March 5, 2003
Mental health centers facing crisis


One in five people in Park County will have to deal with a serious mental illness, either with themselves or with someone they love. But the kind of treatment they can get is becoming increasingly uncertain.

The future of the Mental Health Center in Livingston, the heart of service to the mentally ill, is up in the air. There are three major problems facing mental health services in Park County: 1.) funding cuts from the state, 2.) budget deficits the county program, and 3.) a lack of interagency communication.

Mental health services in Park County are currently handled by a regional mental health center, with a health center here but the main office in Billings. Partly funded by the state, partly funded by counties, the mental health centers are also dependent on the reimbursements they get from Medicaid and the mental health services fund from the state’s general fund. The centers focus mainly on serving the poor, seriously mentally ill, the group most in need of help and least able to get it.

The budget proposed by Governor Judy Martz doesn’t include mental health services, and new legislation in Helena would dissolve the mental health centers in favor of service area authorities. Problem is, these authorities, and their infrastructure, don’t exist yet. “You’d basically have no mental health providers with statutory obligations to the community,” explained South Central Mental Health director Bob Ross. “If they throw us out, that’s going to create a big vacuum.”

This vacuum is already beginning to exist, according to Community Health Partners case manager Rie Hargraves. “We already have minimal resources and minimal services,” Hargraves said. “This is going to affect the sheriff’s office, the county attorney, the hospital. (The severely mentally ill) are going to end up in jail or in the emergency room or committed to Warm Springs.

“More and more physicians are having to deal with this because of funding,” Hargrave continued. And mental health is not a small issue. As many as 70 percent of all patients treated in primary care facilities have unrecognized mental illnesses, as well. Park County also has the distinction of having one of the highest suicide rates in the state. From depression to ADHD, there is a wide variety of mental illnesses that are treatable, if there’s someone to offer treatment.

As of December 2002, there were about 45 adults in the mental health system. Another 40 are waiting for psychiatric evaluations or treatment plans.

Despite a heavy caseload, reimbursements are slow in coming to the program. According to Ross, as much as half of all the bills run up in a county are never paid. Just this fiscal year, Park County was almost $23,000 in the red, compounding more than five years of negative numbers. So far, that hasn’t been a serious issue yet for Park County, because its deficits are being covered by Billings’s surpluses.

But those deficits aren’t something that can last, in the opinion of County Commissioner Ed Carrell. At his request, the governing board, which met in Billings last Friday, voted on whether it wanted to retain Park County, deficits and all. Recently, Gallatin County moved to a different regional mental health program, in part because of deficits in the Yellowstone region of over $70,000. The board voted unanimously to keep Park County, but Carrell still wants to address the “continual minuses.”

The third problem, interagency strife, is an elephant in the living room, apparent but unaddressed, but this is one of the major hurdles Carrell is trying to take. “I didn’t realize what the problem was until that last meeting,” Carrell stated, referring to the monthly meeting Thursday, Feb. 27, of Park County mental health professionals and consumers. “There’s never been any cooperation between employees,” he said. “There’s a lack of cooperation here, and a lack of loyalty in the employees which has created a problem here in Livingston. The people in need of mental health care are the ones who suffer.”

For the most part, the ball remains in the state legislature’s court. Funding and reimbursements will both be worked out there. But the mental health issues here at home—things like awareness, communication and cooperation, some budget concerns—can be worked out here by interested citizens. Hargraves encourages more community involvement. “We as a group,” she urged, “can start trying to get other grants, get other money. We can get a psychiatrist back in Livingston. That’s the biggest impetus for us to form this group.”

“We,” concluded Maja Tregidga, a member of the local advisory board, “are trying to solve a lot of problems at once to help people who want to get help.”

The Mental Health Local Advisory Council meets the last Thursday of every month, at 3 p.m. in the City/County Complex.