In Montana, a lack of mental health resources is linked to an increase in gun violence, particularly in hospitals

It’s hard to ignore almost daily headlines about gun violence, overdose, and crime, especially since many Montana residents remember the state as a more peaceful place. The articles are widely read as locals do not seem to look away from the increasing frequency of violence approaching people’s backyards.

Many medical professionals have cited an acute shortage of mental health resources in the state as one of the drivers of the increase in community violence. Although everyone is keen to make it clear that mental illness does not mean violence.

In general, violence is uncommon among people with mental illnesses. But when mental illness is untreated and intertwined with other co-occurring issues such as substance use disorder, environmental factors, or child abuse and neglect, risk factors for violent behavior can peak.

Three murders and suicides in Montana in a week, two occurring in just over 24 hours He was telling privately to the director of the Community Crisis Center, Marcy Nearley.

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“Obviously (people) are not getting the treatment they need,” he roughly said.

When mental illness is managed with the help of a professional, most people can lead a normal life, but when left untreated, symptoms sometimes peak in hospital emergency departments.

Staff at Billings Clinic and St. Vincent Healthcare exists Increasing number of patients seeking treatment while in the midst of a mental health crisis. These patients tend to contribute more to the increased violence that occurs in hospitals.

A national survey found that 42% of attackers in an emergency department were mentally ill, and 40% of them were seeking drugs or were under the influence of drugs or alcohol, according to American College of Emergency Physicians.

But of the 163,000 Montagne residents diagnosed with a mental health condition and 44,000 citizens with serious mental illness, at least 47,000 did not receive the mental health care they needed in 2020. Of those, 48.6% did not receive care due to cost, According to the National Alliance on Mental Illness.

Brad von Bergen, Billings Clinic ED Department, said: “There is a lot of pressure on people these days financially and people deal with alcohol and deal with drugs.”

Von Bergen has worked as a registered nurse in the clinic for 30 years, and has noticed more mental health crises in ED than ever before.

ER . flow unit

Brad von Bergen, MD, director of the emergency department at the Billings Clinic, sits in the hospital bed of the Surge Unit in the hospital entrance in this October file photo. The corridor mounting unit is used when the emergency department has run out of conventional space to accommodate patients.

Ryan Berry, Billings Gazette

emergency departureSignals

October 16 Shooting in the emergency department of the Billings Clinic It was a stark reminder of the extent of the mental health crisis taking place in Montana. During the incident, a suicidal patient was shot by two, one with a bullet wound and the other from a responding police officer.

The emergency department leadership at the Billings Clinic said the increase in gun violence in Billings could be linked to statewide Lack of mental health resources.

“The resources that people have outside the Billings Clinic have[reduced],” von Bergen said. “It made it really difficult for our community when they needed help or when they had this place to go and now they don’t have it anymore.”

When these people are in crisis, they end up at the center of societal crises. When there are repercussions, von Bergen said, people end up with EDs.

The clinic’s director of emergency department, Dr. Jamie Belsky, said people should still go to the emergency department if they were in a crisis, but cited a lack of mental health resources in the community as a reason for the overcrowded psychiatric units and the long wait for a state psychiatric hospital.

Emergency Department at Billings Clinic

Billings Clinic emergency room medical director Jamie Belsky shows her emergency card indicating the clinic’s Homeland Security team in case of an emergency. The crew was equipped with these cards and they were used on the night of the shooting in the emergency room.

Aimee Lynn Nelson, Billings Gazette

Offloading patients to specialized psychiatric care is where treating mental health crises in the emergency department becomes challenging.

When no beds are available, patients end up going into the emergency department, Plesky said, too uncomfortable for long stays.

“They are also just the nurses and what they are trained to do. Our nurses are still trying to[treat patients in the emergency department]but at the same time they also have to monitor this patient at the same time,” Belsky said.

Counselors can spend some one-on-one time with patients with ED, but patients do not have access to group therapies that are often an integral part of treatment.

With more mental health providers, more group therapy sessions and more support services available, people can seek treatment for mental illness.

“Building (community) resources will give us more tools,” Belsky said. “I think it will help tremendously because they will redirect care immediately. So we are not going to have many acute crises but they will also help you get you[out of crisis care].”

The emergency department at Billings Clinic implements more safety measures after the shooting

Billings Clinic Emergency Medical Director Jamie Belsky and Emergency Division Director Brad von Bergen work in the department on Friday, October 28.

Aimee Lynn Nelson, Billings Gazette

Reducing the state budget is detrimental to treatment

Making an appointment with a mental health provider is becoming increasingly difficult in Montana. Therapists are booked for months and waiting lists sometimes extend beyond the six-month mark.

In rural areas in particular, community resources have evaporated at an alarming rate, according to Mary Windker, executive director of the Behavioral Health Alliance in Montana.

Windecker said the 2017 state budget cuts for the Department of Health and Human Services are largely to blame for the mental health crisis that followed.

Before the $49 million budget cut, Montan residents had access to case workers in their community who helped them stay on top of medications and participate in treatment to manage symptoms of mental illness or substance use disorder (SUD). These resources have allowed people to lead relatively normal lives, Windecker said.

After budget cuts, case workers and providers have been laid off en masse, and mental health centers across the state can no longer afford staff at the same capacity.

So when the pandemic hit, resources were already dwindling. Montanans faced lockdowns, isolation, loss and fear, and a mental health crisis magnified.

Currently, Historical discrepancies in Medicaid repayment rate It negatively affected behavioral health along with just about everything medical sector.

It is difficult to meet the demand now because accepting Medicaid comes at a significant financial loss. Windecker said utilities have limited the number of staff providers in order to keep doors open.

Professionals summed up the situation as a mental health crisis, which is, in some ways, unique to Montana.

Just this year, Billings was ranked the most depressed city in the country. 31 percent of the population has been diagnosed with depression by a professional, according to data from the Centers for Disease Control and Prevention.

Because of the prevailing cultural stigma, Windecker predicts that there are countless people living with an undiagnosed mental health condition, although it is difficult to estimate without data.

But data on diagnosed individuals are well documented.

In February 2021, about 35% of adults in Montana reported symptoms of anxiety or depression, but about 18% had no access to counseling or treatment services, according to data from the Montana chapter of the National Alliance on Mental Illness (NAMI).

In Montana, 44,000 adults have severe mental illness, and among the homeless population, one in four has a serious mental illness.

Substance use disorders often develop as a way of dealing with or masking symptoms of mental illness.

Substance use disorder (SUD) accompanies other psychiatric illnesses about 25% of the time, According to the National Institute on Drug Abuse. And those who receive treatment with over-the-counter opioids are diagnosed or develop symptoms of mental illness 43% of the time.

“You can’t treat substance use disorder without mental health treatment,” Windecker said.


Windecker, in partnership with the Department of Health and Human Services, plans to propose a new model that would place treatment for mental health and substance abuse at the level of physical health compensation for the first time.

The model, called Certified Community Behavioral Health Centers (CCBHCs), will also be available in rural and border communities.

“We have looked at many aspects of the model to ensure that it will meet the country’s rural and border needs and replace communal services that have been decimated by the 2017/2018 budget cuts,” said Windecker.

Windecker said it would also be necessary for the 2023 legislature to pass the governor’s service provider rate study recommendations.

The rate study found that most programs need a 10% to 25% increase in Medicaid rates to remain viable. The total cost to the state to cover the cost of these services is $32 million.

“Without these safety net providers, the mental health and substance abuse treatment system would collapse,” Vindecker said. “With surplus revenue of $1.7 billion and a recreational marijuana tax available, this is a small amount to be spent to fix a system that has long been underfunded and operating at a loss.”

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