Emergency department visits for adults and children in psychiatric crisis have steadily increased across the U.S., reaching levels that some have called unsustainable. According to the federal Agency for Healthcare Research and Quality, visits for psychiatric emergencies have increased more than 50% since 2013.
Nationally, 1 in 8 visits to an emergency department is related to mental health or substance abuse. On an average day in Montana, eight to 11 patients seek mental health services at the Billings Clinic Emergency Department. The highest single-day count in recent memory was 24.
Overall, Billings Clinic has experienced a 20% increase in youth and adults seeking mental health care since 2018.
Once in the emergency department at Billings Clinic, patients in crisis receive two separate evaluations. First, they get a medical evaluation to determine if a physical illness or injury may be causing or exacerbating the psychiatric problem. Once the evaluation is completed, patients undergo individualized psychiatric assessment, which is performed by a mental health professional. Because two unique assessments are required, length of stay in the emergency department can be more than twice as long for patients with mental health issues compared to patients with medical conditions only.
Billings Clinic: The region’s premier resource
Billings Clinic opened the region’s first inpatient psychiatric center in 1987 and moved into the current psychiatry center the following year, increasing capacity to 44 beds. In 2003, the Billings Clinic Psychiatry Center added a 24-patient “partial hospitalization” program for youth requiring intensive outpatient treatment. A Bridge Clinic was established in 2010 to support patient success when “bridging” from inpatient care back to the community. In the past year, 2,023 individuals received inpatient psychiatric care at Billings Clinic.
The Billings Clinic Behavioral Health Center provides outpatient access to psychiatrists, therapists and specialists in addiction, substance use and other areas. In the past year alone, the center completed 22,017 outpatient appointments. This includes opening behavioral health services at Billings Clinic Bozeman to help serve the growing need in Gallatin County. In total, Billings Clinic now employs over 200 physicians, nurses and other staff in mental and behavioral health services.
Leader in innovation
Finding better ways to meet the unique mental and behavioral health care needs of the region has led Billings Clinic to innovate, resulting in well-deserved regional and national recognition.
Some of the most highly acclaimed initiatives include:
- Montana Psychiatry Residency Program trains psychiatrists at Billings Clinic and in the region, while helping to meet the ongoing workforce shortage and improve access.
- Research includes triple chronotherapy for rapid treatment of depression in youth and adolescents and previous evaluation of equine therapy for treatment of PTSD, anxiety and depression.
- Care Redesign, including the Psychiatric Stabilization Unit and embedded mental health resources in the emergency department to reduce treatment delay for patients experiencing a psychiatric emergency.
- Integrated Behavioral Health, placing resources into primary care settings to improve access to care for patients and Project ECHO to support care providers in rural locations.
The road ahead
There are many challenges in providing mental health care: a growing shortage of trained mental health professionals, more people than ever seeking care and limited community resources. But the need for these services is profound. Providing access to mental health care is important in every community. Billings Clinic is committed to being both a leader in care and a part of the solution to this growing crisis.
To address the increasing need for mental health care, Billings Clinic has stepped up to provide acute inpatient mental health services. As a result, in the past year Billings Clinic received patient transfers and direct admissions from nearly every county in Montana and more than half of the counties in Wyoming, plus Idaho, North Dakota and South Dakota.
There is an urgent regional need for more and better access to mental health resources, a need that currently Billings Clinic is striving to meet. The community looks forward to the day when new yard signs and banners in the medical corridor point the way to expanded mental and behavioral health services, because then all will know progress is being made for residents of this region.
If you or someone you know is in crisis and needs help, call the Montana Suicide Prevention and Mental Health Crisis Lifeline at 988 or by texting “MT” to 741741 for free 24/7 help. If it is an emergency, call 911 immediately.
