Legislation one step in repairing a broken system

One of the major accomplishments of the 2023 Legislature came through the passage of House Bill 872.

Rep. Bob Keenan of Bigfork, Rep. Courtenay Sprunger of Kalispell and Llew Jones of Conrad introduced the bill that offers a $300 million surge to help revamp the state’s mental and behavioral health system that was left on life support following budget cuts in 2017.

Those cuts quickly led to diminished services across the state, and were acutely felt in Northwest Montana following the closure of Glacier House, a 24-hour crisis receiving center in Kalispell formerly operated by Western Montana Mental Health Clinic.

Crisis centers like Glacier House provide a “community-based, home-like facility” where treatment is provided to help stabilize individuals and avoid inpatient psychiatric hospitalization, according to a 2022 state report on Montana’s crisis system.

That same report highlighted the funding gap that often prevents programs like Glacier House from sustainable operations.

“The funding challenges arise from the fact that crisis providers largely rely on reimbursed (primarily Medicaid) income based on utilization,” the report stated. “However, providers must staff for full coverage regardless of daily utilization; yet if the number of people served each day is inconsistent (which may be the case, especially in less densely populated regions), funding from reimbursement income is insufficient to cover 24/7/365 operating expenses.”

That’s where legislation like HB 872 is poised to have an immediate impact. 

One funding initiative in the bill that’s already approved by Gov. Greg Gianforte provides about $17.5 million in grants to counties to increase residential bed capacity at a facility like Glacier House. 

It’s encouraging to learn from Keenan that Flathead County commissioners plan to apply for the grant to do just that. Not having a crisis center puts undue pressure on other public services like hospital emergency rooms, law enforcement officers and oftentimes detention centers that aren’t appropriately equipped to handle people experiencing a mental or behavioral health crisis. Reopening a local crisis center would be an important patch in repairing the system.

Funding from HB 872 could also be used to bolster Montana’s mobile crisis response programs. These teams assist first responders by helping to intervene and de-escalate a crisis situation. 

Flathead County Co-Responder Crisis Therapist Sarah Winfrey notes that such programs can’t be sustained by Medicaid reimbursements alone, which are based on how many crisis calls are received.

“Some weeks I’ll go on just four calls, some weeks it’s 15 calls. It’s truly another emergency responder branch that needs constant financial support and can’t be supported by the call volume alone. Just imagine the fire department or police department being only funded by their call volumes,” Winfrey points out. 

Supplemental funding is necessary to keep these programs going.

Rep. Dave Fern in Whitefish is optimistic that HB 872 will put Montana on the right trajectory, but reiterates that long-term funding solutions are the ultimate goal. For Fern, this includes re-evaluating Medicaid reimbursement and Medicaid expansion.

“In order to have a partnership with our third-party providers, I think there has to be a degree of confidence from them that if they set up shop here, there’ll be a reimbursement, at least a realistic and livable reimbursement,” Fern said.

And as Keenan points out, while the Legislature shouldn’t be expected to fix all that ails the broken system, “we can begin the process.”

It appears that HB 872 can be the fulcrum that finally turns the tide on the fallout from the 2017 budget cuts that left Montana’s mental and behavioral system in tatters — but it can’t be misconstrued as a long-term remedy. 

That difficult work has only just begun.