Massive budget cuts that hit the Montana Department of Public Health and Human Services hard have been in the headlines often in the past year. Even before the cuts, though, many of Montana’s small communities were finding it hard to address mental health issues.
In December 2015, the Jefferson County Commission vowed to withhold about $11,000 in funding for services being delivered by the Center for Mental Health (CMH), citing frustration over what the commission saw as inadequate local services.
“Until we begin to see an improvement in services, we’re going to sit on it,” said Commissioner Bob Mullen at the time.
That vow did not last long, however, as the commission worked with the CMH, the only local mental health provider, to try to address the issues.
Michelle Cuddy, Area Director for the CMH, acknowledged at the time that finding someone to serve mental health needs in a community such as Boulder is a challenge. It takes time to build up a clientele that knows and trusts the provider, she said, and staff turnover exacerbates the problem. The provider becomes frustrated with a lack of clientele and leaves, increasing the distrust of clients, creating a vicious circle, said Cuddy and Mullen.
“I have been here ten years, and in that time I’ve seen four different people come and go,” said Jefferson County Public Health official Molly Carey recently.
Keeping a consistent provider that clients learn to trust is critical, said Mullen in a recent interview.
“You need to be here. You need to be here consistently,” he said.
Right after the December 2015 decision to withhold funding, Mullen, Cuddy, Carey and others joined forces with Kenny Bell of the state’s Addictive and Mental Disorders Division (AMDD) to try to make a difference. They formed a Mental Health Local Advisory Council to review and improve service delivery.
That local advisory council (LAC) has met monthly for about two years and has not found the going easy.
First they solicited consumers of mental health services to join the LAC, and found it tough to attract participants.
Mullen pointed to stigma as a factor.
“Nobody wants anyone to know that they have one [mental health issue] or that their family has that,” he said.
“We absolutely know there are people here with mental health needs and we want to serve them,” said Cuddy when the LAC was forming. “In a small community it is often difficult to take the first step in getting help and I want to ease the uncomfortableness.”
To address “the uncomfortableness” the location for the mental health services delivery by the CMH was moved away from its Main Street office.
“People haven’t been comfortable going in that door that says mental health above it,” said Mullen.
By moving the service delivery into the local health clinic, where primary health care and physical therapy services are also provided, the stigma was lessened, said Mullen and Carey.
In its continuing work, the LAC addressed the barriers to access to mental health services.
According to the Public Health Post’s “Barriers to mental health treatment,” among people saying they needed mental health services but did not get them, 13 percent cited cost, 12 percent cited insurance issues, 10 percent cited fear or embarrassment, and 8 percent said they did not know where to go.
A Social Solutions article, “Top five barriers to mental health access,” said finances, lack of mental health professionals, mental health education and awareness, social stigma and racial barriers are the most common barriers across the nation.
In Jefferson County, members of the LAC said they see nearly all of those factors at play and they and others have pursued ways to address them:
- A four-month series funded through a grant from the Montana Geriatric Education Center and held at the Boulder Community Library addressed the needs of individuals and families with Alzheimer’s disease and related dementias.
- A showing of “Walking Man,” a documentary about a father and son who walk across Missouri in an attempt to deal with their own issues and shatter mental health stigmas, was offered free in an area theater.
- Volunteers from the LAC have offered their services in support of other community groups as a way to raise awareness.
- A bus service to transport area residents to services in Helena, thirty miles away, was offered on a trial basis.
- The LAC is also working on a brochure to inform area citizens about mental health care resources.
- While all of those efforts have been praised by participants, measuring the impact on the consumers of mental health services in the short term is difficult.
Mullen and Carey said stigma is a big issue, but consistency is probably the top barrier to services locally.
Unfortunately, it seems that the effort to address the access issues is a tale of “two steps forward, one step back.”
Moving the CMH services into the medical clinic did not work out, plagued by low client numbers. The bus service to move clients to services did not last, either, due to low numbers of riders. And one member of the LAC, Kenny Bell from the AMDD, told the group he is no longer allowed to attend the monthly meetings due to the state budget restraints.
“We offered to pay his travel costs out of our own general fund,” but the response was a rejection based on the need to treat all counties the same, said Mullen.
Despite all the setbacks, the county continues to look for solutions. About $8500 in county funds go to support the work of the LAC, and that $11,000 the county threatened to hold back in 2015 continues to go to the CMH.
According to the U.S. Department of Health and Human Services, one in five American adults have experienced a mental health issue and one in 25 lives with a serious mental illness. In spite of that prevalence, more than half the counties in the nation have no practicing psychiatrist, psychologist or social worker, says the agency.
“The mentally ill who have nowhere to go and find little sympathy from those around them often land hard in emergency rooms, county jails and city streets. The lucky ones find homes with family. The unlucky ones show up in the morgue,” said a USA Today report, “A man-made disaster: A mental health system drowning from neglect.”
Mullen said he and his fellow members on the LAC understand that well.
“We need to take a loving approach,” he said. “Heaven forbid, it could be any of us at any time.”
