Due to severe state budget cuts, the nonprofit Western Montana Mental Health Center in Missoula has had to lay off more than 60 case management workers this year across the state and close offices in underserved rural areas.
Those decisions, the head of WMMH said, have affected everyone from kids to adults who are dealing with depression, substance abuse issues, family crises and all sorts of other mental health issues.
CEO Paul Meyer called it "a brewing crisis" and said that instead of getting cost-effective therapy and preventive treatment, people having mental health breakdowns are now crowding into the emergency rooms of local hospitals or winding up in jails or at state-funded institutions on the taxpayers’ dime.
“We’ve ripped the rug out from under these folks," Meyer said. "It’s irrational and shortsighted, and it’s pushing expenses to other budgets.”
He said the cuts will particularly hurt low-income people who can’t afford health insurance and those who live in rural areas without many support services.
With satellite units everywhere from Libby to Plains to Dillon to Livingston, WMMHC is the largest agency providing mental health services in the region and serves 15,000 clients in the state. Due to a state revenue shortfall, Gov. Steve Bullock and the Legislature told the Department of Public Health and Human Services to enact an across-the-board, 2.99 percent funding cut to mental health providers starting on Jan. 1 of this year. Additionally, the targeted case management reimbursement rate was cut by 58 percent, a rate that Meyers said is “unsustainable.”
The group therapy treatment reimbursement rate also was cut by 66 percent. The Substance Use Disorder decreases from the state alone will result in almost a $60,000 per year reduction at WMMHC.
“Because we deal with a low-income population, a lot of our funding is state and county support,” Meyer said. “We have some private insurance billing but we are tied into state financing, primarily Medicaid.
"We were not a financially rich organization to begin with, but we were able to bear the 2.99 percent cuts. But what they did on top of that, and what completely screwed things up, was cut by 58 percent the targeted case management reimbursement.”
Meyer said case managers are one of the “primary supports” for mentally ill people. They help them find and retain housing, get them medical appointments, help them pay bills and taxes, file paperwork and get prescriptions refilled.
In essence, he said, case managers keep mentally ill people from slipping through the cracks and winding up in jail or in an emergency room.
Jails are taxpayer funded and overcrowded to begin with, and if hospitals treat people with no ability to pay in an emergency room, they have to eat the cost and wind up passing it on to everyone else. The Missoula County attorney told the Missoulian earlier this year that mental health cuts could increase homelessness.
“The analogy I’ve used is it reminded me of the Republican plan to repeal Obamacare,” Meyer said. “They want to get rid of it, but they don’t know what to replace it with. People still have the same set of needs, medical complications, bipolar illness and all of the things they had before. The case management program has been around since the early '90s.”
The satellite offices in Dillon and Libby were closed due to the budget cuts. Meyer said in the past, the Missoula office was able to subsidize the lower-volume rural offices, but that’s not the case anymore. The organization also had to cut back its family-based services.
“That’s clinical staff that would (go) into homes that were referred by the Division of Child and Family Services,” Meyer explained. “It might be a kid with an out-of-control family situation that was amenable to in-home family support. But the cutback was severe enough that we can’t sustain it. So now, the local Division of Child and Family Services doesn’t know where we are going to send these kids. Probably to an institution.
"Before, we used to be reimbursed daily, but now they only reimburse days you go into a home and have direct contact," he continued. "It made it an unsustainable model.”
What really bugs Meyer is that they offered legislators and the governor’s office a host of different solutions and other sources of revenue to solve the problem, including raising the alcohol or tobacco taxes. He said nobody listened.
“These cuts have come down without working with the providers in the community,” he said. “They’ve been made on a bottom-line basis rather than strategically… They’re just cutting to hit that $49 million. I sure would have figured they would ask someone in the community, but they didn’t ask anybody in the community about what to cut.”
In a letter to DPHHS in February, the WMMHC Board of Directors said rural communities where services have been cut have been “devastated.”
“Families helped through these programs are impacted daily by the care given to their children with mental and behavioral health problems,” the Board wrote. “For many, these programs are the last chance before they are forced to place their children in much more expensive institutions. In many cases, the children are placed in institutions outside of Montana due to the limited number of available inpatient beds in Montana.”
They said it costs the state $585 per day to place someone at the Montana State Hospital in Warm Springs, and that doesn’t include treatment. The cost for treating someone in their own community through an organization like WMMHC is $3,000 per year, which is the equivalent of five days at Warm Springs.
“Just as it would have made absolutely no sense to cut CHIP, a program that saves the United States over $6 billion over 10 years, it makes no sense to cut these prevention services and move these children out of their homes to a higher and more expensive level of care,” the Board concluded.
Marlla Johansen is one of the clients who has taken advantage of both case management and other support services at WMMHC in Missoula for nearly 20 years. On Tuesday, she was in the group room with about 20 other clients, chatting with friends and getting ready to take a fitness class followed by a spirituality class. She said she lost her case manager recently and that person hasn’t been replaced.
“I miss her,” she said. “This place has a real family atmosphere.”
Meyer was the CEO of WMMHC for many years before retiring and then coming back on an interim basis while the organization conducts a search for a permanent CEO. He said these cuts are the worst he’s seen in 20 years.
“This is sort of the most dramatic undoing of stuff we’ve had in place for 20 to 30 years,” he said. “We are being more flexible with our day treatment program and our doors are still open, but case management supports the individual to help them live independently and create a life and get a part-time job… So it’s kind of naive at the state level to cut that.''