Before we go to them again, we hope to have solutions we can offer. Then we can see if they can help fund those solutions or if they have other contacts we don't."

Overall, the women feel the survey results are helpful. They believe the data provides a baseline of the community's perception of mental health and mental health services and has led them to better understand what needs improvement.

"This survey has grown into something that has the potential to impact people, which usually doesn't happen with projects like this," Rediske said.

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