Teamwork promises to help improve mental health care

When someone suffering a mental health crisis arrived in the emergency room at Cabinet Peaks Medical Center in Libby, staff there often called Western Montana Mental Health Center, which would send a mental health professional to evaluate the case and determine a course of action.

But that practice ended at the start of 2018, following the Missoula-based center's announcement that it would close its offices in Libby and Dillon. The reason: steep budget cuts made in Montana's special legislative session last November.

The news sent public health staff and health care providers in Libby scrambling. Besides employing 13 people and serving about 200 clients, Western Montana Mental Health Center had been contracting with Lincoln County to respond to the ER crises, and the county had no backup plan.

A county-led mental health coalition hastily set out to determine how to replace the ER response, and what to do for the center's clients who would soon be without therapy, prescriptions and other mental health care services.

The coalition met regularly for weeks. By the end of June, it had established a behavioral health network as the foundation of a still-evolving solution. Managed by the county, the network is comprised of mental health professionals who are paid a stipend for each ER visit, and who work as much on prevention as intervention. While it's too soon to tell whether this will be the long-term fix Libby needs, its success or failure could have lessons for other Montana towns also struggling with mental health service cuts.

"We need to be empowering our community and implementing things that help build prevention and intervention measures, because we have to (consider), 'How do we prevent crisis?'" said Amy Fantozzi, a public health staffer who helped form the network and now manages it. "Because we don't have the resources here for crisis."

Building a provider network

One of the immediate steps the county took was to contract for about six weeks with a former Western Montana Mental Health Center staffer to fill in for crisis response while also helping the coalition establish a more permanent solution.

From the county's perspective, a mental health crisis is when someone has harmed or threatened to harm himself or someone else and has arrived at the emergency room.

By March 1, the county had established the behavioral health network, comprised of two health care organizations - Northwest Community Health Center and Sunburst Mental Health Center - and six or seven private-practice mental health professionals, three of whom will respond when needed to the emergency room.

Where Cabinet Peaks Medical Center staff once called Western Montana Mental Health Center, they now call Fantozzi. What happens next depends on whether the person is drunk or high, which Fantozzi said is often the case.

"A lot of times they end up staying overnight ... until they're free of whatever drug or alcohol is in their system at the time of arrival," she said.

Once the person's system clears -- and if the person is judged to be suffering a mental health crisis -- Fantozzi calls the three standby mental health professionals until she finds one available.

"Once we send somebody in, they'll do an evaluation," Fantozzi said.

Much of the time, the evaluation results in a referral to local outpatient services, Fantozzi said. The mental health professional and the patient create a "contract for safety," an agreement that often includes making an appointment with a mental health care provider.

"That's where the network really comes in handy," Fantozzi said, noting that most of the time she or the mental health professional can call a network provider and find an opening, ideally that day or the next.

Sometimes, the mental health professional, after the evaluation, determines that inpatient care is necessary, requiring the patient to seek treatment outside of Libby. Pathways Treatment Center in Kalispell is the closest facility and most often recommended; two other nearby facilities are Glacier House, also in Kalispell, and Lake House in Polson -- both of which are run by Western Montana Mental Health Center.

If the person agrees with the need for inpatient care -- a situation called voluntary commitment -- the mental health professional will help with placement and filling out the necessary paperwork.

If the person is unwilling to seek the required inpatient care, it becomes a case of involuntary commitment. The person is placed in a 72-hour hold at the medical center, the county attorney is notified and a court hearing is scheduled. Such cases require more of the mental health professional's time, including additional paperwork and appearing in court, before the person is sent for treatment.

Preventing mental health crises

Public health officials have sought not only to plan for emergency-room response, but to point people with mental health issues to other resources before they reach that crisis stage. The goal, called diversion, seeks both to reduce the load on limited resources and to improve people's wellbeing.

Part of diversion, Fantozzi said, is informing the public about what mental health or related resources exist locally. In addition to the behavioral health network, and in recognition of the high correlation between substance abuse and mental health issues, she will refer people, when appropriate, to Flathead Valley Chemical Dependency, Celebrate Recovery and local chapters of Alcoholics Anonymous and Narcotics Anonymous.

Another part of diversion is training people how to spot potential mental health issues in others. To that end, Fantozzi established a county-funded Mental Health First Aid program, outside the behavioral health network, after she was trained and certified earlier this year to teach it.

The first training, held April 30, went "fabulous," Fantozzi said. Seventeen county employees -- including sheriff's deputies, public health staff and a county commissioner -- attended the eight-hour course, took the quiz at the end and were certified for three years.

Mental Health First Aid training enables people to recognize when someone might be showing early signs of a mental health crisis or suicidal behavior, Fantozzi said. Those who receive the training now know what to say, what to ask, how to listen and how to help that person get help, she said.

"You want to help people in the early stages of illness find help before it gets to a point where it's affected their ability to live, laugh and love," Fantozzi said.

The Mental Health First Aid website at http://www.mentalhealthfirstaid.org lists numerous studies of the program's efficacy. One study from earlier this year, funded by the National Health and Medical Research Council in Australia, where the program was created, found it to be "a noteworthy contribution to improving the lives of people with mental health problems."

Next week Part II - Assessing the early results, weighing in from outside, planning what's next and taking stock.