Mental-health needs in frontier communities

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Facing a serious budget shortfall in 2017, the Montana Legislature was forced to slash $120 million from the state’s general fund. The state health department took the brunt of those cuts, to the tune of nearly $50 million. Other cuts would follow, and by the time the dust settled, more than $95 million in funding was gutted from the department.

Montana’s vulnerable mental health-care system was among the department’s services left staggering.

Health professionals told us that the affects of those cuts were most pronounced in Montana’s so-called “frontier” communities, where access to care is limited, if it exists at all.

To better understand how the 2017 budget cuts impacted Northwest Montana’s most isolated areas, Daily Inter Lake reporter Kianna Gardner traveled to Lake, Sanders and Lincoln counties to speak with locals, health-care providers, community organizations, and clinics regarding the past, present and future of mental health care in Montana’s frontier. The findings are detailed in a three-day special report that kicked off Saturday.

According to the people on the frontlines of Montana’s mental-health crisis, the fallout of the budget cuts were expansive.

The immediate impact included multiple clinics closing their doors — including the Western Montana Mental Health locations in Libby and Ronan. In the aftermath of those closures, patients were displaced, caseworkers were laid off, and the mental-health providers who remained were overwhelmed with more patients than they could handle.

“We saw people fall through the cracks after that. It was heartbreaking, it was really, really difficult,” said Western Montana Mental Health’s Abby Harnett.

At its worst, one provider told us that some people experiencing a mental-health crisis were placed in jail as a last resort — an unacceptable outcome for someone in need of professional help.

Two years later, the effects of the budget cuts have proven to be deep and lasting. And while restoring those funds would go a long way to release the immediate pressure, a number of providers told us more needs to be done to address the underlying ailment.

Health professionals said that efforts to fulfill the mental-health needs in frontier locations continue to be stunted by societal issues. Namely unstable housing, low income, unsafe neighborhoods, and drug and alcohol abuse. These challenge a community’s ability to address its mental-health concerns and make it borderline impossible for any one entity to tackle the issue on its own.

The good news is that providers are adapting and making strides toward adopting various integrated behavioral health models in our rural outposts. Offices that provide therapy services are now hiring licensed addiction counselors to holistically treat the whole patient in one location.

The University of Montana now has an integrated behavioral-health program, with an emphasis on rural Montana. Enrollment in that program is on the rise.

And Western Montana Mental Health is working to re-establish a post acute care team in Lincoln County as a way to bring much-needed services back to Libby.

These are all positive steps, but ultimately, taking on this issue will take a concerted, consistent and longstanding approach. A reliable network of mental-health services needs to be restored in Montana’s frontier communities, socioeconomic factors can no longer be ignored, and maybe most importantly, the stigma around mental-health needs to be shattered. Because acknowledging Montana’s mental-health crisis is the first step in the long journey to overcoming it.

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