WARM SPRINGS —The Montana State Hospital, like the rest of the state and the VA Montana Health Care System, wrestles with a dire shortage of psychiatrists. It also struggles, like the rest of Montana, with the state’s out of control suicide rate, which is nearly twice the national average.
This is, after all, where the sickest of the sick travel to seek help.
Many of those who reside here have been admitted because they have attempted suicide or because they are exhibiting suicidal behavior. They have been referred by community health professionals, county attorneys and district and tribal judges. The cost is $500 to $600 per day, depending on the unit in which patients are housed.
The average daily census is 175, with an average stay of 70 days.
The Montana State Hospital, the state’s only public inpatient psychiatric hospital, is a microcosm of the state, where at least 452 people killed themselves during the two-year period that spanned 2010 and 2011.
In the past five years, there have been at least two suicides at the State Hospital. Details about the incidents are not available due to federal patient confidentiality laws.
The State Hospital does everything possible to decrease the likelihood of someone successfully committing suicide while in its care, said John W. Glueckert, administrator.
“However, the reality is that persons determined to end their lives can be successful despite our best efforts to care for them and keep them safe,” he said.
Patients have a right to privacy, yet there are risks associated with privacy for patients who have a history or penchant for self-harm, he said. For example, patients have a right to privacy to go to the restroom, although the hospital can limit the time a patient is alone.
Further, items such as sharp objects, shoe strings and items that can be used for suffocation are kept away from patients. Medications are also controlled.
Physicians order that patients at risk for self-harm be placed on one-to-one observation or receive 15-minute checks.
“These type of orders represent a heightened level of vigilance for patients at risk for self-harm,” Glueckert said. “This method is very successful at preventing suicide, but it’s also very invasive.”
Still, those with mental illness who are determined to kill themselves have found a way to succeed. Even some of those who have received treatment have gone on to kill themselves. In the past five years, at least three former patients killed themselves within 30 days of being discharged from the hospital.
To help address the issue, as well as others at the State Hospital, Glueckert recently recruited and hired more staff psychiatrists and attributes his success to a collegial working environment and improved pay. In July 2012, the average base pay for State Hospital psychiatrists increased from $177,000 to $204,436.
The hospital now employs 6.5 full-time psychiatrists and two temporary, full-time psychiatrists. His goal is nine full-time permanent psychiatrists, so recruitment efforts continue.
The state bumped up the pay after Glueckert and his medical director spent more than two years recruiting additional psychiatrists to fill vacant positions. During that time, it became clear that the hospital’s compensation package was not competitive enough to either retain existing psychiatrists or attract qualified candidates.
In addition to the psychiatrists, the hospital also employs three advanced psychiatric nurses and is recruiting a fourth.
“Recruiting will continue to be a challenge going forward as we try to bring physicians to a remote location to practice,” Glueckert said. “If they are big on collegiality and freedom to practice, we are in a good position.”