Crisis mental health resources are few and far between in rural Montana

The new national suicide hotline 988 aims to make it easier for those experiencing a mental health crisis to get the help they need. While the state’s three call centers are able to de-escalate many situations, in rural Montana, in-person resources to respond to and treat mental health crises are insufficient or non-existent.

Randy Larimer lives in Bozeman. Despite living in what is considered a larger city in Montana, he struggled to find help when his grown child experienced a mental health crisis.

“With Bipolar II, basically what our family member has is a manic episode where they can go weeks without sleep.”

He says these episodes led to suicide attempts.

Mental health professionals say the state’s crisis system needs three components to prevent such an outcome: someone to call, someone to physically respond and somewhere for people to go for treatment.

Mental health professionals say the state’s crisis system needs three components to deal with suicide attempts: someone to call, someone to physically respond and somewhere for people to go for treatment.

Montana’s three crisis call centers address this first step. According to state data, 988 dispatchers are able to de-escalate two-thirds of callers.

But sometimes someone to talk to on the phone isn’t enough, and advocates say the two remaining parts of Montana’s crisis system aren’t working.

Larimer says when his son needs personal care, usually the police respond and his family ends up in the emergency room, where the search for a crisis stabilization service begins. These western Montana facilities are struggling to stay open due to staff shortages and funding difficulties.

“A lot of times you spend a significant amount of time literally begging for a bed in a facility that can offer the help your loved one needs,” says Larimer.

“Many times you spend a significant amount of time literally begging for a bed in a ward that can offer the help your loved one needs.”

Randy Larimer

And things are even more difficult in the mostly rural areas of Eastern Montana, where these services don’t exist in many communities.

Brenda Kneeland is CEO of the Community Mental Health Center of Eastern Montana, which doesn’t offer crisis services. She says her outpatient clients are usually hundreds of kilometers from the nearest mental health facility, where waiting lists for beds can be up to three weeks long.

“This is a reality in eastern Montana that we face every day,” says Kneeland.

Rural communities across the country face similar challenges, says Ben Miller, a psychologist and national mental health policy advocate.

“I’m afraid what’s going to happen is a lot of people are going to continue to show up in the emergency room after they call 988 or 911 unless we have a place we can send them.”

“I’m afraid what’s going to happen is a lot of people are going to continue to show up in the emergency room after they call 988 or 911 unless we have a place we can send them.”

Ben Miller

He says that without trained mental health workers, close patients are more likely to face worse outcomes, such as being locked up. Miller also points to research that says at least one in four fatal shootings are by law enforcement involves someone with a serious mental illness.

Ideally, Miller says, states like Montana would offer mobile crisis units to de-escalate someone or transport them to a regional crisis bed where they can receive treatment.

Without properly trained mental health personnel in Montana, law enforcement officers with limited training and resources may be the ones responding to people in crisis.

Without properly trained mental health personnel in Montana, law enforcement officers with limited training and resources may be the ones responding to people in crisis.

Fallon County Sheriff’s Deputy Nick Eisele says he has helped individuals and families find crisis treatment services several times, but sometimes the closest people can go for care is in North Dakota or Wyoming.

“One in particular I had last year fell on Christmas Eve. That call turned into an 18-hour day trying to get this guy to where he needed to be.”

Eisel says finding a bed is only the first part of the challenge. Many times both his office and local medical services are unable to transport someone to these facilities, leaving them or their families to find their own way.

State health officials are trying to strengthen both response and treatment services.

Montana has six mobile crisis teams, and three more teams will be added soon. However, most are based in counties with urban centers that can afford them.

Montana has six mobile crisis teams, and three more teams will be added soon. However, most are based in counties with urban centers that can afford them.

Melissa Higgins is the chief of the Bureau of Behavioral Health and Developmental Disabilities for the Montana State Health Department. She is working to secure Medicaid funding to expand this work, particularly in rural areas.

“Of course, it depends on each community and their resources, but that would be the ideal outcome.”

Higgins says the state will offer grants through next year to help providers increase the number of crisis treatment facilities. But providers like the Eastern Montana Community Mental Health Center say they’ll need a big infusion of money to build and maintain infrastructure and staff.

Brenda Kneeland again:

“Just like every other social service provider in the state is struggling to hire and retain staff, ever-rising costs, now is a really tough time to take on a venture like this.”

An ongoing state assessment of Montana’s mental health crisis system may offer potential solutions before next year’s legislative session. But it’s still unclear what the Legislature will fund.

Meanwhile, Bozeman resident Randy Larimer says it can be hard to stay positive about the current state of services, knowing his grown child will eventually have to navigate the system without his help.

“We had a lot of pros telling us to just let them go. I can’t do that and I won’t do it.’

He says he won’t stop advocating until he sees the services his family needs provided statewide.

If you or someone you know may be considering suicide, dial 988.

Leave a Comment