Four years ago, while at a workshop on childhood trauma in Arizona, Jill Riley suffered a mental collapse.
Riley, 46, of Billings, was dealing with major stress in her life, and undiagnosed mental illness related to childhood abuse. The episode led to a 2-1/2 month stay at The Meadows, an intensive inpatient trauma and addiction center near Phoenix, and diagnoses of complex PTSD, dissociative disorder, anxiety and persistent depression.
When she returned to Billings, it took her four months to get an appointment to continue her treatment.
“Here I had been long-term in a hospital and I couldn’t get into a psychiatrist,” Riley said. “I didn’t have access to the meds that could balance everything out.”
Eventually she connected with Dr. Rick Pullen, a psychiatrist with Billings Clinic, and saw him for about a year until he retired. But until they met, she spent most of her time holed up at home “knitting and coloring,” unable to manage stepping out her front door.
That gap in care highlights the reason Billings Clinic created Montana’s first psychiatry residency program in 2018, a regional track of the University of Washington Psychiatry Residency Training Program. The first class of three residents began their studies in July.
To help support the residency program, money raised through this year’s Billings Clinic Classic will go toward a sustainable fund to help keep it going. The classic will take place Saturday night in downtown Billings.
A residency program, though expensive to maintain, is crucial for boosting the number of psychiatrists in the state, said Dr. Julie Kelso, psychiatrist and director of the residency program.
“Because residents tend to stay in the state after training, it’s incredibly hard to recruit psychiatrists to a state without a residency program,” Kelso said.
Other medical residency programs in Montana have seen an estimated 70% retention rate, she said. To duplicate that success, the psychiatry residency program has sought candidates who either have ties to this area or an interest in rural psychiatry.
The psychiatric residents will spend their first two years in Seattle and the final two, practicing at Billings Clinic. Over time, the program will have 12 residents, three in each year of study, in Seattle and Billings.
Until Billings Clinic established the residency, Montana was one of only three states without the program, along with Wyoming and Alaska. The trio of states have some of the highest suicide rates in the United States.
Kelso acknowledges that there is not nearly the number of psychiatrists needed in the state to meet all the needs of the population. The eastern part of Montana is home to only one psychiatrist.
Boosting the number of psychiatric specialists is just one part of a strategy to provide the needed care, she said. Employing technology is another, including using telepsychiatry to reach patients in outlying areas.
Another alternative has to do with integrated behavioral health.
“You have mental health services in a primary care setting and then the psychiatrist acts as a consultant to the provider,” she said. “So you can have more people access psychiatric expertise.”
With primary providers prescribing 70% of antidepressants, “those are the providers who need support,” Kelso said.
Billings Clinic also launched Project ECHO (Extension for Community Healthcare Outcomes) to do video-based tele-mentoring with sites across the region. A team of mental health experts at Billings Clinic meets weekly with practitioners to teach on a topic, and allow participants to share cases.
Leveraging a psychiatrist’s time like that frees up more of their time “to focus on patients with more severe mental illness who need to be in a psychiatrist’s office,” she said.
That doesn’t mean that patients with needs like Riley’s don’t have to wait for an appointment. But the hope is the residency program and the other alternatives will eventually make that less likely.
Riley welcomes that news. She is now under the care of a psychiatrist not affiliated with Billings Clinic, but she still remembers what it was like for those initial months after her return to Billings.
“I was totally incapable of caring for my family,” she said. “I was kind of agoraphobic for almost six months, plus the anxiety disorder, (meant) I couldn’t go out without major issues.”
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Riley, married to husband Kyle for 26 years, has four children ranging in age from 18 to 23. These days she works from home, writing a blog and producing a podcast as part of her advocacy for mental health awareness.
With so much stigma still surrounding mental illness, Riley wants to get across the message that everyone deals with mental health crises.
“Whether it be grief, loss, change dynamics like moving, everybody has some kind of mental health episode in their lives,” she said. “We have to get past this idea we can’t talk about it.”
Getting to this point has been a journey for Riley. As a child in northern Idaho, she suffered physical and sexual and emotional abuse, as well as neglect, at the hands of her adoptive parents.
The couple divorced when Riley was young and she moved with her mother and siblings to northern Idaho, where she grew up.
“My mother was cruel and highly abusive,” Riley said. “So that was really the foundation for a lot of trauma in my life.”
After college, she married, and the couple had four children. When the couple moved to Billings, Riley also served as a pastor and ran a consulting business to help nonprofits. Eventually she transitioned to for-profit consulting, including strategic planning, and opened Navigate Church.
She’d get defensive when people told her she was working too hard. But now Riley admits being a workaholic was her “drug of choice” to avoid dealing with the issues she had bottled up for so long.
Ministering to so many disadvantaged, disenfranchised people in her downtown church and dealing with the stresses of raising four teens with an airline pilot husband who often had to travel added to her load. That same year, she lost her sister to addiction.
Riley battled with insomnia. And she started to lose hours in a day, not knowing what she was doing or where she was going.
Leaders in her denomination recognized Riley needed support and sent her to a workshop on childhood trauma at the Meadows to help her better understand what she was dealing with. There, she had a dissociative episode, where she reverted to her childhood self, much as a soldier with PTSD would experience being back in the trenches.
That led to her time at the hospital where, most importantly, she was given an accurate diagnosis.
“That was in a way completely clarifying and reassuring,” Riley said. “In another way it was terrifying because there’s such a stigma around mental illness.”
She recognized that as someone who has spent her life professionally communicating, she had the skills to help others understand that mental health is an issue that everyone deals with, one way or another.
“I have a diagnosable severe chronic mental illness,” she said. “But everybody has mental health that needs to be nurtured. It’s an ‘us’ conversation, not a ‘them’ conversation.”
She also focuses much of her time on self-care, making sure she’s taking medications, getting enough sleep and exercise, visiting her psychiatrist and seeing a trauma therapist twice a week.
Riley knows she’s lucky to have insurance that gives her access to the care she needs. But even with those resources, a shortage of psychiatrists four years ago made it difficult for her to continue on her road to recovery.
Kelso hopes the new residency will be one tool to help others like Riley in the future.
“Billings Clinic has a huge commitment to mental health,” she said “It’s something a lot of people are passionate about.”