When someone has a medical emergency, they go to an emergency room.
But when someone has a mental health emergency, it gets more complicated.
People having mental health emergencies may still find themselves in an emergency room. But Bozeman has no inpatient mental health care beds inside a medical facility.
That means when the few beds at the local crisis care center, the Hope House, are full, Gallatin Valley residents who need care that exceeds 24 hours for a mental health emergency are sent to Providence St. Patrick Hospital in Missoula, St. Peter’s Health or Shodair Children’s Hospital in Helena, Warm Springs State Hospital in Warm Springs or any of the other inpatient mental health crisis centers around the region.
That transportation is regularly done by the families of people having a crisis or local law enforcement, who say that taxpayers take the hit for gas and overtime.
But local mental health care advocates say it shouldn’t be as complicated as it is to get long-term inpatient mental health care in Bozeman.
“Somebody who has coronary artery disease, they may have a heart attack. That’s a crisis,” said Dr. Colette Kirchoff, a family and hospice physician who has been practicing in Bozeman for more than 25 years. “Mental illness is the same, and so is substance abuse disorder. There are crises that don’t go away in an hour or two, or even ten hours in an emergency room.”
There was a dearth of mental health care for patients in crisis in Bozeman when Kirchoff started practicing more than two decades ago, she said. A growing population has exacerbated the problem.
Roughly one in five U.S. adults have a mental illness, according to the National Institute of Mental Health. That means, of the more than 114,000 people living in Gallatin County, roughly 22,800 locals are living with some form of mental illness.
That number may grow in the months following the COVID-19 pandemic, which exacerbated mental health issues for people across the nation. More children and adults are reporting symptoms of anxiety and depression now than before the pandemic, according to the Kaiser Family Foundation. Young adults especially are at a higher-than-before risk of substance abuse and suicidal thoughts.
Many of those people won’t have a mental health emergency that requires long-term hospitalization — but at least some will.
Since 2018, a local, loosely organized group of medical professionals, both active and retired, and others who have been impacted in some way by the lack of inpatient mental health care have been asking Bozeman Health to add inpatient beds for mental health care.
For a long time, Kirchoff said, that work was done quietly. Kitchoff and Beth Sirr, a former nurse practitioner who is also heavily involved in mental health care activism in Bozeman, both said that, for a long time, their work was met with silence or apathy.
But in recent months, the group has raised the stakes and folks have started paying attention. The group held rallies outside Bozeman Health Deaconess Hospital, which have attracted local celebrity attention. The group wrote a guest column in the Chronicle, which received rebuttal from Bozeman Health on the opinion page.
Bozeman Health administrators say a complicated problem needs a complicated solution, but top-level officials at the hospital have heard the demands.
“We are deeply and seriously considering the introduction of inpatient behavioral health care at Bozeman Deaconess Hospital,” said Jason Smith, the chief advancement officer at Bozeman Health, in a May 20 presentation at a Prospera Business Network monthly member networking meeting. “We are open to that conversation and very seriously asking ourselves, and others, what should we do and what should it look like.”
Officials with the health care system emphasize the need for the full continuum of care — meaning everything from education and preventative services to care for the most at-risk people experiencing acute mental health crises.
Bozeman Health announced in February that it was transitioning five rooms in its emergency room to dedicated short-term treatment of people with mental health emergencies. Two of those rooms will have recliners instead of more traditional emergency room gurneys and other amenities intended to make the space more relaxing and less stressful to a patient experiencing a crisis compared to the normal hustle-and-bustle of an ER.
People will be able to stay in those rooms for up to 24 hours, said Maureen Womack, the system director of behavioral health at Bozeman Health. They’re scheduled to be open to patients this fall.
Once opened, those new ER rooms — which will remain under the purview of ER doctors — will also be staffed during at least part of the day by “peer specialists,” people who have gone through similar situations and can provide a helping hand to patients.
Bozeman Health has expanded into offering telepsychiatry and other forms of telemedicine, as many health care systems did during the pandemic. The facility is also adding a crisis intervention service in the emergency department, staffed 16 hours a day with a crisis intervention specialist and the remainder of the time with telepsychiatrists.
The need for additional mental health care has grown with Gallatin County’s population, Smith said May 25 at a meeting with Gallatin County commissioners. That meeting was convened to bring people who are part of the conversation about inpatient mental health care to the table and talk about potential solutions to the problems Bozeman and Bozeman Health are facing.
One issue that Smith said Bozeman Health is facing is familiar in Bozeman: hiring enough people.
“We know that the introduction of inpatient care seems like a clear and easy decision to make and that, on its own, it will lift (Bozeman Health) up in a really big way,” Smith said. “That may be the case, but we want to encourage all of us to recognize that there are these additional dimensions and challenges.”
The answer to whether Bozeman Health Deaconess Hospital will add an inpatient psychiatric unit isn’t yet decided, Smith said. He expects a recommendation for the hospital’s board of directors at its September meeting.
But mental health activists and health care workers involved in mental health treatment elsewhere in Montana say Bozeman Health isn’t treating the issue with the urgency it deserves.
Dr. Eric Arzubi, a psychiatrist who worked at Billings Clinic and later founded the telepsychiatry business Frontier Psychiatry, said that during his time at Billings Clinic, the clinic was seeing people having mental health crises from nearly all Montana counties.
“I was the one in the ER taking care of patients being sent from Bozeman. Lots of patients were being sent from Bozeman, from Bozeman Health and the Hope House,” he said at the May 25 meeting. “One of the things that drives me nuts is that we’re meeting and meeting and meeting and meeting, while these patients are suffering … there needs to be a sense of urgency.”
Smith said the decision making process happening now within the organization is happening faster than most.
“We are very thoughtful and deliberate in the way we consider the introduction of new programs, the expansion of existing programs and the investments into our facilities,” Smith said. “Over the last three years, we’ve taken really important and foundational steps forward … we recognize that there is still much work to be done across the entire behavioral health continuum.”
When patients need to be transported from Bozeman to inpatient mental health or addiction care facilities around the state, that transportation is often done by law enforcement.
During the May 25 meeting, Gallatin County Sheriff Dan Springer said it’s not uncommon for deputies to go into overtime hours transporting patients.
“We spend entire shifts going to Hamilton,” Springer said. “It’s not just taking them out of the community, it’s taking them an 8 hour drive away, and then we have to bring them back. It’s multiple trips.”
That also takes deputies away from Gallatin County, Springer said, and means the Sheriff’s Office has to pay for more mileage, gas and overtime than it would otherwise. All of that is shouldered by taxpayers.
An inpatient mental health facility — or even a facility in a nearby town like Belgrade — would be a major change for the better for the Sheriff’s Office, he said.
Springer has been working in Bozeman for about as long as Kirchoff has — more than two decades — and echoed her sentiment that the conversation about inpatient mental health treatment until recently seemed to be going nowhere.
“Like Dr. Kirchoff said … there is an absolute need for inpatient assistance in this town,” Springer said. “That allows for people to stay in their community, and it allows others the opportunity to not be driving all over the state.”