Ravalli County has a dark history when it comes to mental health emergencies. In spring 2005, three inmates at the county's Adult Detention Center committed suicide in a span of only two months as a result of mental illness. Public officials still consider the incident a black mark on the Bitterroot, and pin blame on the community's lack of adequate crisis facilities.
That all stands to change in 2010. Ravalli County received a $310,000 stimulus-backed grant from the state on Jan. 19 to build a crisis stabilization center in Hamilton. Many hope the seven-bed facility, when completed this fall, will help erase the county's disturbing past.
"If anything good came from [the inmate suicides]," says Ravalli County Commissioner Kathleen Driscoll, "it was the fact that we've learned our lesson and we've decided this is the way to do it and do it right."
Oddly, the timing of the expansion coincides with talk in Helena of budget shortfalls and potential cuts to the state's network of mental health services. The annual budget for Montana's Mental Health Services Plan (MHSP) grew from $3.7 million in 2005 to $7.5 million in 2009, but whether that level of funding will last into the next fiscal year remains uncertain. Possible cuts to Montana's statewide day-treatment program have already been discussed. In other words, Hamilton may be plugging one hole while budget concerns open more.
"We just don't know what's going to happen with any funding right now," says Chuck Council, communications director for the Department of Public Health and Human Services. "It's really up in the air for a while."
Council says one indisputable fact is the rising need for a seamless network of mental health services across the state. Alongside the budget increase, Montana's MHSP experienced a dramatic spike in 2009—from 100 applicants per month earlier in the year to 250 in July. Twenty-five percent of those individuals applied for aid during crisis situations, Council adds.
"It jumped really quick," Council says, "and the money started running out a lot faster than [the Legislature] anticipated."
Driscoll notes a similar surge in Ravalli County. Expenses for mental health crisis services rose from $180,000 in 2008 to $300,000 in 2009. If ever the county needed to enhance its crisis infrastructure, Driscoll says, it's now.
The Bitterroot's existing mental health crisis system is both pricey and piecemeal. Crisis situations arise when individuals with mental illnesses like schizophrenia become a hazard to themselves or the public, and are taken into law enforcement custody. Local jails lack the proper training or facilities to restrain patients, so patients are either submitted to Room 301 at Marcus Daly Memorial Hospital under law enforcement supervision or transported to facilities in Missoula or at the Montana State Hospital in Warm Springs.
Marcus Daly Memorial Hospital recently eliminated the long-term availability of Room 301 when it filed a lawsuit against the county over security concerns. Outsourcing to non-county programs can cost thousands of dollars per patient and often accelerates a crisis situation.
"When they are in crisis, it's not unlike having a stroke or a heart attack," Driscoll says. "When they're having these crises, you don't want to make it worse by shackling them and sending them on long trips."
To that point, the Western Montana Mental Health Center (WMMHC) views a crisis stabilization center in Hamilton as a quick and easy fix. Executive Director Paul Meyer says WMMHC will step in to operate the facility, simultaneously treating patients and alleviating the stress placed on its already taxed Missoula treatment center by transfers from the Bitterroot.
"The Missoula County resources get kind of parochial," Meyer says. "If we have a county resident first, we're going to take a county resident."
Meyer admits establishing a new center in Hamilton could be financially risky given uncertainties over the continued stability of state funding levels for mental health services. But he says the potential long-term savings outweigh any immediate concerns.
"The state's going through fiscal crisis and they probably will be for the next two or three years," Meyer says. "But the issue for us is, does that mean we don't do anything over the next three years, or do we try to do things that look more cost-effective and make better sense for the counties?"
Marcus Daly Memorial Hospital has also gone in on the effort, donating one acre of land adjacent to the hospital for the future crisis center. Driscoll says the county's ongoing relationship with the hospital remains crucial in providing crisis intervention services to people with mental illness.
"It's not like they are just closing the door," Driscoll says of the hospital's decision to close Room 301 to crisis management. "They've always been at the table, and they'd just reached the maximum capacity as far as the room they had."
Hospital administrators have yet to comment publicly on the donation.
Driscoll says the county realizes it won't see an immediate drop in expenses when the crisis stabilization center is complete. The $540,000 project itself necessitated the county taking out a $20,000 loan, and even with seven beds, the county will likely continue to see an overflow of patients traveling to Warm Springs. But with other mental health services cropping up in Hamilton—including a new, privately owned drop-in style location downtown that opened this week—the Bitterroot is turning a corner in addressing the problems of its past.
"They're betting this will be financially much better for the county," Meyer says, "as well as for the patients that won't have to be hauled around in cop cruisers."