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Next month, the Bullock administration will shuffle money in the state budget to cover “unexpected” expenses in certain health department programs, including Montana State Hospital at Warm Springs.

The supplemental appropriation for the only state-operated psychiatric hospital in Montana is expected to be $1.58 million for the current fiscal year, according to information released this week by state budget director Dan Villa. The hospital spent more than budgeted for temporary psychiatrists and nurses, according to Villa.

Meanwhile, community-based mental health services in Montana will continue to struggle with cuts in reimbursement rates from their biggest customer: Montana Medicaid. There is no supplemental cash request for the regional mental health centers that serve thousands of seriously mentally ill, low-income Montanans, keeping them healthy in every county of this state. There will be no relief from the 2.99 percent rate cut imposed on Jan. 1. Many community providers are now required to do the extra work of having their services pre-approved by an out-of-state company that the state is paying for utilization review in an effort to reduce state costs.

Medicaid reimbursements for outpatient psychiatric visits don’t even cover the cost of employing the doctors, according to Barbara Mettler, executive director of the 10-county Mental Health Center headquartered in Billings.

With the state cutting payments last year, the Mental Health Center eliminated 20 case manager positions. Those bachelor’s degree professionals helped seriously mentally ill people navigate the system upon their discharge from Warm Springs. Now there are no such navigators for most MSH patients who return to Billings needing housing, health care and other basic services.

“They’re basically discharging people to the streets,” Carl Eby, of the Billings Mental Health Center told The Gazette. “It’s a systemic problem. It’s everybody’s problem.”

Let’s consider why MSH has to keep hiring more temporary help. The state hospital is a holdover from the era when people with mental illnesses were “put away.” It became Montana’s sole public mental hospital in 1912 when there was much less understanding of these brain illnesses and few effective treatments. In recent decades, mental health care has made great strides. Recovery is possible for most people.

There is a national shortage of mental health care professionals. With a job market like this, few psychiatrists and other mental health professionals choose to work at a state institution in a remote location where the entire village is the hospital complex.

The MSH staff does good work, but they are working in a hopelessly outdated treatment model that separates patients from family, friends, community treatment and support.

The MSH staff also must care for patients who would be better served in a nursing home. The hospital’s caseload includes elderly people with Alzheimer’s disease and other dementias whose behavior made them unsafe (or at least unwelcome) at nursing homes. If they cannot be served in their own community, these elderly dementia patients should receive care at the Montana Mental Health Nursing Care Center in Lewistown. That institution is full, so they are at Warm Springs.

The state should provide more appropriate placements for these dementia patients. Perhaps, the capacity of the Lewistown institution should be expanded. But first, the state ought to talk with community nursing homes about accommodating more high-need dementia patients in their hometowns. These folks are more expensive to care for than average nursing home residents, but it can’t be cheaper for taxpayers to keep these elderly people in the Warm Springs hospital.

The average daily number of patients at MSH has trended slightly down over the past year with the daily patient count averaging 223 for April compared to 227 for the same month of 2017. Yet expenses are up.

For the past year, Montana’s mental health system has been rapidly going backwards. More money is treating fewer people in the highest-cost state institution while many other Montanans are denied care or are waiting longer in their hometowns.

In 2017, the legislature’s budget overstated expected revenues and built in automatic cuts to health services with no meaningful public participation in the decisions. The November 2017 special session was a partisan blame game that resulted in cuts to health and human services for the most vulnerable Montanans. Montana must do better for the sake of our health and our state economy.

This state needs a sustainable source of revenue dedicated to adequate funding of community mental health services, including addiction treatment. Montana must have a viable health care budget that is based on provider and other public input, debated publicly and hammered out in the 2019 regular Legislature.

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