Lawmakers debate state's mental health crisis

Nobody argues that investment in Montana’s mental health care system is needed, but exactly how and where is turning into one of the longest and most complicated debates of the Legislative session.

State officials and lawmakers have said that state institutions -- like the Montana State Hospital in Warm Springs -- are overcrowded and need help. But they’ve also said more community-based services should be available throughout the state. These would be places that can offer mental health evaluations, care for someone having a psychotic episode or places to house mentally ill, small-time criminals.

Expansion measures for both have been proposed, but some lawmakers and mental health advocates are staunchly opposed to any expansion of the state institutions.

“We should be looking at alternatives to expanding institutions,” said Kathy McGowan, who represents the Montana Community Mental Health Centers.

Rep. Ron Ehli, R-Hamilton, has emerged as the Republican leader on mental health policy. He served on the interim committee tasked with finding solutions to what many are calling a “mental health crisis” in the state. Five bills that came out of the interim committee have been endorsed by the Montana House so far.

‘Guilty but mentally ill’

Ehli said the focus is on people who have been ordered by a court to go to the state hospital.

“Guilty but mentally ill is what the hospitals are struggling with,” he said.  

Ehli’s talking about people who are convicted of crimes and need around-the-clock attention for their mental illness, so a judge sends them to the state hospital. He also said there are a number of civil commitments -- people sent by a judge as part of a civil proceeding.

Some of the people who have been committed are ready to get out, but have nowhere to go. Rep. Casey Schreiner, D-Great Falls, said that between the state prison, state hospital and other facilities there are more than 80 people ready to be released.  

To help solve that problem, Schreiner’s House Bill 24 puts $3 million toward building a group home for people who are eligible to be released from the state hospital and into a normal community.

“It’s all about getting people back into the community,” Schreiner said. “A lot of times they really don’t have anywhere to go.”

Kathy Dunks, operations director at the Western Montana Mental Health Center in Butte, said a program like that has worked in Butte. Their facility includes a group home with some programs to help people rejoin society.

“The purpose is to get them back in the mainstream,” Dunks said. She added that a major obstacle for people leaving a state institution with a criminal and mental illness background often faces challenges in finding a job and a place to live.

That bill works on the back end of the process, reintegrating people into society.

Patients, not prisoners

The other interim committee bills are aimed at preventing people from being sent to the state hospital in the first place.  

Custer County Sheriff Tony Harbaugh has been a policeman for almost 40 years now, and he’s noticed an uptick in the number of mentally ill people his officers have to take on a day’s drive to the Montana State Hospital in Warm Springs.

“That’s not uncommon in our agency,” Harbaugh said.  

Making the long drives often creates an inconvenience for his department, but he said the important thing is getting a person care.

These folks are patients,” he said, “not prisoners.”

Four bills from the interim committee seek to cut down on the number of drives police have to make to the state hospital.

Rep. Carolyn Pease-Lopez, D-Billings, is carrying House Bill 47, which gives $1.2 million to children’s mental health providers for pilot projects for youth diversion programs. It would be meant to keep mentally ill kids from needing higher levels of care.

Ehli is carrying three bills, one of them being House Bill 35. It spends $1 million to expand short-term voluntary inpatient mental health treatment. Expanding inpatient treatment at the local level would give more options to a person who might otherwise be ordered to the state hospital, granted they choose it for themselves.

Ehli’s two others House Bills 33 and 34 include more than $2 million focused on crisis intervention and alternatives to the Montana State Hospital to house mentally ill people ordered by judges to be detained.  The money would be given out in grants to counties.

Now, people who are ordered by a judge to get a mental evaluation or are deemed unfit to stand trial are often sent to the state hospital.  They usually end up in what’s called the forensic unit. It has around 50 people currently – with only around 30 beds for them.

Gov. Steve Bullock’s budget proposal requested money for expansion at the Montana State Hospital in Warm Springs. The proposal would add 20 beds to its forensic unit.

But a joint subcommittee – chaired by Ehli – has so far rejected the request, a decision Bullock spokesman Dave Parker called a mistake.

Schreiner agreed with Parker.  He said patients at the state hospital need help immediately.

“The folks that are there are already there,” Schreiner said. “We’re allowing them to stay in an unsafe situation.”

Ehli dismisses the immediacy argument, saying construction to add to the state hospital would take longer to help those people than community-based prevention methods would take to kick in.

The conflict may appear to be about community-based care vs. the state institutions, but Ehli said that’s not true. He said there are people who belong in the state hospital, and stressed that he’s not against the state hospital’s very existence—just the expansion of it.

Kathy McGowan, the lobbyist for Montana Community Mental Health Centers, said the same thing. She said the state is over-institutionalized, and that the national trend is going away from institutional care.