Teamwork promises to help improve mental health care

Last week: Part 1 discussed the closure of Western Montana Mental Health Center in Libby, how the behavior health network was built and how mental health crises were averted.

Assessing the early results

Overall, Lincoln County's behavioral health network Manager Amy Fantozzi said there have been fewer roadblocks and obstacles than expected in responding to Western Montana Mental Health Center's closure.

"Things are going well for the most part," she said.

From the start of March to the end of June, behavioral health network providers performed 31 evaluations at the medical center, plus two at the jail and one at the senior care center. From those, six voluntary commitments and eight involuntary commitments resulted.

Jennifer McCully, Lincoln County Public Health manager, said it's too soon to draw comparisons with previous years' results.

"However, something to note is that we usually have 12 to 15 involuntary commitments each year, and already since March we have had eight," she said, indicating that the workload for the fledgling network has not been light.

What's not reflected in those numbers is the increasing number of evaluations done by medical center staff. Though only specially certified mental health professionals can work on involuntary commitments -- and the medical center has none on staff, nor does it employ mental health professionals per se -- Fantozzi said doctors and physician's assistants are sufficiently educated to evaluate many mental health crises, and some do.

What some might lack, she said, is the comfort level that comes from regular experience with evaluations, which more often than not in the past were left to Western Montana Mental Health Center.

Weighing in from outside

A consultant with the National Council for Behavioral Health of Washington, D.C., Joan King has been to Montana more than 30 times since January 2016 to help communities with integration, or the merging of physical and behavioral health systems.

Having consulted statewide, King said she finds Lincoln County's response particularly compelling.

"Your community has come together to say, 'Nobody is going to save us, and we need to figure out how we can use the resources we have while advocating for other resources to meet the needs of ... our community,'" she said.

King has been meeting with the county's mental health coalition since before the Western Montana Mental Health Center closed, consulting with the group as part of a previously awarded Montana Healthcare Foundation grant.

She recalled a meeting in January, soon after the center's closure, where she was struck by the attendees' love for and commitment to the community and a "need to make this work."

"That is very powerful," King said. "That doesn't mean that there aren't going to be bumps, and that there isn't still a need for probably a higher level of care than the community is able to provide at this point. But right now they're going to figure that out, and then it's going to be a question of, "How do we get the resources we need?'"

Planning what comes next

One crucial need public health officials want to fill is case management, which McCully said is the county's "next big step," and one that will help encourage continuity of care for patients.

"How do we make sure that they got to their appointment?" McCully asked. "How do we make sure that they've actually gotten the services that they need, and what level of follow up can we and should we do?"

With the Western Montana Mental Health Center gone, only Sunburst Mental Health Center offers case management locally, and its caseload is "overflowing," Fantozzi said. The county therefore wants to find ways to help those returning from inpatient care to stay on track with their follow-up care, she said.

Billing also remains an issue for paying the network's mental health professionals who respond to emergency room crises. For now, the county offers a $100 incentive, an amount Cabinet Peaks Medical Center recently agreed to match. The county pays an additional $300 for the extra time a mental health professional works on an involuntary commitment.

The county incentives -- for now, at least -- are paid out of the $18,500 the county previously budgeted for Western Montana Mental Health Center's services.

"We have committed funding for this interim incentive plan for next year," McCully said. "However, we are still looking for long-term, sustainable solutions."

Other pieces of providing broader mental health care in Lincoln County are starting to fall into place. The county recently received a Montana Healthcare Foundation grant to combat substance use disorder, and seeks funding to expand the Mental Health First Aid program.

In addition, the public health department arranged for Karl Rosston, suicide prevention coordinator for the Montana Department of Public Health and Human Services, to come to Libby July 19 to introduce health care providers and others to the suicide assessment five-step evaluation and triage (SAFE-T) protocol.

In augmenting the awareness raised through the Mental Health First Aid program, Fantozzi and McCully anticipate that the SAFE-T training will contribute to diversion.

They also hope the training will help overcome the stigma of mental health and substance use problems, "because a lot of people aren't reaching out for help because they feel like they're going to be stigmatized," Fantozzi said.

Taking stock

It's too soon to tell whether the behavioral health network will be a long-term fix for filling Lincoln County's mental health care needs, or what a broader solution might encompass. But the leadership is in place to start planning for the longer term.

Fantozzi said the network's development "has been the biggest, most positive" result of Western Montana Mental Health Center's closure.

"The fact that public health has stepped up and integrated mental health and behavioral health into the public health system is really huge for our county and for the state," she said. "I don't know of any other (Montana) county that has mental health in their public health system."

Fantozzi praised the coordinated effort undertaken by the mental health coalition, saying that "everyone's worked really well together."

King noted that pulling together various community resources to build a network can't happen without leaders such as Fantozzi and McCully, citing their tirelessness, commitment and passion.

Even when calls or meetings have begun with discouraging news, King said their attitude by the end has been "we live to fight another day."

"That's why things are happening [in Lincoln County]" King said. "Because they're the catalyst to bring people together."