As the COVID-19 pandemic tightens its grip, the services provided by Montana’s mental health and addiction clinics are getting even more complicated.
Those who survived the 2017 state budget cuts have hung on by their fingernails ever since. And it may get a lot more difficult.
There’s no convenient time for a global pandemic. The novel coronavirus outbreak is hurting everyone. But for Montana’s mental and behavioral health care providers, "This couldn’t have hit at a worse time," says Mary Windecker.
Windecker is executive director of Behavioral Health Alliance of Montana, which represents about 30 addiction and mental health care providers. In at least one case a judge told a treatment court’s clients they no longer needed to be tested for the next three weeks.
"A lot of the in-patient substance use models have closed because so many patients went AWOL; they just left against medical advice and went home. And then, many of the outpatient substance use agencies are struggling to provide care."
The pandemic is just the latest in a string of blows providers have been dealt in recent years.
After the state budget collapsed in 2017 the state health department was forced to cut nearly $50 million to help balance Montana’s books. This led to a chain reaction of events that disrupted care for thousands of the state’s most vulnerable people.
Providers say the situation was helped by the reauthorization of Medicaid expansion during the last legislative session and several million dollars allocated for substance use disorder treatment and targeted case management services. While this didn’t fix Montana’s mental health and substance abuse service crisis, providers say it gave them a glimmer of hope that change was possible.
Now they’re dealing with COVID-19.
"This feels like a dime store novel, almost," says Jim Fitzgerald, CEO of the Helena-based Intermountain. The non-profit serves about 1,200 children daily, ranging in age from 4 to 12.
Fitzgerald says these are some of the most difficult cases in the state and the kids lived through a lot of traumatic experiences.
"They’re very treatment resistant. They do not do well in public school. They don’t do well with untrained foster or adopt-parents. They can be powerful at engineering their own rejection."
Fitzerald says the novel coronavirus is making it harder for Intermountain to bring kids in for care in its group homes in Helena, Missoula and Kalispell.
To protect existing residents from exposure to COVID-19, incoming children must now first be quarantined off-site for seven days.
"We always have a waiting list of anywhere from 30 to 40 children for our residential programs. This only backs it up further. There’s not a place 'in the community' when a child is at psychological risk of hurting themselves or others that you can take them. Not being able to be as responsive is very tough for our kids who do need a residential bed."
About a third of the agency’s clients are served in outpatient settings directly in Montana schools; which are now closed.
Montana Public Radio reached out to the state health department for comment on how it’s facilitating the delivery of mental health care services during the pandemic. In response, the agency issued a statement saying it’s working with clients and providers to ensure medical coverage continues safely. One of the ways it’s doing that is permitting qualified providers to offer telemedicine and telehealth services.
Intermountain CEO Jim Fitzgerald says that helps, but adds:
"It’s tough to do telemedicine with a first grader, but we do what we need to do. You pretty much go to war with the army you’ve got and the tools you’ve got, so that’s what we’re doing. We have very committed staff."
But as COVID infections grow, Intermountain’s 260 employees have their own family obligations and health concerns to consider.
Fitzgerald says this all adds up to an interruption in the delivery of services, and lost revenue.
"We have all the normal expenses, 80 percent of which is payroll, without the normal revenue. We’ll be turning to our donors, asking for some help with that. Non-profits like ourselves, quite frankly, don’t have margin. It’s not like we have a bunch of reserves sitting around; and a lot of us who did have some reserves go really hit the last couple of years. It’s not been easy."
Fitzgerald says nobody was prepared to deal with a global pandemic. He says he believes state health officials are working hard to keep mental and behavioral health care services flowing.
But he says it would help if Montana could enact some form of financial relief for providers.
That sort of relief doesn’t appear to be on the table in Montana – at least right now.
Officials with the state’s mental health and addiction services programs, meanwhile, say they will continue to do their best to provide timely and necessary treatment.
Behavioral Health Alliance’s Mary Windecker says those services may be more important during the unfolding pandemic than ever before.
"As you know, with everyone, anxiety and depression and concern has just been a huge factor. With the clients who’ve struggled with that all their lives it’s even more important that they not feel completely isolated right now."