As the Community Crisis Center marks a decade this week, program director MarCee Neary recalls a particularly difficult man who used the nonprofit's services.

It's not that the man was difficult to work with that's memorable — the center serves people in crisis and acts as an assessment and referral resource for mental health, chemical dependency and social services, and tough-to-work-with clients come frequently with that territory — but rather something he said.

The center likes its clients to fill out comment cards about their experience and provide details on what services are missing or what else they'd like to see, but the man never did so at any of his visits.

So Neary asked him about it.

"He looked at me and he said, 'Do you think would continue to come here if it wasn't helping,'" she said. "I think that's a sign that people feel comfortable coming here. Some of these folks aren't welcome everywhere else."

On Wednesday, the crisis center will celebrate 10 years since a group that included St. Vincent Healthcare, Billings Clinic, RiverStone Health and the Mental Health Center recognized a need in the community for access to mental health and chemical dependency services for people in crisis and formed the Community Crisis Center as a response.

It's a decision that, in hindsight, health care officials in the community say has had a significant and positive impact and provided much-needed aid in getting people set up with the proper resources.

"Not only is it a place that meets people's basic needs, but there also has been some success in achieving that longer term success," said Dr. Michael Bush, St. Vincent's chief medical officer and chairman of the crisis center's board of directors. "It's a need that was recognized by the entire community, and the entire community came together to help fill the need."

Chief among those benefits, Neary said, are that it has helped develop relationships between multiple service providers and community partners and diverted people from either jail, a hospital emergency room or the Montana State Hospital in Warm Springs and into mental health, chemical dependency or social services in the community that best help with their issues, especially when they're not sure where else to go.

That might involve getting a person into a program at Rimrock treatment center, getting them connected with a doctor to help with medication problems or referring them to proper counseling services.

"We don't just do assessment and referral any more," Neary said. "It's a comprehensive, continuous integrated system of care for persons with mental health and substance abuse challenges."

The center is a collaborative effort between a number of health care entities and includes 18 stabilization beds, all of which are full most nights, and has 30 total employees that include nurses, counselors, mental health workers and administrative staff. Last year, it received state funding to hire a full-time case manager.

"Without the amazing staff and employees and guards we have, we would have nothing," Neary said. "We have the most wonderful core staff."

John Felton is president and CEO of RiverStone Health and is one of the original team members who formed the Community Crisis Center. He said that understanding the center's origin is important in its place in the community.

The group was tasked with finding a way to address mental health treatment concerns in the community while reducing pressure on emergency departments from visits dealing strictly with mental health and substance abuse issues.

That in part led to what he calls "the no wrong door" concept.

"No matter who walks in the door, they get attention," Felton said. "And if it isn't the right place, let's find the right place for them. It's a program that from day one has been about collaboration. All of us sort of pitch in a little bit."

The center sees an average of 853 visits each month, about a quarter of which are from people who haven't been there before, meaning most of the crisis center's clients visit multiple times.

About 68 percent of the people it sees have co-occurring disorders.

Dr. Nicholas Wolter, CEO of Billings Clinic, noted that it's not just Billings that it serves, either. He said that it has seen people from about 80 percent of Montana's 56 counties.

"I'm very proud of what they're doing," he said. "I think it's serving a really important population and that's the key thing, with mental health support being fairly thin across our state. Services like this mean a great deal."

It also works closely with the county jail and local law enforcement, since there's is significant overlap in the people each organization sees. It has worked with jail staff in assessment and referral in the past, officers and deputies sometimes bring people straight to the center and it organizes crisis intervention training for emergency responders to teach them to better respond to and work with people in crisis.

In addition to the collaborative effort from the health centers and mental health and treatment organizations, it's also garnered widespread support in the form of funding, both from a local mill levy approved by residents and in money approved by the Montana Legislature.

Looking ahead, the center is working on ways to expand its services to meet ever-growing demands and increasing client loads.

"The long-term programs to help folks with substance abuse or mental health are woefully limited," Bush said. "The next step is for us to see if we have the opportunity to help further strengthen our programs to help the people we serve."

Neary said that while the center provides aid on a short-term basis, it actually works on three-to-five-year plans with people to help address their needs and communicates regularly with other entities throughout the process.

"It's kind of that whole 'it takes a village' approach," she said. "It's all about the person. It's not about who's helping them, because all of us do it."

Felton said that is has provided "a new place with a new service in addition to what we already had" that wasn't previously available.

He expects to continue to grow and take on more and more prominence for its role in the local health care system.

"It’s woven into the fabric of the health care system, of the law enforcement system, of the emergency response system," he said. "The real lesson in the crisis center has been that sometimes you just need to step out and do something. You know these are big issues, you know they’re difficult problems to solve. Sometimes you just have to take that first step."

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