Local government agencies and healthcare facilities are scrambling to fill the void created by the abrupt year-end closure of Western Montana Mental Health Center’s Libby facility, which had been providing evaluation, case management and other mental health services to residents and county government alike.
The Mental Health Center, whose administrative offices are located in Missoula, closed the Libby facility — and one in Dillon — following sweeping cuts state lawmakers made during November’s special legislative session to address a $227 million deficit.
Cuts to Medicaid reimbursement rates and case management programs are what led to the Mental Health Center’s decision to close two facilities and layoff 44 case managers across its 16 county service area, according to a list of talking points dated Dec. 20 and provided to The Western News by Lincoln County Public Health Department employee Jennifer McCully.
According to the talking points, the state-level cuts would hit the Mental Health Center with a roughly $4 million shortfall a year, most heavily in the case management services it provides adults and children.
“These cuts will make the Western offices in Dillon and Libby unsustainable,” the talking points state.
“Rural offices are the most difficult to cover costs at any time, but because of the reduced reimbursement from the state, it became impossible to cover the costs of providing care in those offices,” Abby Harnett, executive director of the Libby facility, said via email Thursday.
The closure, effective Jan. 2, sent 10 employees looking for work, she wrote.
According to McCully and other county employees, the mid-December announcement of the imminent closure was unexpected. Among other ways the Mental Health Center served the community, it contracted with Lincoln County to provide mental health services in crisis situations.
Broadly speaking, McCully explained, a crisis can occur as a result of a number of situations — including the commission of a crime or the threat of suicide — in which someone has harmed or threatened to harm themselves or others and has arrived at the emergency room at Cabinet Peaks Medical Center.
At the ER, a mental health professional determines whether the person needs to be committed for mental health treatment. If the mental health professional determines the person needs to be committed, and the person is committed involuntarily, the county is responsible for covering the costs of the evaluations and pre-commitment services, McCully said.
With the Mental Health Center closing, “we don’t have anybody contracted to do that work,” she said.
The Lincoln County Commission held a special meeting Dec. 27 to address how to respond to the closure. In addition to the commissioners and McCully and other local health officials, it included representatives from local law enforcement and the courthouse. Among other items, the group discussed hiring contract employees as a short-term fix.
At Wednesday’s meeting of the County Commission, County Administrator Darren Coldwell said he was wrapping up a contract with one mental health professional; McCully said two others have offered to help in some way for a month or so.
Harnett said the center was “also caught unaware of the timing of the cuts.”
“We didn’t get notice of the (cuts) until Dec. 7 and (they) went into effect on Jan. 1, 2018,” she wrote. “We had to create a plan and implement it quickly because of the short notice we received from the state.”
If the state had provided the center with two to three months of funding to ease the transition, Harnett added, “we could have transitioned our patients in a more orderly fashion.”
Harnett said she has met with Lincoln County public health officials and representatives from the Northwest Community Health Center and Cabinet Peaks Medical Center to provide transition care for its patients.
“A provider from Western Montana Mental Health Center will be also providing telemedicine care in the interim while new treatment plans are created for each patient,” she wrote.
The topic of telemedicine care was discussed at the Dec. 27 Commission meeting, according to its minutes. McCully and Maria Clemons, executive director at Northwest Community Health Center, wondered whether the law requires that evaluations of involuntary committals be done in person; District Court Judge Matt Cuffe said the statutes “are not entirely clear on the issue but it is better to have a mental health professional do the assessment in person.”
Repercussions of the center’s closure in Libby extend beyond county government needs, for the facility served almost 200 clients.
“Mental health professionals from Western Montana Mental Health in Libby provided crisis intervention evaluations in our emergency department at Cabinet Peaks Medical Center to help determine if a higher level of care was needed for our mental health patients,” Cabinet Peaks Medical Center spokesperson Kate Stephens said via email. “We have not yet identified a solution to the impacts of their closure, but we are currently working with area clinics and Lincoln County personnel, including the Sheriff’s Office, county health, and county commissioners, to develop short and long term solutions for the county as a whole.”
Clemons called the facility’s closure “significant”and said that Northwest Community Health Center staff also has “been participating in planning meetings with Lincoln County officials as well as other healthcare stakeholders to assist in the development of a plan for potential solutions.”
“(We) will be evaluating our own capacity and available resources in the coming months to determine a course of action in the development of a strategic plan,” she said via email.
Kindra Hageness, the chief probation officer for 19th Judicial District Youth Court Services in Libby, said the facility’s closure “will impact the kids and families as well as our communities in many ways.”
“As probation officers, we have relied heavily on WMMHC for many years,” she said via email. “The children’s case managers have been a huge asset for the kids and families they serve. They have made sure kids get to both their mental health and medication appointments. They are also very good advocates in all systems for the kids and families who are receiving their services.”
The case managers were also proficient in the “huge task” of properly and accurately filling out the paperwork that secures Medicaid funding, she wrote.
Without them, “getting a youth into a therapeutic placement will become a much longer and I am sure more frustrating and difficult process,” she wrote. “Which may mean, kids sitting in detention centers longer.”
Hageness also noted that the parents of many of the children her department works with are themselves clients at the Mental Health Center.
“I can only imagine the stress that will be in some of those homes,” she wrote. “With stress will come calls to the police officers or child and family services. I am guessing there will be a rise in criminalizing kids so they are able to get services, (since) the WMMHC case managers and therapist will not be available to assist these families.”
Hageness is also sad to see the dedicated mental health professionals she’s worked with lose their jobs.
“I have seen tears from an employee, not because of the loss of the job, but because of the unknown for the kids and families,” she wrote. “That’s true dedication.”