Gazette opinion: Reform must start with support for community care

2014-03-10T00:00:00Z Gazette opinion: Reform must start with support for community care The Billings Gazette
March 10, 2014 12:00 am

The state may be able to more effectively serve individuals who have similar treatment needs if it reviews and reconfigures its system of public institutions.

So says House Joint Resolution 16, which requested a study now under way by the Children, Families, Health and Human Services Interim Committee. The assignment is to study state-run health care and correctional facilities to determine if changes to the system could:

- Provide more effective treatment of mental illness, addictions and other disabilities

- Serve individuals in a more cost-effective manner.

The committee will continue its HJR16 work Friday morning in Helena by focusing on services outside these institutions. Community treatment is an essential part of the behavioral health care system. If appropriate services were available when needed in the community, fewer people would institutionalized for mental health treatment. Effective chemical dependency treatment lessens the risk that addicts will get in trouble with the law and wind up in prison.

Earlier intervention

Early intervention with appropriate, high-quality care delivered in the community is a significant deterrent to crime and recidivism. However in Montana, many ill people don’t get care until they are so sick their cases are emergencies and they need to be hospitalized.

“We believe having sustainable community crisis services can impact Montana State Hospital transports and evaluations,” said Kristianne Wilson, executive director of health policy at Billings Clinic. The clinic, St.Vincent Healthcare, the Mental Health Center and RiverStone Health are partners in the Community Crisis Center, which has served people from 44 Montana counties. In recent months, demand for crisis services has increased sharply from around 700 visits per month to more than 900.

Care closer to home

In fiscal 2013, Yellowstone County sent zero emergency detention patients to Montana State Hospital at Warm Springs.

That begs the question: How many of the 218 detentions at Warms Springs last year could have been avoided with sufficient access to high-quality community crisis services statewide?

“In Yellowstone County, emergency detention need is taken care of at the Community Crisis Center and Billings Clinic,” said Lyle Seavy, director of Billings Clinic Psychiatric Center. Thus, sheriff’s officers aren’t required to make those day-long trips to Warm Springs, and ill individuals aren’t removed from their community to get crisis care.

“When Warm Springs is at maximum capacity, people often are discharged back home with no services,” Wilson pointed out.

The vast majority of Montanans needing mental health care have committed no crime. However, there is an important connection between how well we care for these folks and what the state must provide for criminal offenders who are mentally ill.

Hospital-prison link

Thirteen miles from Montana State Hospital, which often is filled with 200 patients, and even larger number of seriously mentally ill people are housed at Montana State Prison.

The prison needs to improve its treatment of mentally ill inmates. The busy state hospital does not meet the community treatment needs of its patients.

Some Montana mental health advocates have again suggested regionalizing the state’s psychiatric inpatient services. If civilly committed patients were treated in their home communities, the facilities at Warm Springs could be used to treat mentally ill inmates.

Such a transformation would have to be done carefully and gradually. The state would have to make up-front investments. Local health care providers would need to be integrally involved.

Reform should start with investing in what works in our communities. Let’s assure successful community providers that they will see stable, ongoing state funding if they deliver and document effective services.

We urge Children and Families Committee members to commit to making significant recommendations to the 2015 Legislature. We call on these lawmakers to be champions of better treatment -- inside and outside institutions -- when the Legislature convenes.

Too many Montanans struggle with untreated chemical dependencies and mental illnesses. We see them coming into the system repeatedly without ever getting the ongoing treatment that could help them live healthier, more productive lives outside of institutions.

Copyright 2015 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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