The study highlights MT’s personal experience of the mental health crisis

One patient drives three hours to get treatment for his suicidal ideation at a hospital in Great Falls. One woman described being treated “like a criminal” by police officers when she suffered a manic bipolar episode. A meth addict suffering from post-partum depression begged police to take her to jail instead of hospital during her crisis in the hope that women incarcerated “would have compassion for me” and treat her “like a human being”.

Instead, she was placed in the prison’s solitary confinement cell.

The stories are part of a recently released study commissioned by the state Department of Public Health and Human Services detailing first-hand experiences with the Montana Behavioral Health Crisis System.

The JG Research & Evaluation report includes information gleaned from interviews with 26 people, including former patients identified by pseudonyms and anonymous family members, health care providers, administrators and law enforcement officials. Study participants were residents of Custer, Gallatin, Glacier, Hill, Lewis and Clark, Missoula, Silver Bow, Valley, and Yellowstone counties.

The peer-reviewed study is notable for its first-person qualitative approach, a rare strategy in Montana behavioral health research that the authors said “significantly expands our existing understanding” of the state’s crisis response systems. One of the authors, Brand Green, told the Montana Free Press that the respondents’ interviews were analyzed to identify key points.

“Thematic coding looks for patterns across all interviewees to identify common insights in qualitative research,” Green said. “The quotes that are included in the report are intended to reflect themes identified by multiple interviewees.”

The report’s findings are organized into four sets of recommendations for public health officials and community service providers: breaking down the burden of care by adding case managers and improving coordination between different groups of service providers; developing a network of accommodation, crisis and transitional housing; improving mobile crisis units and emergency response; and linking current mixed systems with state-level databases, infrastructure and financial investments.

The report comes as the Interim Legislative Committee on Children, Families, Health and Human Services develops bills to improve mental health systems for children and adults in Montana. Lawmakers on that committee also await the release of a separate study on how much health care providers are reimbursed for treating Medicaid patients, a study that behavioral health advocates said could help stabilize the struggling health care workforce in Montana.

State health department spokesman John Ebelt declined to comment on the JG Research & Evaluation study, saying department officials were still reviewing the final version.

Without significant changes to Montana’s crisis response system, the report states, “significant gaps” and “obstacles to services” will continue to exist.

Among other difficult experiences, interviewees described being handcuffed in the back of law enforcement vehicles for transport to and from various health care facilities, including local hospital emergency rooms and the Warm Springs State Psychiatric Hospital. Some reported spending time in prisons during the crisis or seeking help from suicide prevention and poison control hotlines.

Many describe feeling isolated and misunderstood during their health crises.

“Taking someone who is suicidal into a back room and leaving them alone is probably not the best idea,” said one participant, who told researchers he was placed in an isolation room in a hospital emergency room in one of the urban areas of Montana. “It just compounded, I guess, the feeling that I felt hopeless and alone and that even when I tried to get help, I didn’t matter. I was a nuisance.’

Some law enforcement officials and health care providers spoke of a lack of crisis services for patients, leaving these frontline workers scrambling for solutions. In one case, a law enforcement official from an unidentified Montana town described a young man in crisis who was denied services after damaging hospital equipment.

“They [the hospital] said, “No, we won’t take it. We refuse to take it. We won’t take it. You guys have to deal with him,” the officer told the researchers. “So that puts us in a terrible situation because we can only take people to detention centers if they’ve committed certain crimes… So we took this kid to [another city] and released him to his grandmother because the grandmother was the only person in the state we could get who would take that child.

A lack of immediate crisis resources, including drop-in centers and long-term care facilities, was one of several barriers identified by participants.

“Nearly every provider, family member, or individual experiencing a crisis cited lack of housing as a barrier to care and eventual recovery,” the report said. “From homeless mothers unable to take their children or pets to treatment centers, to time constraints, to the lack of affordable or transitional sober housing, Montana’s shortage of transitional and/or supportive housing remains a significant barrier to sustaining the restoration.’

The report highlights additional deficiencies in the state’s health care system: inadequate communication between medical and social service providers, isolation of patients during and after a crisis, inefficient transportation and an overall lack of services.

Several respondents, the authors said, emphasized the importance of diverting patients from the crisis through better community services and case management.

“Participants largely agreed that more time could be spent working to prevent behavioral health crises through a better network of community mental health centers, caseworkers who helped manage ongoing recovery, or other facilitators instead by prioritizing response resources over recovery,” the report said.

The study received initial approval from the Montana Behavioral Health Alliance, which represents service providers. Executive Director Mary Windecker said Wednesday that the report is long overdue.

“Everything in it is what providers have long said the system needs, but to hear it from customers makes it impossible to ignore and heartbreaking,” she said. “We need compassionate case managers and community-based services to treat people in their communities, close to families and loved ones, rather than taking them away for hours during a crisis. We need short-term crisis and long-term residential care available in more communities than just the public hospital, so that people can receive treatment for as long as they need it and as often as they need it.

A researcher from JG Research & Evaluation told MTFP that no further discussions are planned with DPHHS to review the report’s findings, but that the research group will continue to work with the state agency on other overlapping behavioral health projects.

If you or someone you know is in crisis, call 988 to reach the National Suicide Prevention Lifeline.