The emergency room at Bozeman Health Deaconess Hospital is seeing an influx of people seeking mental health care.
The hospital has seen an increase — whether people are checking in voluntarily or being brought in by law enforcement — over the past four to six months, said Diane Patterson, the health system’s chief nursing officer.
“We’re seeing more patients and it’s been a bit overwhelming,” she said.
For several months, the hospital has seen an average of about 80 to 120 behavioral health patients per month in the emergency department.
March saw 114 such patients in the emergency room. By way of comparison, there were 28 patients during the month of October.
This pressure is largely due to Gallatin County cutting ties with one of the area’s leading mental health providers, the Western Montana Mental Health Center.
With WMMHC no longer under contract to provide mental health services – specifically its voluntary and involuntary psychiatric inpatient beds – the hospital is taking on the workload.
It comes as local authorities and Bozeman Health work to set up new services to address mental health care. Many of these services are at least one year old. Meanwhile, the hospital struggles with a lack of inpatient psychiatric beds, resources, and a reliance on a beleaguered Montana state hospital.
Meanwhile, with more behavioral health patients coming through the ER, the hospital has worked to increase the number of mental health care providers and strengthen mental health care training for other members. emergency personnel. The ER has hired a psychiatrist, a crisis intervention specialist and a psychiatrist, she said. The hospital has also provided additional training to other ER staff.
Officials say it’s working for now, but won’t be sustainable much longer.
Gallatin County has a complicated infrastructure for mental health care. Several nonprofits and organizations are filling critical gaps in the behavioral health care continuum.
If one is not fully functioning, the system struggles to fill all the gaps.
The Hope House, an adult crisis stabilization center and the countywide provider that had inpatient psychiatric beds, received particular attention.
The county said WMMHC had broken its contract to provide mental health services at Hope House on “repeated occasions”.
Mental health services provided by WMMHC, including counseling and outpatient care, were partially funded through a contract with the county.
In 2020 and 2021, Hope House has had to deal with the closure of its secure emergency detention, often leading law enforcement to drive patients to another WMMHC facility or to the state psychiatric hospital. .
When Gallatin County ended its contract with WMMHC, the tentative plan was to take behavioral health patients to the hospital emergency room.
Almost five months later, there has been no formal resolution on the matter. But solutions may be on the horizon. Those who spoke to the Chronicle said mental health services were about to change.
“We knew it would be a chaotic transition period,” County Commissioner Zach Brown said. “That’s right, but we are mobilizing for a better situation with more reliable partners and a more modern service model that involves our health system very intimately. I feel optimistic.
Since February, law enforcement has been taking people in mental health crisis to the emergency room at Bozeman Health Deaconess Hospital.
If patients need higher levels of care, law enforcement takes them to the public hospital in Warm Springs. So far, it has worked, Gallatin County Sheriff Dan Springer said.
“It works for the interim but it’s not a definitive answer,” he said.
Yet a key part of the interim plan – taking patients who need a higher standard of care to the public hospital – has been thrown into disarray.
The state hospital has faced a series of problems in recent months, including a severe understaffing, four patient deaths blamed on unsafe conditions and a patient assaulting another patient. The hospital also lost federal funding after an inspection.
Diane Patterson, Bozeman Health’s chief nursing officer, said the decision to transfer patients from Bozeman Health to Warm Springs is made on a case-by-case basis.
Instead, they have sought to transfer patients to other hospitals in the state and will transfer patients out of state if necessary.
Despite the problems at the state hospital, Springer said there were no problems with transporting patients there.
But, he fears it will burn out ER staff if this becomes a more permanent solution.
Patterson said the hospital has tried to stay ahead of burnout, increasing emergency room staff and working to provide specific emergency rooms for people in mental health crisis.
The hospital began building these rooms just weeks ago, Patterson said.
They should be finished this fall.
Brown thinks the county is almost in a better position than others.
“The other communities aren’t in that position and it’s almost a weird advantage,” he said. “We get to design something from scratch.”
Ideally, Brown said, the county will end its near total reliance on the public hospital by building enough services to care for people locally.
Advocates have long said there are other gaps in the continuum of care, including youth mental health services.
The continuum of care is an integrated system of care for a patient over time, with a range of health services spanning different levels of care intensity, from education and prevention services to care for the most vulnerable. at risk who experience acute mental health crises.
Acute crisis care was one of the biggest gaps identified, Patterson said.
The psychiatric unit is still being designed, said Denise Juneau, government and community affairs manager for Bozeman Health.
Bozeman Health is looking to fill other gaps, including the one left recently by the county ending its contract with Hope House. But those are still a few years away.
Bozeman Health, which is the county’s largest healthcare provider, is working with an Arizona-based company to help stabilize the crisis – a void left when the county severed ties with WHMMC and the Hope House.
Connections Health Solutions, which provides behavioral health crisis care in Tucson and Phoenix, Ariz., would operate the Crisis Stabilization Center in partnership with Bozeman Health.
The Crisis Stabilization Center would be an open door and landing space for a wide range of behavioral health issues and acute crises and would be a destination for law enforcement to take people in crisis – instead of the emergency room or the detention center, Patterson said.
“It’s really meant to be a place to go,” she said, adding that it would be a place people could go regardless of the type of crisis or intoxication.
“It’s really what the community asked for,” Patterson said.
Springer and Brown said they looked forward to the services provided by Connection.
“Our hope is that they fill more than the gaps – which the Hope House was unable to accomplish,” Springer said.
Bozeman Health and Connections are considering a space at Spanish Peaks Plaza at 120 N. 19th Ave., but the ink hasn’t dried yet, Juneau said. The space on 19th Avenue and the partnership are still in negotiation.
A deal is also in the works with WMMHC on land near Deaconess Hospital. The Gallatin Mental Health Center, located near the hospital, is built on land donated by the hospital.
In late 2021, Bozeman Health made an offer to purchase the land from WMMHC. In November, WMMHC declined the offer.
WHMMC executive director Levi Anderson later told the Chronicle that accepting the offer would represent a loss of “multi-million dollars” for WMMHC.
This spring, Bozeman Health made another offer. WHMMC agreed, according to Bozeman Health. Anderson did not respond to a request for comment.
Juneau declined to say how much Bozeman Health was offering and said the purchase had not been finalized.
Patterson said Bozeman Health does not know how it will use this campus — whether it will continue services already offered or provide new services — or what updates will be needed.
“Everything needs to be reviewed,” she said.
A clause is attached to the ownership of the property that WMMHC must use the facilities to provide mental health care. Otherwise, ownership reverts to Bozeman Health, according to county attorney Marty Lambert.
Lambert said the county would like to have a similar clause on the property to ensure it is still used for mental health care.
While the county and the hospital remain in a “waiting pattern,” Brown said the region is poised to make progress toward better services.
“The ultimate goal is to provide as many services here in our community to reduce our reliance on the public hospital, for example,” Brown said. “That was the plan before the public hospital started to deteriorate and it emphasizes that direction.”