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Flathead County faces dearth of mental health care options

by ADRIAN KNOWLER
Daily Inter Lake | April 16, 2023 12:00 AM

Mental health care options in Flathead County remain scarce, with clinics and emergency facilities closing and new patients turned away or placed on months-long waitlists.

The burden is falling on already strained emergency responders who often lack the mental health training required to navigate tense situations and vulnerable patients.

In the absence of fully-staffed inpatient facilities, people in the midst of mental health crises are finding themselves picked up by law enforcement and held in jail or the emergency department.

Health care administrators and elected officials point to reductions in state funding as the culprit, with slashed reimbursement rates undercutting sustainable service delivery.

As the crisis continues, social workers and behavioral health experts are urging local governments to do more to close the widening cracks.

Elected officials say they understand the needs, but believe that funding mental health programs is the state’s responsibility and have spoken in opposition to dedicating local funds to the issue.

FOR FLATHEAD VALLEY residents going through a mental health crisis, there is often nowhere to go.

After the crisis stabilization center Glacier House closed almost a year and a half ago, the options for people going through such crises — especially those who are homeless or without private health insurance — have mostly disappeared.

Crisis stabilization units are designed to stabilize individuals experiencing a mental health or substance use disorder crisis – often within 72 hours – and refer that individual to longer-term care.

Glacier House had been operated by Western Montana Mental Health Center through an agreement with Flathead County and funded by alcohol tax revenue. It had five beds and the legally required security measures to take on these difficult tasks.

A stressful workplace and insufficient pay weighed down by low Medicaid reimbursement rates meant Western Montana Mental Health could not hire or retain enough staff to keep the crisis center open, according to CEO Levi Anderson.

Anderson said that unfilled positions at Glacier House only got “entry level” compensation due to the reimbursement rates, although the high stress of working with clients in the midst of mental health crises led to burnout and turnover.

“It’s a stressful job. It’s deserving of a higher wage,” Anderson said. “If we could get a higher rate and do higher compensation, it would help with hiring.”

Anderson said the mental health organization had attempted to reopen the center for over a year, but has since given up hope that they would be able to find the required staff.

The alcohol tax money that had been going to Glacier House from the county has since been allocated to Oxytocin, said County Commissioner Randy Brodehl.

Oxytocin is a for-profit rehab center that has been questioned about using the tax funds to pay Medicaid beneficiaries to receive treatment and meet sobriety benchmarks, according to KFF Health News, formerly Kaiser Health News.

The clinic is also under investigation by the Montana Department of Justice, said Department of Justice spokesperson Cantrell.

In the article, Oxytocin’s clinical director Pamela Liccardi denied wrongdoing.

Oxytocin’s facility does not meet the security standards as required by law to operate as a crisis receiving or stabilization facility.

For patients seeking longer term care, options are also limited.

Sunburst Mental Health, a clinic that had served up to 200 patients, shuttered its doors in February following allegations of Medicaid fraud and an investigation by the Montana Department of Justice.

The Sunburst board of directors found evidence that an employee had filed fraudulent Medicaid reimbursement claims and was subsequently fired, according to board President Mark Anderlik.

Anderlik said the board turned over evidence to the state Department of Justice. Department spokesperson Emilee Cantrell confirmed an ongoing investigation but declined to share details.

Anderlik also blamed low Medicaid reimbursement rates for putting the clinic in a difficult financial situation.

Although the employee denied wrongdoing to the board, Anderlik said that the alleged billing fraud was probably an attempt to boost Medicaid reimbursement and keep the clinic afloat.

“The best explanation that we can come up with is that they did this for the benefit of the clinic,” he said.

For former Sunburst patients and other residents seeking ongoing mental health treatment such as therapy or psychiatric prescriptions, the shortage of clinics and long waitlists present obstacles to getting the care they need.

In the wake of Sunburst’s closing, Greater Valley Health, one of the area’s health care providers, has had to turn away new psychiatry patients after the requests for care were met with monthslong backlogs, according to spokesperson Catherine Todd.

Greater Valley offers counseling and substance abuse disorder treatment as part of its comprehensive health care services, but was not able handle the influx of Sunburst patients by itself.

In 2022, Greater Valley provided care for 1,000 individuals seeking mental health services and 158 for substance use disorder treatment, according to Todd.

Logan Health hospital network’s 40-bed inpatient behavioral health center, formerly known as Pathways, has also had to turn away potential patients, according to Sean O’Neill, chairperson of Collaborative Housing Solutions of Northwest Montana and a former Sunburst social worker.

Logan Health did not reply to questions about waitlists or denials for new patients.

In an email, Logan Health spokesperson Chris Leopold said that the hospital network saw patients for about 15,000 mental health visits between Pathways and their two outpatient centers in 2019.

Many Rivers Whole Health is offering to take on new patients, according to operations manager Dawn Rustad-Link. Rustad-Link estimated that the health group, which merged with Gateway Community Services in July 2022, has seen about 300 patients, though she didn’t say how many of those were new.

FOR PEOPLE whose mental illness may prevent them from being able to take care of themselves or may pose a threat to themselves or others, state law and a shortage of local, qualified mental health professionals can make involuntary commitments and mental health evaluations at the Montana State Hospital at Warm Springs difficult.

As director of the Flathead Warming Center, a low-barrier homeless shelter, Tonya Horn has seen firsthand how those with serious mental illness can fall through the cracks. Horn has shared stories of people whose illnesses have left them prone to disregarding their physical and mental health. She described cases of frostbite so bad as to require amputation, as well as erratic and sometimes violent behavior against shelter staff.

Horn has said she has called police, but they often cannot do anything in situations that don’t rise to a threat to public safety.

The county attorney’s office filed petitions for 20 individuals to be committed to an inpatient center or the state hospital in 2022, according to County Attorney Travis Ahner.

If someone “is in imminent danger of death or bodily harm from the activity of a person who appears to be suffering from a mental disorder and appears to require commitment,” they may be detained on an emergency basis, though it typically can only be for 24 hours before requiring further evaluation by Montana state law.

Longer-term commitments require two separate mental health evaluations, as well as petitions by the county attorney and a judge’s approval.

Ahner says the lack of qualified professionals, combined with the state’s vast geography and strict procedural requirements can make getting a judge’s approval difficult. State law requires a second opinion after the petition has been filed, and courtroom testimony must be delivered in-person.

“It's been harder and harder over the last couple of years to find mental health professionals to perform the second evaluation,” Ahner said. “Sometimes a second evaluation gets done in Warm Springs, but the provider can’t travel to Kalispell.”

In certain cases, the lengthy delays have created situations in which criminal charges get dropped for a lack of timely due process, only for the accused to go back onto Kalispell streets and be arrested for new violations.

The multiple criminal cases of Kalispell’s Ilya Khmelev have brought these issues to the forefront, with one case going all the way to the Montana Supreme Court.

In one case, Khmelev, 26, was originally detained at the Flathead County Detention Center on Feb. 5, 2021, for violation of a protection order. The Justice Court ordered the state hospital to evaluate Khmelev's fitness to proceed. Khmelev had been previously diagnosed with schizophrenia, according to court documents.

The hospital did not admit or evaluate Khmelev, and the Flathead Justice Court dismissed the charges on June 25, 2021, because of the delay. Khmelev was rearrested three days later on June 28, 2021, for criminal trespass to property, according to court documents.

He was arrested again in January for an alleged assault and is in jail awaiting trial.

Ahner said waits of two or three months for mental health evaluations are common, and he’d like to see local facilities open up to take reliance off of the distant state hospital.

The Montana State Hospital, colloquially referred to as Warm Springs, has had plenty of issues of its own.

The hospital has been at the center of controversy over several years, with documented budgeting issues and patient safety scandals leading to the facility being decertified and losing federal Medicaid funding last year.

Last month, the hospital’s interim head was placed on administrative leave. The previous administrator was transferred after high staff turnover rates and allegations of mismanagement went public in 2021.

In his filing to the Montana State Supreme court in 2021, Ahner addressed the need for larger local facilities that can treat and evaluate people in Khmelev’s situation, saying that the county is in the midst of a mental health crisis.

“Sadly, [Khmelev’s] situation is not unique within the criminal justice system,” Ahner wrote. “The backlog of other individuals who are in the same position as Khmelev demonstrates that others who suffer from mental health issues remain in detention awaiting the same treatment. This situation suggests that more resources are necessary to address this issue.”

THROUGH A STATE GRANT, the county set up a co-responder crisis diversion program in 2019, which pairs a mental health professional with law enforcement on certain calls. Currently administered by Greater Valley Health, the program is designed to bring qualified mental health professionals directly to people in the midst of a mental health crisis. Their mission is to de-escalate tense situations and link people with resources for ongoing treatment.

Kalispell Police Chief Doug Overman praised the program, and said that the majority of his department’s officers now receive conflict intervention training. Overman said he’s seen ad hoc mental health interventions become an increasing portion of police responsibility over his two decades in law enforcement.

“The biggest surprise is how much mental health care falls on law enforcement,” Overman said in an interview. “We’re getting better, but the need is higher.”

Overman hopes to see the co-responder initiative extended and expanded to reduce the burden on law enforcement.

Although the grant provides funding for three full-time positions, the program has never been fully staffed, with the health care organizations charged with administering the program struggling to fill the roles.

Currently, there is only one employee, which Overman said leaves officers without the help several days per week when the co-responder is not on duty.

The program is funded through June, but county Health Officer Jennifer Rankosky said that with funding options still being negotiated, its future is uncertain.

For his part, Overman said he’s confident the program will be extended.

THE LACK OF crisis receiving and stabilization facilities in the county leads to a higher burden on law enforcement and hospital resources, according to Jerramy Dear-Ruel, Mental Health Coordinator for the City-County Health Department. Dear-Ruel is the only county employee dedicated to mental health issues.

“It means an increase of individuals, our jail is full, the emergency department gets inundated,” Dear-Ruel said. “If people aren’t receiving the necessary treatments they need it has many impacts on the community.”

Overman agrees. “Lack of a crisis stabilization center becomes one of my frustrations,” he said.

“As law enforcement, our options are to move them along to the next place, to place them into custody if they’ve done something illegal, or take them to the hospital.”

Sean O’Neill of Collaborative Housing Solutions said that mental health case management is often falling on housing navigators like those employed by the nonprofit Community Action Partnership, although they are not necessarily social workers.

He said he’d like to see a detox center that would allow for up to a month of detoxing before inpatient rehab, more nonprofit inpatient rehab centers, and a day center to provide services and a regular place to connect with social service providers.

He also called for a further expansion of the state’s Severe Disabling Mental Illness Waiver program, which allows for people with disabling mental illness to receive ongoing care. The program is expanding from 357 to 750 slots statewide by 2025. O’Neill thinks that’s just scratching the surface.

“We have that many people just in the valley that could qualify,” he said.

O’Neill wants to see local and county governments step up to help bridge the gap, with resources from the state level uncertain.

He said it’s important to extend and expand the crisis response program, and wants to see local publicly funded mental health services like those offered in Missoula.

The county currently doesn’t offer mental health services, according to Rankosky, and only has one employee dedicated to mental health issues, in an administrative capacity.

Kyle Waterman, who is on the Western Montana Mental Health board of directors, also says the county should do better to catch up with the growing need.

“This county has been under-investing in mental health services,” Waterman said. “Historically Missoula was the commerce center, now Kalispell is. We need to do the same thing with our social services.”

Waterman said that the county commissioners are focused on the taxpayer and property owners, but that at a minimum, a large, one-time investment is required to beef up local resources.

“The county needs to have some skin in the game,” he said.

For Waterman, taking care of residents’ mental health is a moral imperative, as well as a way to keep locals productive and contributing to the economy.

“There’s the right thing fiscally to do and there’s the right thing morally,” Waterman said. “We are stronger as a community when we can keep locals in the community and make sure that they are productive,” he said. “They’re Montanans and they deserve and require these services to be healthy.”

Flathead County Commissioner Randy Brodehl sees the need for a crisis stabilization center and inpatient center in the wake of the Glacier House closure, but doesn’t think it should come out of the county budget.

Brodehl said the county is looking for such a facility in the hopes of getting one open, and said they have found land that would be appropriate.

“It’s a state responsibility — mental health and behavioral health is a state responsibility,” he said. “We have a lot of private pay and nonprofits that provide drug treatment services, so that is already established.”

Brodehl said newly collected cannabis tax funds could be used for mental health treatment, but the commissioners think it should be used elsewhere.

“The need is there,” Brodehl acknowledged but said appropriating the new funds, which will likely total several hundred thousand dollars based on last year’s sales, wasn't a priority.

“All mental health care is defined by law as the state’s responsibility. We are not going to initiate county taxes on top of what the state is required to fund,” Brodehl said.

“We could fund our own process in parallel to the state. I don’t see us saying [cannabis tax money is] going to be spent on behavioral health. The state is already creating that, and why would we want to create something that they’re already creating?”

He said he’s had conversations with state legislators and Gov. Greg Gianforte’s office, and said that he wants to see a state-funded inpatient facility in Flathead County that could offer both crisis and long-term services. He also said he's spoken with the local legislative contingent, and described the conversations as positive.

Brodehl said he hoped to see such a facility open in three years’ time.

“We’re paying for it one way or the other,” Waterman said. “We’re paying for the consequences.”

Reporter Adrian Knowler can be reached at 758-4407 or aknowler@dailyinterlake.com

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