A series of stories, “Kids in Crisis, Care in Question” by The Montana Standard’s Ted McDermott, last week delved into issues involving Acadia Montana, a for-profit psychiatric residential care facility for children in Butte than has had a turbulent three-decade history under a succession of owners and management.

The thoughtful, well-researched series raised significant questions regarding oversight and accountability.

Because Acadia accepts children from a wide variety of jurisdictions — several states across the region as well as Montana and several Native American tribes — and because of its for-profit status — the regulation of the facility is a checkerboard of various entities who play a role. The state Department of Public Health and Human Services takes a lead role, but other entities with a stake in Acadia’s performance and a regulatory reach include the state Mental Disabilities Board of Visitors; Disability Rights Montana; the states of Oregon, Alaska and potentially others; tribal governments, individually and with the Indian Health Service; and the federal Center for Medicaid and CHIP Services.

While this collection of bureaucracy seems imposing and in fact must be somewhat frustrating for Acadia, it also seems less than sufficient when one looks at the specifics.

One of the biggest takeaways from this is the concern that the Board of Visitors is significantly under-resourced to complete its mission.  As per its mission statement, “The Board is responsible to ensure that people receiving services from mental health programs in Montana are treated humanely and that treatment is consistent with established clinical and other professional standards, and meets the requirements in state law.”

In carrying out that mission, the Board of Visitors is tasked with monitoring no less than 45 facilities across the state, including the Montana State Hospital — and Acadia.

The Legislature in recent years has deeply slashed the resources available to the Board of Visitors.

Right now, the board’s executive director position is vacant.

So is an “advocacy specialist” position.

Its staff legal counsel, Craig Fitch, has an outstanding record of advocacy for the vulnerable and has been with the Board since 2002. Similarly, its advocate for Montana State Hospital patients has been in place for 13 years and has done admirable work. 

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But that staff is woefully insufficient to do what is an absolutely vital job. The board, which reports to the Governor, needs resources and it needs the governor’s ear. The recently concluded legislative session did not provide any help. The governor must do so unilaterally or face the risk of the further degradation of mental-health services in a state that desperately needs more such services than it has.

We know that there are many dedicated people at Acadia, including its CEO, Peggy Cunningham. We also know those folks have very difficult jobs and a huge cascade of responsibilities and challenges.

But at Acadia, the bottom line is the welfare of the children in the organization’s charge. And we believe the DPHHS needs to take a very active role in mandating improvements to care — particularly with the all-too-frequent use of drugs to control patients in emergent situations.

Everyone involved at the institution for years — including the former CEO of Acadia who is now in charge of the DPHHS division responsible for regulating the facility — has recognized that the frequency of such emergent measures has been far too high at various points over the institution’s history. The fact that the institution has porpoised between criticism and praise from regulators for years indicates endemic issues.

DPHHS and Acadia must work together to make the facility safer and better for its residents.

Adding to problems with oversight is uncertainty surrounding what rules psychiatric residential treatment facilities like Acadia Montana should be following.

DPHHS has been slow to provide The Montana Standard with clarification about whether, when, how and how often interventions like locked seclusion and emergency medication may be used on young patients in PRTFs.

And while the agency has offered some insight about its view of the rules, DPHHS has so far been unable to provide the rules themselves. Without clarity about what the rules are, how are regulators, providers, families and patients to know whether Acadia Montana is complying with them?

Coincidentally, this series comes on the heels of another excellent project by The Missoulian examining for-profit youth care facilities in the state. Reacting to that powerful report, the Legislature did take action this month to shift oversight of those youth care facilities from The Department of Labor to DPHHS.

That’s a constructive step, on the surface. But given the regulatory challenges DPHHS has had with Acadia, adding 16 more institutions to its list of responsibilities sparks new concerns. Children’s lives are at stake — at Acadia and at these other for-profit facilities. We urge the governor and DPHHS to step up the quantity and quality of state oversight.

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