April 18, 2024

The State Commission pledges to rebuild the mental health system

A group of lawmakers, health department staff and service providers launched a years-long effort, designed during the 2023 Legislature, to “rebuild” Montana’s snarled and fragmented system to serve people with developmental disabilities, mental health needs and addictions.

The IS Commission on Behavioral Health Systems for Future Generations, the brainchild of the Gianforte administration and Republican lawmakers, pulling together $300 million for potential capital development, bolstering community services, and fixing other system deficiencies in the coming years. Gov. Gianforte has touted the effort as a “historic investment” to repair the Montana State Hospital in Warm Springs, strengthen local and community-based services, and more.

During their inaugural meeting Thursday, members generally agreed that the commission’s direction is as scary and important as it could be.

“We are all excited to take the first step toward implementing our collective vision for a system that will take care of our families and friends with these life-changing problems,” said Sen. John Esp, R-Big Timber, one of four Republican lawmakers on the commission.

Led by Rep. Bob Keenan, R-Bigfork, and governor Charlie Brereton’s health department director, the commission is also made up of two Democrats and two Montana behavioral health and developmental disabilities experts.

During their meeting of about six hours on Thursday, most of the appointees, guests and public commentators agreed on a basic principle: The state is far inadequate in caring for vulnerable groups.

On any given day, residents sit stubborn waiting for unstaffed group homes; A patient leaves a state hospital federally uncertified facility only to find a local homeless shelter; thousands of Montanans live with a substance use disorder, most of whom have never received treatment; suicide rates continuously, tragically high.

But finding solutions, participants said, will take months of creative thinking and building support among stakeholders, the governor’s administration and lawmakers.

Charlie Brereton, director of the Montana Department of Public Health and Human Services, and Mike Randol, director of Montana Medicaid, participate in a Health and Human Services committee hearing at the Montana State Capitol on Thursday, January 26. Credit: Samuel Wilson / Bozeman Daily Chronicle

“As you build this out, remember: It’s going to be a long, hard fight for this stuff,” said Matt Kuntz, president of mental health advocacy group NAMI Montana and one of several public commenters who spoke to the committee.

According to the commission’s original piece of legislation, House Bill 872, the group is tasked with developing a report by July 2024 containing recommendations, which they will later submit to Gianforte. The governor may review the recommendations and recommend new initiatives subject to review by the commission and other legislative oversight committees. If a legislator does not approve a designated proposal or funding, he can use the existing process for polling legislators to convene a special legislative session.

The Commission focused much of its meeting debate a series of seven priorities developed by Brereton and state health department staff to guide her work. Topics include developing a sustainable, evidence-based crisis response system that spans the entire state, finding “clinically appropriate” settings for Montanans with diverse diagnoses and needs, expanding mental health and addiction services for adults and children, and strengthening the development capacity of disability providers.

The group is also accepting “requests for information” until Aug. 11, later than the original July 31 deadline, from patients, family members, advocates and providers about ways to improve behavioral health and developmental disability services in Montana.

Brereton also made it clear that the commission’s work would be based on s a contract not yet awarded to a third party consultant. That contract, according to a background packet provided Thursday by department spokesman Jon Ebelt, is intended to “support the department in designing and implementing an integrated behavioral health system and disability service development strategy that best meets the needs of Montana.”

Brereton said the state has closed the contract for additional bids and plans to pick a consultant in the next two to four weeks. He did not reveal how much money the state offered; Ebelt later referred questions about the value of the contract to the Department of Administration, citing ongoing selection.

The Gianforte administration has already received input from consultants in its ongoing handling of the state hospital crisis and pressure on other state-run facilities, as well as how to fix the weakened reimbursement rates for health care providers who accept Medicaid patients. It is unclear whether those groups, Alvarez & Marsal LLC and Guidehouse, Inc., submitted bids for the new contract.

The members of the Commission emphasized their interest in contacting a wide range of experts and people with experience in these health care systems in the coming months. The effort to evaluate the current system and design a better system, the group said, will likely take many hands on deck.

“I’m willing to listen to innovative thinking about how we can do things better, how we can get more bang for our buck, how we can move the bar up and forward,” said Esp. “We are committed to doing this work. The Legislature as a whole is committed to doing this work.”

“Or else,” Keenan said.

The group is due to meet again in September.

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