The behavioral health resources in Butte-Silver Bow are trying to better support people in the community struggling with behavioral health, from grants to events for mental health awareness month.

St. James Healthcare received two grants that address mental health in and around Butte-Silver Bow, one of which wrapped up in March, the other which started in October.

Behavioral Health System Crisis Redesign grant

The former, called the Behavioral Health System Crisis Redesign grant, was awarded to St. James in 2019 for $34,200. The money was used by the newly formed Butte-Silver Bow Alliance for Improved Mental Health and Wellbeing to hire Bozeman-based firm JG Research and Evaluation to conduct an in-depth analysis of different mental health resources in Butte-Silver Bow, including Emergency Medical Services, St. James, as well as Community, Counseling, and Correctional Services, Inc., and a host of others.

The final report looks at the crisis response system between 2019 and 2020.

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“It’s really a road map for what the Crisis Response System in the community should look like,” said Scott Malloy, program director at the Montana Healthcare Foundation, which awarded the grant.

Malloy said the grant was awarded right before COVID-19 hit, and really evolved with the pandemic. He explained although St. James is the funded partner and “backbone” of the grant, the planning and redesign of the crisis system was handled by many players in the Butte-Silver Bow mental health field, such as CCCS.

Part of the goal of the analysis is to move Butte-Silver Bow to the “Crisis Now” model of mental health intervention, Malloy said.

He said the Crisis Now model is comprised of four legs. The first leg, early intervention, involves a help line, or somewhere someone experiencing a crisis can call without needing face-to-face intervention, he said.

The second leg, response, involves having a mobile crisis response team that can come to people experiencing a crisis rather than that person having to travel to receive care. The third leg, stabilization, requires a stabilization place, Malloy said.

Prevention, the fourth leg, is recovery and peer support.

Problems and possible solutions

The analysis found: the available mental health resources in Butte-Silver Bow don’t know about each other, there aren’t a lot of early intervention services for mental health in the area, and, although there are lots of resources that offer preventative care, they are under-staffed, according to Kathy Dunks, the Criminal Justice and Behavioral Health Systems program coordinator at Butte CCCS.

Each mental health resource in Butte-Silver Bow offers one or more of the different legs of the Crisis Now model, but it’s important for one resource to know what other resources are available in the community to be able to effectively refer patients to the help they need, according to Dunks.

“Collaboration of all the services is huge,” she said.

Of all the behavioral health services Butte-Silver Bow has to offer, the only one that could be included in the research under the umbrella of early intervention was the Montana 211 call center through the Help Center, Voices of Hope and Missoula 211. Examples of early intervention resources are crisis response telephone lines, a same-day access program and a drop-in center, according to the report.

Another resource, the 988 line, should be operational by July 16, 2022, according to the National Alliance for Mental Health, and will add to the area’s early-intervention services. The 988 line was designated by the Federal Communications Commission as a nationwide mental health crisis and suicide prevention line.

The overarching goal of the Crisis Now model is that people experiencing a mental health crisis will have somewhere to go other than the emergency room. Malloy said although the emergency room is the highest level of care, it isn’t necessarily equipped to help people with mental health emergencies.

The St. James Emergency Department is heavily relied on for immediate stabilization of people experiencing mental health emergencies, according to the Butte-Silver Bow Crisis System Analysis.

After a patient goes to the emergency room, they can choose to utilize voluntary inpatient services for stabilization. Montana State Hospital, which has been struggling with inadequate staffing, is one of the places available for this.

Soon after St. James was awarded the grant, the county reached out to CCCS CEO Mike Thatcher to ask if he would take on the contract for a Crisis Response Team and Mobile Response Unit, Dunks said. He brought Dunks out of retirement to head it up and hire a team, which she’s been doing since May 2020.

The response team employs two full-time and a few on-call response workers who service various places in the county, such as the Southwest Montana Community Health Center, Southwest Montana Veteran’s Home, and more.

Malloy said the Crisis Now model would like to see the mobile Crisis Response Team expanded, which Dunks said is a topic of upcoming discussion.

Dunks said the recent incident at Montana State Hospital has been hard both on her team and the people they’ve referred there.

“A lot of really super-sick people we refer there tell us ‘Please don’t send us there, we’re afraid we’ll get hurt’.” Dunks said. “It’s been really hard on my team, because both people hurt in the last incident were committed by my team.”

She also said the understaffing at Montana State Hospital is a large part of the problem, and that the recent incidents there aren’t a reflection of the quality of the staff, just a reflection of a staff stretched thin.

Dunks said as of now, there aren’t any available beds in any adult mental health in-patient programs in the state, which makes stabilization placement for patients in crisis more difficult.

Preventative mental health resources, like Western Montana Mental Health Center, AWARE, CCCS and Southwest Montana Addiction, Recovery and Treatment, are also understaffed, Dunks said. She said one way to solve the understaffing would be for these organizations to take better care of their staff. She also said preventative care in Butte-Silver Bow would be stronger if there was more case management to ensure patients stay on their meds and make their doctor appointments.

In order to have a better flow of mental health resources for patients, Malloy said another big step Butte-Silver Bow has taken is posting for a behavioral health coordinator, which will be fundamental in making sure the components for the crisis system redesign are seen through to finish.

“What’s really exciting is the community of Butte-Silver Bow is driving these changes,” Malloy said.

Mary Windecker, executive director at the Behavioral Health Alliance of Montana said the agency received money from the M.J. Murdock Charitable Trust to look into implementing Certified Community Behavioral Health Clinics in Montana, in partnership with the Montana Department of Corrections and the Montana Department of Public Health and Human Services.

CCBHCs have been implemented in several other states, Windecker said, and could be particularly helpful to rural areas in Montana because CCBHCs follow the same reimbursement model as federally qualified health centers.

Whereas now, mental health services can only bill for the cost of service, CCBHCs bill for the cost of service, the costs of receptionists, and travel costs for mental health professionals treating patients in rural areas, much like doctors can. This would make mental health services a lot more accessible, especially to people in rural areas, Windecker said.

The implementation of CCBHCs in Montana is still in the vetting process, and it will be at least a couple of years before they would become a reality, which could be helpful for the Crisis Response System in the state.

Rural Community Opioid Response Program Implementation Grant

St. James Healthcare was awarded a $1 million grant from the Health Resources Services Administration’s Federal Office for Rural Communities Opioid Response Programs in October.

The Rural Community Opioid Response Program Implementation grant, will be used to conduct needs assessments and develop plans, including prevention, treatment, and recovery interventions for opioid use disorder in several organizations in Silver Bow, Deer Lodge, Beaverhead, Madison, and Jefferson counties, according to a press release from SCL Health published in October.

Katie Tiernan, the executive director of community impact for SCL Health, said the grant has a focus on pregnant and parenting women struggling with opioid addiction, but other people struggling with other addictions should feel welcome to utilize the services that will become available because of the grant money.

Tiernan said the “seed” for SCL Health applying for this grant was the Meadowlark Initiative, a two-year grant St. James Healthcare got approved for in 2018. The Meadowlark Initiative awarded the hospital $150,000 to implement routine screenings and treatment for substance use disorders as part of pregnancy and post-partum care.

“It was really very eye-opening,” Tiernan said. She explained pregnant and parenting women who struggle with addiction are hesitant to open up because there’s a big stigma surrounding them. “They’re afraid to reach out, afraid to be judged, afraid their kids will be taken away, so we want them to have a safe place.”

Much like the Behavioral Health System Crisis Redesign grant, St. James is just one of many organizations in the area working in partnership on the grant.

Tiernan said the grant will run for three years.

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