'A major toll': Effects of state cuts to mental healthcare reverberate in region
Montana StandardMay 13, 2018
But that's exactly how it started: as a number, a dollar amount.
That was the size of a 2017 state budget shortfall that led to enactment of Senate Bill 261, which included language that slashed funding for mental health targeted case management services and to a special session of the
Those cuts have set off a wave of changes to services for some of the most vulnerable populations in the state -- the mentally ill and the developmentally disabled.
That's where the human beings come in.
According to
But as budget cuts have reduced the rate at which providers like WMMHC are reimbursed for providing mental health case management by approximately two-thirds, it has become untenable for many of those providers to continue offering the service.
At WMMHC's
"It's been a pretty drastic change for the clients," Dunks says, "as well as the staff."
"Since HI (
While Hoar says those clients were then "assigned a state caseworker," the clients "didn't know them at all, and they didn't live in this town."
So, while the approximately 200 to 250 case management clients with developmental disabilities in the county were able to continue to receive assistance, Hoar says the disruption created confusion for the vulnerable population and depersonalized a process that works best when people build lasting relationships that can lead to long-term improvements in quality of life.
"They're getting case management, but it's a glorified paper-filler-outer," Hoar says.
In
Since late last year,
According to Buckley-Patton, "Elimination of those four offices really left a significant gap for individuals, particularly those with behavioral health."
While DPHHS has attempted to fill that gap by providing people access to a website and an 800 number where they can connect to services, Buckley-Patton says avenues are "not effective for everyone -- and for some folks who are most vulnerable in our community, it's particularly not effective for them."
Buckley-Patton says the abrupt loss of mental health and other public services in
"What we've found is people are coming dis-enrolled from their health coverage, from Medicare and Medicaid," Buckley-Patton says.
She says others failed to connect with primary care providers after the closure of WMMHC's
And as people lose longstanding providers, she says, they have increasingly started to seek care only when it reaches a crisis point by visiting emergency rooms to deal with mental health issues, "which is the most costly way to deliver health care" and which "isn't what an emergency room is for."
In addition to hospital emergency rooms, people with mental health issues are also increasingly finding their way into another setting that's not designed to house them: jails.
"Our jails end up being our mental health facility in
And this is a cycle that's also being felt in
According to a spokesperson for
"The police and the emergency room at the hospital will see increased calls for service because some people who are in acute crisis don't have access to other resources," Lester said via email.
And Dunks says there's another area facility -- along with hospitals and jails -- that has had to deal with ramifications of the cuts to mental health care in the state: the
While
According to a federal inspection released last year, "chronic, pervasive staff shortages" led to assaults on facility's staff and put the facility at risk of losing its federal certification. That has some observers concerned about what reduced localized case management services in
"The emergency system is already overloaded," says Seccomb of
Another place they end up, Seccomb says, is the homeless shelter
According to Seccomb, people are sometimes discharged from
While Seccomb says her group is working with the state hospital to give the shelter enough lead time to prepare to receive released patients, she says that she wishes there were a better option for providing people with care in the community.
"Shelters are not good environments for people who are trying to stabilize," Seccomb says. "It is not optimal to have people released into homelessness."
As the ramifications of last year's budget cuts take effect in southwest
"I believe that when you make these cuts at these levels to these programs that the net effect doesn't save money," says
It's a sentiment echoed by Lester: "Any purported cost savings are not really accurate because costs are simply being pushed to the local taxpayer or medical provider in the form of increased time and resources required to help people in crisis. If case management was still in place, most of these folks would probably never require our services and they would be in a much better situation."
But as the reverberations of the cuts to DPHHS funding spread throughout southwest
And people are working across agencies to lend a hand.
When WMMHC had to stop providing services to kids through the Butte
"My philosophy is, if we're helping the community and we're breaking (even), then we're doing good," says the community health center's CEO
While the community health center, which has clinics in both
"This community is an amazing community," Malone says. "If people can step up, they do."
Evidence of that can be also found in
While she acknowledges that "we can't replace what's gone," Buckley-Patton says citizens also can't wait for the Legislature -- or anyone else -- to swoop in and solve the challenges they are facing.
"I think
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