Coalition aims to improve care of people in mental health crises

County health care workers and mental health providers came together July 13 to address growing concern about the care of people in mental health crises. During the meeting, a clear need for a standardized data collection system, better mental health care to prevent jail time and a way to address the stigmatization of having a mental illness became apparent.

The meeting was organized by Jennifer McCully, public health manager for Lincoln County, who said one of its main goals was to improve communication among different agencies.

“Community referrals are working better than ever,” McCully said in an advance interview. “We’ve got everyone at the table and we’re sprinting to keep up the momentum.”

But local data collection still needs to be fine-tuned, she said.

“We need to strengthen our systems for collecting information,” McCully said. “So much is anecdotal and we need the sheriff’s department and the hospital working with other organizations to collect data.”

A one-year planning grant looking at socioeconomic disparities, which currently employs two fulltime staff at Cabinet Peaks Medical Center, will collect data countywide to better service the clients who need them may be a starting point for better collaboration between providers.

Laura Larson-Crismore of Cabinets Peaks Medical Center said at the meeting that although the grant is not focused on mental health specifically, having the data standardized will help mental health clients, who might go to different organizations in the same week for services unbeknown to their other providers.

The need to identify these “frequent fliers” is important, Larsen-Crismore said, because their frequent reappearance means “We’re failing.”

Another goal of the meeting was to develop tactics for jail diversion amongst community partners, McCully said.

“Sometimes when there is a mental health crisis, it escalates to the point where clients end up in jail,” McCully said. “And 80 percent of inmates locally have a diagnosed mental health condition.”

There appeared to be unanimous agreement during the meeting, held in the County Commission’s room and packed to capacity, that there are not enough beds in nearby psychiatric treatment centers to house the clients in crisis who need one.

“There is almost never a bed when we need one,” said Libby Community Health Center’s behavioral health case manager Amanda Dampier.

Because many of the Medicaid or insurance-funded services represented at the meeting can only provide limited in jail services because they cannot bill for them, religious services such as the Church of Christ are often called to be with clients in crisis who are incarcerated.

Church of Christ’s Liz Erickson spoke about sitting with people in desperate need of psychiatric care until care became available.

“I’ve had seven situations like this in the last nine months,” Erickson said.

“We do provide crisis evaluations in jail,” said Western Montana Mental Health Executive Director Abbey Harnett. Libby Community Health Center’s Maria Clemons said they can also provide some therapeutic services to inmates, but not on jail grounds.

“We’ve found it’s not very effective” [to transport clients out of jail for therapy] Clemons said. “Anxiety and stress levels are so high for inmates that it’s not an effective time to heal.”

Clemons also commented that a lack of psychiatric doctors locally meant that primary care doctors are dealing with medications they don’t know enough about.

“Our doctors are OK with refilling prescriptions while someone is stable,” Clemons said. “But once something changes and the person is in crisis, the doctor’s are saying, ‘I’m out of my comfort zone, I don’t have enough experience to do this.’”

While stable mental health is something physicians and indeed all of us aim for, as Dampier said “you can’t standardize mental health care. It’s something that waxes and wanes.”

Liz Erickson responded by saying “I think we need to look more at preventative. Who do you have to do life with to prevent breakdowns? This is not an ‘us and them’ situation, I’ve been depressed and others in this room have too. Isolation breeds mental illness and connecting people can make the difference.”

Erickson continued by saying that the stigma of mental illness prevents people from speaking out about their experience.

Another concern voiced during the meeting and backed by many of those at the meeting was the effect of possible cuts to Medicaid in the new health care budget, which will be approved or denied in August.

“The budget has significant Medicaid cuts, 3.5 percent cuts across the board and a 40 percent cut targeted at case management, which will absolutely affect our services,” said Harnett.

Next steps for the coalition are somewhat dependent on external factors, such as Cabinet Peaks Medical Center applying for and receiving a follow up grant after the current one-year planning grant is completed on March 31, 2018, and seeing the extent of Medicaid cuts when the federal budget is finalized.

“We will certainly keep meeting,” McCully said Monday. “In the meantime, Amy Fantazzi is working on training trainer’s to become ACES [Adverse Childhood Experiences Score] certified so we can work towards being a trauma informed community.”