Bipartisan efforts to address a crisis in mental health care in Montana are nearing the finish line at the Montana legislature.
“Both sides agree things have really went bad since about 2017. Our state-funded mental health system is just really in shambles. While we can agree or disagree on how to rebuild it, both sides appear to agree that we need to,” said NAMI Montana executive director Matt Kuntz.
Some aspects of the state’s fractured system developed due to budget decisions made during the2017 legislature and special session.
In 2017, the Montana legislature cut $200 million in state and matching federal dollars from the state public health budget.
That all but eliminated community-based case management for people with severe, disabling mental illness and substance use disorders.
MTN interviewed multiple providers, case managers, and budget experts at the time who anticipated harsh consequences for people in need of case management.
Executive director of the Montana Budget and Policy Center, Heather O’Laughlin, projected at the time that the cost of caring for people with disabling mental illnesses would become more expensive over time after community-based case management was eliminated.
“Those cuts are going to have a ripple effect throughout communities and long-term implications,” O’Laughlin said in 2018.
Western Montana Mental Health Center contracted over the past several years, closing rural services and satellite offices and eliminating positions.
Case managers told MTN in 2017 they dealt with immediate blowback when their positions went on the chopping block.
“I had a client who, because of this news, did attempt to kill himself. Wasn’t successful, but that’s just the beginning. I don’t know how many more. I’ve got people going into crisis, calling me up, freaking out, how am I going to get to the doctor, how am I going to get to this…I don’t know who's going to do that. I don’t know what to tell them,” said former WMMHC caseworker Lisa Leon.
Longtime CEO of WMMHC Paul Meyer returned to the organization at the time to serve as interim director. He told MTN in 2018 that decades-old community-based care would be devastated by the cuts.
“I think they didn’t think through the consequences of what they were doing. They’re decimating some of the community pieces that have been in place for decades and have been the underpinnings of the community support system, and when you take that away from people you inevitably create chaos in the system, and these cuts have done that,” Meyer said.
Mary Windecker was at Western Montana Mental Health Center several years ago as well. She anticipated the fallout and high costs to state systems that Montana is experiencing now.
“Targeted case management, home support services, day treatment, the outpatient substance use disorder was cut, there was just a lot of things cut out of the budget that caused people to not be able to get care and to be stable. So through that time, we saw a 30% increase in acute care admissions,” Windecker said.
She is now the head of the Behavioral Health Alliance of Montana and says the 2023 legislative session has been historic for mental health funding efforts, aided by the state’s $2 billion massive budget surplus going into the session.
“If there is a silver lining to this cloud, it is that it can no longer be ignored. The impacts in every single community, in every single sector of the community, everywhere across the board, mental health and substance use was right out there for everyone to see. Finally, the acknowledgment even from the most fiscally conservative legislators is something that has got to be done. We have got to start treating these people,” Windecker said.
The Montana legislature is weighing multiple big-ticket proposals.
Republican Rep. Bob Keenan of Big Fork was tasked with creating a measure to spend $300 million earmarked by Gov. Greg Gianforte in the state budget proposal to fund behavioral health.
“$300 million dollars is a lot of money. What we’ve really tried to do is put those guardrails on it so that we can show the legislature and the people of the state of Montana that this is an honest, true commitment for the future,” Keenan said.
Other efforts include creating a constitutional amendment to create a trust for mental health care. That push is led by USMC veteran and Miles City Republican Sen. Ken Bogner.
“It's become very important to me..being in those two communities, cowboys, marines, and the very Montana ethos of stoicism and working hard to get the job done. That’s great, but we have a behavioral health crisis in Montana that has led to one of the highest suicide rates in the country. I wanted to do something so that we didn’t have to come in every session and debate how much we should be giving to mental health and to what programs...and thats where the constitutional amendment came from,” Bogner said.
Democratic Rep. Mary Caferro of Helena is carryinga measure that would increase Medicaid reimbursement rates to providers to support community-based care in Montana, including behavioral health. The measure is in the Senate Finance and Claims Committee.